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Does the latest nursing home scandal show that Hiqa is a regulator with no bite?
To read Hiqa's media statements during covid was to read measured reassurance from a health watch dog doing its job to the best of its ability in difficult circumstances.
The reassuring tone was similar to the early days of its inception in July 2006 when its stated aim was to 'ensure delivery of high-quality services based on evidence-supported best practice'.
It promised to 'work in partnership' with the expertise of the wider healthcare community including 'patients, clients and carers', healthcare professionals, the voluntary sector, the academic community and 'industry'.
The views from this wide variety of stakeholders would be, Hiqa vowed at the time, 'key' to its plans for a bright new regulatory future for Irish health care.
With thousands of reports by its inspectors and a gradual ramping up of - to its credit - better standards in nursing home care, what's there to criticize?
After all, before it started regulating nursing homes in 2009, the infamous Leas Cross Nursing Home scandal in Dublin lead to the creation of Hiqa and a brave new world of regulation.
Hiqa was created as a response to the infamous Leas Cross Nursing Home scandal in Dublin. File picture: Billy Higgins
That scandal revealed similarly shocking treatment of residents that featured in RTÉ's most recent nursing home exposé which saw scenes of older people being forced into chairs or left in incontinence pads for so long their clothes were soaked.
There was also footage of 80-year-old Audeon Guy being roughly handled at the Beneavin Manor nursing home in Glasnevin.
A number of the subsequent comments last Tuesday by Professor Des O'Neill, who wrote the 2006 Leas Cross Review Report, related to Hiqa.
'As was obvious from the RTÉ documentary, and long clear to informed healthcare professionals, Hiqa cannot assure the public of appropriate and dignified care standards in Irish nursing homes, nor respond effectively and in a timely manner to grave concerns reported to it," he wrote in the Irish Times.
People may well have scratched their heads and wondered what - after all these years - has gone wrong?
However, there is a cohort of people who have long since stopped scratching their heads - those whose loved ones died in Hiqa-regulated nursing homes during the pandemic.
They question whether Hiqa is little more than a toothless report-writing, box-ticking regulatory wonder.
In RTÉ's most recent nursing home exposé there was footage of 80-year-old Audeon Guy being roughly handled at the Beneavin Manor nursing home in Glasnevin. Photo: ©
Its refusal to launch any statutory investigations into nursing homes during or immediately after covid - despite the fact that more than 1,500 residents died in nursing homes during the pandemic - is a case in point.
Referencing Section 9 of the Health Act of 2007, a Hiqa spokesperson told the Irish Examiner in March 2021 it 'may' undertake an investigation as to the 'safety, quality and standards of services' if the authority believes 'on reasonable grounds' there was a serious risk to the health of residents.
The act also states the minister of health 'may' require Hiqa to undertake an investigation if it believes there was a serious risk of harm to residents.
Hiqa's statutory investigations
Of the nine statutory investigations carried out by Hiqa up until March 2021, five were initiated after each case was covered by the media.
A sixth was initiated after Hiqa had been in 'extensive engagement' over three years with the Adelaide and Meath Hospital in Dublin about concerns raised about acutely-ill patients being treated in a corridor next to its emergency department while waiting for an inpatient bed.
Its statutory investigation was launched by Hiqa after a 64-year-old man - who had been cared for while in the corridor adjacent to the hospital's ED awaiting admission to an inpatient bed - died unexpectedly in March 2011.
When asked in February 2022 about why it wouldn't initiate any statutory investigation into nursing homes, Hiqa said its statutory investigations 'do not carry any enforceable sanctions' and therefore 'could not be guaranteed to achieve improvements for resident care'.
When asked by the Irish Examiner this week if it is fit for purpose, Hiqa replied: 'Hiqa is due in the Oireachtas Committee on Health next week, where we look forward to engaging with members to answer these and other questions.'
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