I beg to move

That this Assembly approves the report of the Committee for Health on its 'Inquiry into the Impact of COVID-19 in Care Homes' [NIA 59/17-22]; and calls on the Minister of Health to implement the recommendations contained in the report as part of the ongoing response to protect care home residents during future surges of the pandemic.

The Business Committee has allowed two hours for the debate. The proposer will have 15 minutes to propose the motion and 15 minutes to make a winding-up speech. All other Members who speak will have five minutes.

As of 1 January 2021, 775 of our care home residents had died with COVID-19, which is some 40% of all registered COVID-related deaths. It was clear from the early stages of the pandemic that there would be significant impacts on older people, particularly care home residents. Much of the Committee's work in the spring was focused on that area, prompting our decision in July to conduct an inquiry.

In setting its objectives, the Committee agreed that it wished to be forward-looking and to put its energy into learning from recent experience in order to provide constructive suggestions for the future. Many of the issues, from staff terms and conditions to workforce shortages, and funding and regulation, brought the wider question of adult social care reform into sharp focus. There was virtual consensus on a number of significant points on pandemic planning from the acknowledgement of pre-existing workforce shortages to initial problems with PPE supply and testing capacity.

Mr Speaker, you will be glad to hear that I do not intend to go through all 54 recommendations. However, I want to give the House a sense of the areas that we looked at in the report.

With regard to visiting, whereas the Government's speed of response was challenged, I do not believe that anyone could have said the same of care homes; most had restricted visiting or closed their doors before they were actually told to do so. One of the sessions that really hit home for me and, I think, other members was an informal Zoom call that we had with families of residents, who described the traumatic impact of visiting restrictions on the physical and mental well-being of their loved ones, the importance of ensuring meaningful contact and the limits of technology for those with sensory or cognitive impairment. They recognised the sterling work that was being done by staff to provide care in the most difficult circumstances and the risks that were involved in visiting. However, they were clear that the risk had to be managed in communication with families and that it must also be balanced against the harm that would be caused by isolation as their loved ones approach the end of their life.

Our report endorses their calls for safe and meaningful contact to be facilitated through identification and implementation of innovative measures, rapid roll-out of the care partner initiative and better communication and consistent implementation of guidance.

Significant progress has been made on testing since this time last year. It is certainly one of the key elements to addressing this and any future pandemic. The Committee recommends that, subject to rapid testing becoming available, there should be daily testing of all those who enter a care home, including residents who have attended an external appointment. Capacity issues remain. The Committee recommends further consideration of pooled testing in order to make better use of existing capacity and an increase in local capacity to test and analyse results.

From an early stage, the Committee expressed concerns about patients being discharged from hospitals to care homes without a negative test. That was reinforced by evidence on the challenges of isolating older and vulnerable individuals, particularly those with cognitive decline. The Committee recommends that no one be discharged from hospital to a care home in which they are a resident without having tested negative for COVID-19 unless the care home confirms that it has the staffing and facilities to ensure isolation for the required period. That should be subject to monitoring and review. We continue to believe that step-down isolation facilities should be explored as a way of further reducing risk.

Having heard very worrying evidence of PPE shortages in the spring, aggravated by a global shortage and spiralling prices, it came as a great relief to hear by May that supplies to care homes had stabilised and were being provided free of charge, which we understand remains the case for the moment. There remains a longer-term question around procurement, and the Committee recommends that charges should not be imposed on care homes without a review of the tariff.

The pre-existing strain on the sector regarding funding, staff levels and staff terms and conditions was exacerbated by COVID, which generated additional costs from staffing to cleaning and support for visiting. A number of very welcome additional funding allocations were made available: some £6·5 million in April; £11 million in June; and a further £27 million in October, as well as staff support and PPE. Questions remain, however, about underspends arising from administrative constraints, leading to the Committee’s recommendation that streamlined processes are required, subject to audit and verification, but they need to be flexible to allow care homes to meet their needs at any given time.

Throughout the past year of the pandemic, we have asked some of our lowest-paid workers to shoulder an enormous burden on our behalf. The skill and value of that work is long overdue proper acknowledgement. For many, it is a vocation rather than a job, but we must look at recognition, reward and retention in what is a hugely challenging work environment. While the Committee welcomed the Minister’s commitment guaranteeing sick pay, we are calling for urgent reform to address low pay, poor terms and conditions, and additional measures to make social care a more attractive career in the time ahead.

Moving on to issues with staff levels, understaffed homes had to manage sickness absence and staff self-isolating as a result of COVID-19. Others were unable to come to work due to caring responsibilities, with schools and day centres closed. Care workers’ responsibilities increased, with symptom monitoring, increased infection-control measures, and providing additional care to large numbers of unwell residents. Caring for dying residents and grieving relatives has undoubtedly taken its toll on their mental health. Access to the Health and Social Care psychology helpline was appreciated in that regard.

Staff support was also offered by trusts and brought in via agency workers. Each solution created other difficulties, adding to pressures in the health service generally, as well as increasing risk of infection through staff movement. Efforts must continue to ensure that, where possible, agency staff work in one home only. Recognising the workload, the Committee also wants to see staff ratios for care homes agreed in discussion with stakeholders.

Turning to regulation of the sector, stakeholders expressed appreciation for the advice and support role provided by the Regulation and Quality Improvement Authority (RQIA) during the first surge of the pandemic. Others expressed concern at the consequent reduction in inspections at a time when oversight from families and other professionals going into homes was almost non-existent. The Committee concluded that inspections and dedicated advice and support need to be resourced to continue in a pandemic.

The RQIA briefed the Committee on its move to a risk-based assurance framework and on its research to identify a number of key characteristics associated with homes most at risk of an outbreak. Those included larger homes and larger providers, as well as those with recent or frequent management changes. The Committee endorses the Minister’s desire to ensure that providers can be inspected corporately, rather than the RQIA being confined to looking at each home individually.

The Committee also welcomes the Minister’s review of regulation and believes that there must be consequences for failures of care. We recommend consideration of models by which quality and delivery of care can be linked to funding and reviewed in future contracting arrangements. There should also be the capacity to recoup public funds where poor service has been evidenced.

With regard to access to health and social care, while we heard impressive reports of innovation and the use of technology to provide safe and effective care during the pandemic, there are clearly limits to approaches such as virtual ward rounds. The Committee welcomes the ongoing work being led by the Chief Nursing Officer on an enhanced clinical care framework for care homes.

Members were concerned to hear of the adverse impact on residents' overall well-being of reduced access to podiatry, occupational health and other care. There is a need for consistent implementation of the policy regarding in-person access to care homes as is deemed necessary by the health and social care professionals concerned and subject to testing and PPE requirements.

Advance care planning (ACP) issues were also raised with the Committee. That conversation needs to happen with each care home resident on an individual basis, ideally well ahead of any crisis. It should be led by the clinician who knows the individual best, with the input of other relevant professionals, and should be reviewed periodically as required.

Moving to pandemic planning, the Committee believes that a key lesson for the future is ensuring that care homes are at the very centre of pandemic planning from the outset. There should be centralised procurement and supply of PPE to care homes without charge and ring-fenced funding that can be accessed quickly via a streamlined and transparent mechanism. The Committee endorses the call in the rapid learning initiative for accredited regional training on infection control. The Committee recommends that each home be required to designate an appropriately trained staff member, other than the manager, to lead on infection control.

While the Committee recognises the enormous pressure under which Health and Social Care (HSC) and departmental staff were working at all levels and the considerable volume of guidance developed and advice put in place, communication and engagement issues were central to criticisms raised with us. The Committee was concerned to hear on several occasions that initiatives had been introduced without prior engagement with providers or unions. Co-design, co-production and robust communication plans remain essential, even in a pandemic, and could have averted some of the problems raised with us.

Having heard impressive evidence of the success of other countries in learning from SARS and containing the current pandemic, we recommend that renewed efforts be made to gather and learn from the breadth of international experience of pandemic planning and management.

Human rights concerns were raised in respect of visiting, testing and end-of-life planning. The Committee recommends that guidance be developed on the consideration of human rights issues during a pandemic.

In conclusion to my remarks as Chair, the Committee wishes to put on record its gratitude to the 691 individuals who took time to respond to our survey, the families who engaged with us virtually and the stakeholders who appeared before us and informed our recommendations with their experiences, concerns and ideas. On behalf of the Committee, I also thank the Clerk and Committee staff, who put so much work and effort into the completion of the report.

Members will, no doubt, join me in thanking and acknowledging once again not just our precious care home staff but the wider health and social care family, who continue to struggle to get us through the emergency after what have been eleven exhausting months. I wish to convey the Committee’s appreciation to the Minister and his senior officials for their positive engagement with the Committee throughout the period, and I acknowledge the number of positive initiatives that were implemented in a short few months.

Case numbers and pressures remain worryingly high, but the vaccination programme is already offering protection in our care homes and some hope for the wider community. That said, there is so much work to do, and recommendations in the report have potential read-across to other sectors in the case of future pandemics. The good news is that we know what needs doing: adult social care reform and wider transformation of the health service have never been more urgent. The mental health toll of the pandemic will require a long-term investment.

The recommendations in the report were developed in a collaborative manner and agreed unanimously and are offered in a spirit of constructive engagement as a contribution to future pandemic planning. We look forward to engaging further with the Minister on the implementation of the recommendations and trust that the Executive will give positive consideration to the financial support required to do so.

I will make a few short remarks in my role as Sinn Féin's health spokesperson. I thank every one of the stakeholders who participated in this, including independent care home providers, family members, the unions and many other groups and organisations who assisted us with the report. I also acknowledge the strong cross-party work by all members during the inquiry. It was clear that identifying the flaws and areas of concern was done constructively and in a bid to offer workable solutions and recommendations. I hope that the Department and Minister will consider each in that spirit and commit to their implementation.

As a personal reflection, I say that the impact that this devastating pandemic has had on our people continues to weigh heavily on us all. I offer again my condolences to everyone who has been a victim of the pandemic in any way and for those who have sadly lost their lives.

The report is on the impact that COVID-19 has had on care homes, especially during the first surge, but many of its warnings and lessons would have been suitable for consideration before the COVID pandemic and will remain suitable afterwards. Care home residents are not just patients but have wider family and friends. COVID-19 has a considerable impact on their relationships and visiting, and there is stress about loved ones catching it. I recommend the report to the Assembly.

By and large, I concur with many of the Chair's remarks. Many Members have been touched by the COVID-19 pandemic. We can all look to an experience where we have watched how cruelly COVID-19 has, sadly, affected those in care, many in end-of-life care. As, I am sure, other Members have, I had a close friend in a care home. He was somebody whom I visited regularly in normal times and someone who valued friendships and visits. Sadly, I had to watch from a window in his closing days as he breathed his last breaths. That was not because he was COVID-positive but because of the restrictions that were put in place. It really has been devastating, particularly in this sector. We have seen loved ones lose those who are most precious to them, not having been able to be at their side in their darkest days.

I came to the Committee late in the process, when evidence had already been taken. It was of value for the Committee to look into this and to see ways in which we could reflect, learn and plan the way forward. The purpose of the inquiry was to help mitigate and manage the impact of a potential second surge of the virus in care homes. The Committee received 21 submissions from a range of organisations spanning public, private and charitable organisations, professional bodies and trade unions. Shortly before the report was agreed, the HSC began to roll out the vaccination programme. While some of the report's content may, therefore, now be dated, the recommendations are a contribution to present and future planning. The Committee was very aware that this is a rolling situation with continual developments. We welcome the vaccination programme that has been rolled out into our care homes at high speed. That is really welcome and can help to bring them towards some sense of normality.

I will not have time to touch on them all, but there are some notable recommendations. We have recommendations on visiting, testing, PPE, funding reform, standards of care and mental health. Those are real issues, every one of which merits an Assembly debate in its own right, but we know that the point of the inquiry is as a conversation starter. It is now up to us, as Committee members, to engage directly with the Department and others to ensure that we find a credible way forward and prepare for such events.

I sincerely thank every stakeholder who provided evidence to the inquiry in what were extremely challenging times. Carrying out a Committee inquiry like this in such circumstances has been difficult, whether that has been the online forums in which we have had to engage or, indeed, dealing with the here and now of COVID-19. We recognise that the roll-out of the vaccination programme has dramatically changed the nature of the public heath response, but that does not mean that we should not reflect seriously on the deficiencies of the steps taken in the first wave and use that learning to adopt more effective measures in future.

The report focuses on only one aspect of society that has been impacted on by COVID-19. We acknowledge that much more work and investment will be needed to assess the effectiveness of Northern Ireland's response and to look at events in a much more holistic way for the future. In the immediate future, we would like the Minister to take forward the recommendations on enhancing visiting arrangements. That is something that has struck a chord with us all and is still very live and very relevant.

Asymptomatic testing should be ramped up, and mental health support for residents and staff should be expanded. As the Chair mentioned, rapid testing can prevent staff having to drive significant distances for a test at mass testing centres.

One of the strengths of the report is that it looks beyond the current crisis to the reforms that are needed to transform and revitalise the care home sector in the future. The pandemic has laid bare the weaknesses in relationships between the Department, the trusts and care homes. It has also highlighted the great void between staff terms and conditions in the public and private sectors. We want to see cooperation overhauled in those areas. The proof will be in the pudding in terms of the Health Minister's stated plans to bring staff terms into line with those in the public sector. We are mindful that recommendation 29 on staff ratios must be considered in the context of full workforce planning across the health and social care system.

The report raises many questions, which we will take up in due course with the Minister, but I am glad that it is a conversation starter about this serious issue, which we have to deal with as we move on from the first and second waves of COVID-19.

I speak today as a member of the Health Committee and as my party's spokesperson on health. I thank all the organisations and individuals who contributed to the report and discussed the issue of care homes and COVID-19. I regret that I have only five minutes in which to speak. I thank the Minister for his regular, positive engagements with and briefings to the Health Committee. As a new member, I definitely found them helpful. I appreciate that, given the serious nature of health at this moment in history, the Minister has kept open and transparent communication with us.

The report gives a very clear picture of what things have been like for care home residents, staff and families during the pandemic. I hope that the Minister and the Department will implement the report's findings and recommendations. As is outlined, at the start of 2021, 30% of COVID-related deaths — 607 — had taken place in care homes. That is 607 people. That is a shocking figure. The report looked into many aspects of care homes and the impact of COVID-19. I will touch on a few in particular.

(Mr Deputy Speaker [Mr Beggs] in the Chair)

I have great and deep admiration for the staff, who are working in such a challenging environment, but I will, first, speak about testing. Although it is good to note that the context has changed significantly since the outbreak of the pandemic in terms of testing capacity, increased frequency of testing, regular symptom monitoring and new approaches, it is deeply regrettable that, at the start of the pandemic, care homes were not equipped to carry out testing better to ensure that the spread of the virus was kept to an absolute minimum. Of course, I welcome the fact that the report finds that the situation now is much improved. The Committee's recommendation is that, subject to rapid testing becoming available, care home workers should be tested daily and that testing should be extended to all those entering nursing homes. It is vital that those crucial steps to track and monitor the virus are taken to ensure that every safe measure is taken to protect those in a vulnerable category.

Like the Committee's findings on testing, the situation with PPE and its availability has improved from what it was at the start of the pandemic. That is also welcome. We all recall the real fear last March about access to PPE. That must never happen again.

The lack of visiting has had a severe and negative impact on families with loved ones in care homes. They have had a particularly difficult and upsetting time not being able to visit their loved ones, and residents have not been able to have that really important time with their family. In line with the Committee's recommendation that the care partner scheme be expedited, perhaps the Minister, in his concluding remarks, could include an update on the scheme and its uptake to date and what more he and his Department are doing to encourage it. Several families in great distress have reached out to me on that matter. The inability to see their mum or dad safely and the lack of visitation are causing severe distress and uncertainty. There is also an element of suffering; it is very difficult not to see your loved ones. The lack of visitation has undoubtedly contributed to the cognitive decline of those with dementia. It has been almost a year now — 11 months — since families have seen their parents and loved ones due to the fear of passing on the virus.

I recently spoke with Julieann McNally from Care Home Advice and Support NI. Julieann lost her mother and grandmother in the Dunmurry Manor home and has since fought to get answers about appalling care standards. We had a very thought-provoking discussion. During our meeting, she said, "The elderly in our society are not treated equally. If we were talking about children, would it be allowed?". I do not think that it would, and that is why the report on COVID in care homes is so important. It outlines the immediate steps that we must implement and recognises the evident failures from last year. So many have been impacted by separation from their loved ones, and I fear that, one day, when we come out the other side of COVID-19, not all loved ones will be here with us. We must recognise that.

In conclusion, I very much welcome the report and the opportunity to speak about it today. We have a responsibility to ensure better preparedness for such an eventuality, should it happen again. There are also many lessons to be learned from this awful experience and many issues that we must urgently address in care homes —

Will the Member draw her remarks to a close?

Yes.

— for residents, staff and families, and I hope that the report will go at least some way to addressing those issues.

I hope that the report will be viewed not as a critique of the performance of anyone or any body during this pandemic in relation to the impact of COVID-19 on care homes but as a learning curve for us all as we continue to try to protect the well-being of everyone, especially the most vulnerable.

It was certainly not the desire of the Health Committee that any aspect of the report should descend into a party political debate on any of the recommendations, and I am confident that that will not happen. I am sure that all in the House will welcome the report and support the recommendations. All the recommendations have been put on record in a constructive way, and I am sure that that is how the Minister and his officials will view them.

It is important to remind ourselves that we went into this pandemic, with all the twists and turns that the virus has created, without any recent experience of dealing with such a situation, and it was not a case of nipping down to the library to borrow a textbook that spelled out how to handle it. The report acknowledges that, prior to the arrival of the virus on our shores, we had no sitting Assembly for three years and, consequently, no Health Minister in post. That is hardly the best set of circumstances to prepare to fight an enemy like COVID-19. Our NHS was due, during those three years of inertia, to be reformed by a debate around the Bengoa report. That report was gathering dust for those three years and, given the priority demands of tackling the pandemic at the moment, it continues to gather dust. In the early part of 2020, our hospital waiting lists were the longest in the United Kingdom. Given all that, we were hardly in the best place to deal with a pandemic that none of us had any experience of dealing with.

Our care homes were also under pressure for a number of reasons. Many had staff vacancies that they struggled to fill. On the plus side, they had in post many dedicated people who view their duties as a vocation rather than just a job. The fact that many of these jobs are paid in accordance with the minimum wage, as set by government, is hardly an incentive for anyone to choose working in a care home as a long-term career opportunity.

I will use the example of one home that I am familiar with. It is a home that has a modern design and an ethos of providing top-class care. That said, it has 40 rooms to be fully serviced, and bedding needs to be changed and cleaned daily. It has corridors, specially adapted bathrooms and common rooms to be cleaned, and four workers share that task during the week. If one worker is off for any reason, the others have to pick up the extra work, which is carried out during a six-hour shift. At weekends, only two staff are on duty to complete those tasks. Shortcuts are inevitable, and, in normal circumstances, they are not visible and do not compromise anyone's safety, but, during a pandemic, it can be a different story.

It is easy to see how a virus can enter a care home and, unless every surface is constantly cleaned, take hold. That is labour-intensive, and adequate staffing levels are needed. The issue of staff levels will be paramount going forward. I know that the Minister is aware of the situation, and I have every confidence that any future reform of the care home sector will address the important issues of staff levels and increased levels of pay to attract workers to make a career in care and will ensure that proper working conditions are in place.

The report has 54 recommendations. Many have been overtaken by events and have already been addressed, either fully or partially. Many of them cannot be taken up overnight and will need careful consideration by the Department. They have been made in a constructive manner, and I have every confidence that they will be received and studied in that spirit.

We owe a huge debt to front-line hospital staff but we must also recognise the dedicated work being carried out daily in difficult circumstances in care and nursing homes. I commend the Department of Health and the Minister for all the assistance, both financial and practical, that they have made available to the care home sector during the past difficult year. All that teamwork and cooperation has, undoubtedly, helped to save lives. However, we must remember all who fell victim to this dreadful virus, and also their grieving families. Those families had valuable time with their loved ones stolen by COVID-19.

Naturally, I support the motion on the inquiry report. The Health Committee staff are to be commended and thanked for all their work on it, and I echo the Chairman's thanks to those who gave evidence to the inquiry. I agree with him that the informal Zoom session that we had with relatives was probably one of the most moving experiences during the pandemic.

I would like to put on record that I have a family member who works in a care home.

I start by passing on my sympathies to all the families whose loved ones died in our care homes due to this horrendous virus. Their grief will undoubtedly have been made worse by the circumstances of the pandemic. We need to recognise how difficult it has been for residents and their loved ones to have such limited contact, waiting months to catch even a glimpse of their wives, husbands, mothers or fathers. Then, when they did, they were aghast at how much they had become withdrawn and sorrowful, with their conditions worsened, feeling that they had been abandoned. That was alongside the general confusion of the pandemic.

It does not suffice just to pay tribute to care home staff. We need to do so much more to show them how much we value them and the support that they provide at all times, not just during pandemics. They are another group in society who have, until now, been undervalued, and we must never ever forget their contribution.

We have seen, with huge concern, the impact of COVID on care homes in Northern Ireland and, indeed, in many other places. Our preparations for a pandemic had not fully taken into account the potential of a virus that would spread indoors and leave older people particularly exposed to death and serious illness. Therefore, it is evident that the system had not adequately prepared for the impact on care homes.

The report, rightly, outlines the fact that there was already a broader context of an underfunded and unreformed health and social care system, and thus of undervalued care homes within that system. That made it very difficult to respond adequately when capacities suddenly became limited by greater pressure on homes, with fewer physical rooms with which to meet demand because of social distancing requirements. Nevertheless, specific issues were raised regarding a lack of urgency to get ahead of the virus.

Moving on, we saw for a long time an inability to take account sufficiently of the importance to mental well-being of visiting and meaningful contact. The risk of the virus was increasingly understood but there was, for many weeks at least, a tendency to focus on the virus without recognising the severe impact of having no contact with family and friends. There was, for example, a missed opportunity to introduce care partners at an early stage. It should be noted, and has been noted here today, that that is still not fully implemented across all care homes. What we describe in the report as innovative methods to allow visiting needed to be put in place long before they were discussed as part of a Committee inquiry. Sadly, it is likely that we will pay the price for that lack of contact for years to come.

I put on record in mid-April a call for testing in care homes regardless of symptoms, as it was an obvious means of protecting those who were vulnerable to the virus, so this is not a matter of speaking in retrospect. It was obvious early on that testing was one tool that needed to be implemented proactively. We should not have waited until other jurisdictions acted first.

Regarding the future, the report contains further findings and recommendations which I hope are helpful to the Minister and his Department.

There are ongoing concerns about the true independence of the RQIA given the resignation of its entire board during the pandemic, and I trust that those concerns are now being addressed. We also need to be better prepared for future pandemics, including with equipment storage and helping people to cope with bereavement in times of a public emergency.

The pandemic has shone a light on the crucial role of the sector, how much more we need to do to equip it to play that role and, indeed, how much we rely on staff who often go beyond the call of duty and acting — it is a vocation — to keep it operating. The exact nature of an emergency is never easy to predict, but we must apply learning now for future generations.

In closing, I recognise the amazing work of Pauline Shepherd and her team at Independent Health and Care Providers. From the start, she raised with the Department of Health issues that were affecting care homes and kept pushing for them to be addressed until the additional funding, PPE and other supports were made available. I genuinely believe that without her tenacity —

Will the Member draw her remarks to a close?

— the number of deaths and serious illnesses would have been a lot worse.

Whilst I was gathering my thoughts about the motion, I noted that it is a very sombre topic, as we are talking about those who have lost their life. Like others, I offer my thoughts and prayers to the families.

When Mr Chambers spoke, it struck a chord with me. It was disappointing that he brought political point-scoring into the debate while criticising others. Today is not a day for political point-scoring or for talking about devolution or the three years of the suspension of Stormont. The other Member whose contribution struck me was Cara. She talked about lessons being learned.

I welcome every one of the recommendations and look forward to hearing what the Minister has to say about them, but, if we look at them, we could also be critical of being too prepared for the pandemic. Eighteen months ago, it would have been unheard of, and if all the stuff had been sitting there, we would be talking about wastage in the system. There is a balance to be struck between what should be done, what could have been done and what was not done.

On that point, I welcome the recommendations. They all make common sense, but we all, as Members, have to reflect that, 18 months ago, we would never have foreseen something as tragic as this hitting us. We were all shocked beyond belief at some of the suggestions that came forward. We took our reliance on care homes as a matter of fact; they were there, and they were there to look after our loved ones. No one predicted what was going to happen.

Jonny's speech struck a chord with me because, for our older population — I have lost both my parents — one thing that is important to them is to not die alone. In care homes, older people were cut off from their family and could not have them around them at the time of death. It was in the newspaper last week about one hospital — I am not sure where it was — where they brought the husband and wife in together and they died six minutes apart. That is testament to the care staff who organised that for the family and for the husband and wife to die together.

One of the cruel things about this horrid pandemic, and this is not a criticism of the Minister or the homes, was that we were absolutely blindsided by it. I think that the care homes stepped up to the mark. Primarily, the focus was obviously on the hospitals because that is where the most seriously ill people were presenting, but I am sure that each and every one of us was contacted by care homes with their concerns about the lack of PPE as the virus continued. Again, as I said at the start, if we had an abundance of that stuff sitting about, there would have been criticism about overstocks. There were clearly concerns about PPE, and we should give credit where credit is due because there was a rallying call. Folks, we have to realise that it was not just in Northern Ireland; it was a worldwide pandemic, and we were bidding for the same stuff as everyone else. Whilst it took time to get that roll-out of PPE, it got there and there has been a meaningful change.

The only criticism that I have is that there is a concern that families still cannot get into homes to see their loved ones. If your elderly relative is upstairs in a care home, you cannot get to talk to them through a window, whereas others, whose relatives are downstairs, can. I have a member of staff, and her sister is in a trust facility. I am not referencing the trust. Her sister has been moved upstairs, so that point of contact has been taken away. That is absolutely brutal because families and patients need that interaction.

I want to support the Minister, but the other thing that strikes me about all this is that, whilst we refer to these homes, we have to bear in mind that lots of them are private homes and that those who own them are profiting from them. That is not to say that the recommendations say that we have to introduce systems to make them better places. However, I do not believe that all the responsibility should be on the Minister to fix them, given that some of them are running private businesses. Broadly speaking, I support this.

Paula mentioned rapid testing. Like her, I asked about it once we heard that it had been rolled out in Liverpool. We worked with the Westminster Government in the roll-out of this and were very dependent on them for it. I remember the Minister saying that, in response to the pilot scheme in Liverpool, we were going to carry out our own tests.

It is OK for us to be critical now that we do not have it. However, imagine if we had rolled it out and it was not accurate. To be fair to the Minister, he got it right. However, what we want to see as part of the recommendations is testing being carried out daily. One of the things that struck us all was —

I ask the Member to draw his remarks to a close.

— how can all these people be so sick if they are not allowed out. It was obvious that it was being brought in. I welcome the report and all the recommendations in it, and I commend the Committee for bringing it forward.

First, I would like to thank the Health Committee members and Clerks and all those who gave evidence and who shared their experience for the report. There are quite a few finds and recommendations to go through, but I will pick out a few that I think will add to the debate and which deserve to be mentioned in detail: advance care planning; the impact on relationships in families; and the do-not-resuscitate (DNR) orders.

We know that coronavirus is highly infectious and that it can kill. Tragically, we hear daily updates of rising numbers. However, we must not forget that, each time, there is a person, a family and a community wrapped up in grief. In the first surge, nearly half of all deaths occurred in care homes or to care home residents.

With the second and third surges seeing a decline in that ratio, it is clear that care homes and residents were disproportionately affected. They were truly at the centre of this storm.

I wish to declare an interest in that I have family members who work in care homes. Almost all staff working in a care home do so because they love the job. They treat the residents like their own family and work tirelessly to keep them safe. Members of my family have said that the hardest thing was that residents, many of whom have dementia, thought that they had done something wrong because no one had come to visit. They had not remembered about COVID but had remembered that no one had come to visit them. Speaking to family through closed windows and doors is heartbreaking.

One of the most difficult things for human beings is not having close contact with family, especially older members of the family. I am fortunate in that I have a granny who — she will not mind my saying — is in her early 90s. She maintains that her family contact keeps her young at heart and keeps her going. However, the past year has been very difficult for her, just as it has been for many elderly in our communities. Speaking to her on the phone is just not the same.

It is worth remembering that most of the older people who receive care, receive it in their own home and community. The lessons of this report must be considered in many other settings.

I want to highlight the issue of advance care planning, as it can play an important role in a person's life if it is person-centred and does everything to make people feel safe. Recommendation 34 states that:

"Advance Care Planning should be discussed with each care home resident, on an individual basis, ideally ahead of any crisis; it should be led by the clinician who knows the individual best, with the input of other relevant professionals; and reviewed as necessary."

There is no substitute for planning ahead for person-centred care.

Recommendations 35 and 36 call on the Department to:

"clearly outline and communicate the rights of older people and families regarding end-of-life" care and to ensure that there is sufficient training for the relevant professionals and making talking about advance care planning and end-of-life care easy.

Unless it is done in a positive way, it can create a sense of doom. In particular, I would like to bring people's minds back to the early stages of the crisis when images showed hospitals and care homes in Italy and Spain being overwhelmed. There was a lot of concern about older people and care home residents being pressured into signing do-not-resuscitate forms. Let me be very clear: no one should be pressured into signing a DNR.

A few other recommendations deserve a mention, including ensuring that there is sufficient PPE through procurement and pandemic planning; regional access to e-learning on infection prevention and control; learning from international best practice and experiences; addressing staffing levels and so much more.

To finish, most of the report centred on the pandemic and how best to respond. It highlights the need to ensure a sustainable and high-quality care sector. I look forward to the Minister bringing forward his Department's proposal for the reform of adult social care and welcome and support this report into care homes.

I thank the Chair of the Health Committee, my colleague Colm Gildernew, and the members of the Committee for bringing the motion to the Assembly today and giving us the opportunity to debate it. To be clear from the start, I welcome the report and acknowledge the work that has gone into developing it from all the members of the Health Committee, the Committee staff and the wide number of organisations and individuals who participated in the inquiry.

I echo much of what other Members have said today. The themes that are covered on staff levels, access to care, access to PPE, emergency planning preparations, discharge policy and visiting restrictions are all extremely important. I will focus my remarks on funding and the impact that that has on the social and emotional needs of care home residents, staff and their wider families.

I start by acknowledging that the social care sector was struggling before coronavirus arrived on our shores. As Trevor Clarke mentioned, most care homes are privately run, but they are commissioned to provide residential or nursing care beds. I have also heard that many care homes ask for third-party contributions as part of the process of securing a bed. I would be interested to know whether the Minister is aware of that and whether he has looked into how common that practice is, as, apart from a few statutory or trust homes, the vast bulk of care is provided by the private sector.

Social care in the North would be virtually non-existent if it were not for the private or independent sector. It is important that we understand the system in which care homes operated before the pandemic and how, to use the Minister's own words:

"The social care sector has been struggling for years and as a whole is not fit for purpose."

The North has few large care home providers, and so the ability to buy or introduce quantities of scale just do not exist. That is why the learning around regional decision-making and providing additional funding was so critical for many care homes, their staff and, ultimately, the residents.

The lack of comprehensive pandemic planning for care homes in the private sector left them to their own devices. Recommendation 44 clearly offers a solution. The Committee recommends that future pandemic planning should factor in the central procurement and supply of PPE to care homes. Surely, when we reflect on impact of the pandemic, it will be a matter of immense shame that many care homes were just left to their own devices and left on their own to secure much-needed PPE. In south Down, we had a phenomenal community response when care homes had to put out a call for PPE. That was great and commendable, but it is not how it should have been; that responsibility should have been with the Department of Health.

During the first surge, many care homes could not buy PPE and were using their normal weekly stocks in a matter of days. However, it was not only care homes that were left in limbo. Assisted living sites were also left rudderless, and the Minister will know that I have constantly raised with him the case of Camphill Community Mourne Grange in south Down. With assisted living, we are often talking about high-functioning people, and they have effectively been locked in since last March. They have missed huge family milestones — marriages, births and deaths — and were denied the chance to process the consequences of those important markers. Why was that? Because assisted living was treated like a care home setting although we know that it is fundamentally different.

It was clear that care homes needed additional funding, and I welcome that, especially as it helped to ensure that care homes had no reason not to pay staff more than statutory sick pay for those who had to take time off. So, I fully back the report's recommendations on funding, particularly where it argues that there should be a streamlined process for funding, development of a true cost of care for future social care reform and consideration of funding to the wider social care sector, an essential part of the healthcare service.

To close, I very much welcome the report and its recommendations, but the sad reality is that if the recommendations had been in place before, some of those who lost their lives in our care homes as a result of COVID might still be here to see their implementation.

As someone who is not a member of the Health Committee, I welcome the opportunity to take part in the debate and thank the Committee for its work on this important issue. The report is timely, but it is also key to learning for the future. Residents in care homes are our most vulnerable citizens. It is not an easy decision for a family to place a loved one in a care home or a residential facility. A family's decision is based on where a loved one will be safest and best cared for. When we see the dignity and care that is afforded to our loved ones by those who care for them, we see compassion in action. The staff in those homes are trying to juggle their care roles with their family lives at home. During the pandemic, they left their own homes to effectively go and look after their second family. We all know the impact that the restrictions have had on our daily lives, but for those who are in care homes not to be able to have any contact with their families and the outside world was heartbreaking — residents, families and staff alike.

In the spring and summer of last year, many of us gathered on doorsteps to applaud NHS workers and others on the front line. Those who work in care homes are a critical part of our healthcare system, but they do not often get the recognition that they deserve and certainly do not get the financial reward that they deserve. To the front-line healthcare workers who staff our care homes in every capacity with compassion and selflessness, I say this: we owe you an enormous debt of gratitude.

As I said at the outset, residents in care homes are some of our most vulnerable citizens. As the coronavirus wave hit Asia and Europe, our television screens were flooded with stories and images of people in care homes amidst escalating outbreaks in those facilities and, unfortunately, bereavements. The natural reaction here was to shut the doors and keep visitors out, which meant keeping families out. It meant talking to loved ones through windows and not holding their frail hands for months. My experience of that was talking to a close family friend through a care home window and asking him where he would like to have his mother laid to rest. He did not get to attend his mother's funeral.

The report captures many of the issues that we have all heard about from our constituents, including restrictions on visiting, staffing levels, PPE, discharges from hospitals to homes and support for staff and families. Like others, I applaud the leadership of Pauline Shepherd, who was a steady hand at the tiller and a proactive voice for care homes at the height of the first wave and has been since.

The pandemic arrived like a bolt out of the blue, and it has pushed society and our healthcare systems to the brink. The report contains a sad and stark statistic, which is that 40% of COVID deaths here occurred in care homes. My sincerest sympathy is with every family who has lost a loved one to the virus. Who could forget the sense of panic almost, as staff struggled to get access to appropriate PPE? The community rallied round, thankfully, to make and donate PPE.

Care home staff have relayed to us all their stories of heartbreak and pain at the loss of residents whom they looked after and cared for as though they were their own family. All of us have been contacted by families who are at their wits' end because they have been denied the opportunity to visit a loved one in a care home. Some of them have told us of their pain, anguish and heartbreak as their mother or father or relative passed away without the company of a loved one.

The report highlights very clearly the systemic underinvestment in older persons' care, and it shows how unprepared the system was, public and private, for the arrival of such a devastating transmissible virus.

I ask the Member to draw his remarks to a close.

I welcome the publication of the report and the recommendations therein and support their implementation.

Like everyone, I welcome the report and thank everyone, particularly the Health Committee, the Chair, my colleague Colm Gildernew, and all who contributed and helped to complete the findings and recommendations. The report covers a broad range of areas, and I certainly think that it forms the basis for improving a future response. I hope that the House supports the report.

The impact of COVID-19 on care homes will be felt long into the future. It will be felt by the families and communities who have lost a loved one; it will be felt by the residents, who were unable to see their families and friends in the usual way throughout this time; and it will almost certainly be felt by the thousands of care home staff who were on the front line. I have serious concerns about the impact of this on their health and well-being in the long term. I declare an interest, having worked as a care assistant in a nursing home in my area for many years and in the social care field. I can safely say that working in a care home is one of the most rewarding jobs that I have done. Care home staff look after not just the physical needs of residents but their emotional and mental well-being. They are a friend, a listening ear and a support for the wider family, and they play a key role in recognising and responding to every resident's needs. To be able to do all that in normal circumstances, let alone under the pressures of a pandemic, is an immense task but one that is a vocation and something that we all enjoyed.

There is an obligation to ensure that social care as a whole, not just care homes, is better prepared going into the future. That includes better support not only for unpaid carers but for day-care and domiciliary care settings. I welcome the recommendations that call for a wider look into all those issues and into how care homes play a key role in the delivery of health and social care services.

As other Members have done, I particularly highlight recommendation 53, which clearly calls for greater visibility and places human rights at the centre of a pandemic response, including visiting arrangements and communication with loved ones. That is crucial, and I, like all Members, have been contacted throughout the pandemic by many families who were unable to see their loved ones or had to make an excruciating decision about which family member could visit their mum and dad. There is an important balance between supporting personal relationships and keeping care home residents safe, but it is imperative that a regional standard is clearly set out to ensure consistency and fairness of approach and to support care home management in making those really difficult decisions.

I thank all the staff who went over and above to care for and support residents and their families through this really challenging time. Without them, we would be in a very different place. I am especially pleased that the report recommends urgent reform in relation to staff terms and conditions. One thing that the pandemic has shown is that it is some of the lowest-paid workers who have stepped up to the mark and played a vital role for the most vulnerable. It is past time that they got the recognition that they deserve.

I thank the Committee for bringing the report to the House for debate. It highlights incredibly difficult and systemic issues that we need to start to address immediately in order to improve and, indeed, to save lives. As many Members have done, I put on record my appreciation for those who work in care homes, often in challenging and complex circumstances and, in many cases, without adequate support or appropriate pay. For many, it is a vocation, and their compassion and hard work need to be recognised.

In 2020, 775 care home residents died with COVID-19 — 40% of the deaths in Northern Ireland. Every one of those deaths is an immeasurable loss. For the individuals, their families and care workers, the response was quite simply unacceptable, and we must start to work out what went wrong and make sure that it cannot happen again. How we got into this situation, with such high numbers of deaths in our care homes, is complex. The report outlines many contributing factors, including testing, hospital discharge policies and structural problems in the sector and in Health and Social Care.

Time is limited, so I will not cover all areas of the report. I will take some time to go over a few of the structural problems highlighted. I fear that our social care system has been run on a shoestring for far too long. The Department has, of course, had to channel additional funds into the sector during the pandemic, but we need to take a serious look at ensuring that it is properly funded going forward to provide the high quality of care that should be expected. The lack of investment in the system has, undoubtedly, exacerbated the issues of staffing levels and poor pay and conditions. Organisations including the Commissioner for Older People, Age NI and Marie Curie have highlighted those issues.

Staffing levels have been a challenge for the care home sector for far too long. The situation has been made more difficult by the pressures of the pandemic, sickness, Brexit, staff movement between homes, self-isolation and systemic issues such as the lack of childcare. It is clear that much work has to be done to recruit staff, and, while I welcome the measures to speed that up, it is vital that the Department and the RQIA monitor this. We need to set out more robust staff-to-resident ratios and ensure that staff movement between homes is low and practical. We must ensure that the qualifications and training of care home staff are improved, which is vital to turning it into a real opportunity for people who want to work in the care sector.

As mentioned, many who work in our care homes are among the worst paid despite the vital service that they deliver. Naturally, that contributes to difficulties in recruitment and, particularly, retention. I strongly support the Committee's recommendation to set minimum standards for sick pay and to tackle issues with low pay and poor terms and conditions of employment. Better staff remuneration and contractual sick pay to reward care home staff properly will encourage skill retention as well as allowing staff to be financially secure and able to self-isolate when ill.

Further to that, it is critical that employers ensure that staff who are at high risk, such as those from the BAME community, are properly protected. I am aware of the wider issues of care home regulation and of what are, I believe, failings of inspection and enforcement. I have had first-hand experience of that in my constituency. I have concerns about the halting of inspections last year. I appreciate some of the reasons behind that, but we need to step up care home inspections.

We need to move back to routine inspections as quickly as possible and with all the necessary mitigations and PPE in place. I strongly agree with the Committee's recommendations on the consequences for the failures of care and how those should be considered in future contracting arrangements, including the capacity to recoup funding where poor service has been provided. I am concerned that the owners of some care homes do not have the appropriate background for providing high-quality and caring services. They simply see their homes as an investment.

Finally, the report highlights communication problems in health and social care.

Will the Member bring his remarks to a close?

We need to learn from our previous complacency and get it right in the future.

I thank the Chair, the Committee and the Committee staff for this important report and inquiry. Before I comment on the inquiry's findings, I offer my sincere sympathies to all families who have lost a loved one during the pandemic. It is always difficult to lose a loved one, and it must have been especially challenging and difficult throughout the last year. I offer my sympathies and solidarity to all residents, families and workers for the challenges that they have faced over the last year. Care workers are among the heroes in the fight to keep people safe during the pandemic, and we must salute their efforts despite the situation that they faced.

The need for the inquiry and its findings are a real indictment of the Executive's care home policies and demonstrate the inability of the private sector to put residents, families and workers before profits. The Executive failed to put a protective ring of steel around our care homes at the onset of the crisis, and that produced tragic consequences for residents and families. We will, no doubt, hear excuse after excuse, but that is a fact.

As the report mentions, families felt that they were outside the decision-making process and that there was a lack of communication as a result of the chaotic failure of regulation. The fault for that lies with the House and the Executive. The system of regulation is designed to fail because the private care model exists on the basis of cutting corners. The report highlights staff shortages, low pay and poor conditions for workers, and, as others have mentioned, that was a fact before the pandemic. Why has it taken a pandemic to bring that to our attention in such a big way?

The Executive have tolerated and, in fact, promoted a system that treats workers, residents and families unfairly in which they are denied dignity, respect and even a semblance of equality. 'New Decade, New Approach' commits the Executive to extending workers' rights, but we see none of that in how workers in this sector are treated. The vast majority of care homes exist in the private sector, and, as I have said, the regulations are weak and chaotic at best. That is designed deliberately so that employers can pay workers a pittance and fall short in their obligations to residents and families. It is quite concerning that former heads of RQIA have joined the governing body of one care home about which massive concerns have been raised.

How can it be the case that the Government give free PPE to private owners? Obviously, we want all care homes to have the PPE that they need, but why are we spending millions of taxpayers' money when the employers — the big care homes — have millions and, in some cases, tens and hundreds of millions in the bank?

The report refers to sick pay. Again, how can it be that employers in the sector do not provide sick pay for their workers? We are now in a situation where taxpayers essentially foot the bill for sick pay because some big employers with millions in the bank refuse to do it. It is simply disgraceful and unacceptable.

Staff shortages are referred to in the report as well. Health service workers have been sent into care homes to give assistance. We all know that there are extreme pressures on our health service already. We have had to send health service staff into care homes because care home bosses essentially pay a pittance to the workers already in their care homes. The health service workers are working for those employers free of charge.

The issue of PPE is in the report as well. The Executive have handed millions of pounds to private companies in the forms of PPE, sick pay, training and health service workers. That is called a bailout, and it demonstrates that the for-profit model simply does not work. It has not worked, and we have thrown millions into the bank accounts of private care bosses who have stood in the way of workers trying to join a trade union and treated many families who have raised issues with them as, at best, a nuisance. Some of those employers have had the cheek to threaten libel suits against those who have challenged them on their treatment of residents and workers.

I want several points to ring out clearly from the report. The Stormont Executive and the for-profit model that they tolerate and promote have failed residents, families and workers. All decision-making must directly involve residents and families. All workers have the unobstructed right to trade union representation. We must urgently end the atrocious pay and conditions that these workers endure.

Will the Member draw his remarks to a close?

The private, for-profit model should cease. The Executive should act urgently to bring care homes back into the health service, where we can focus on upgrading, accountability, regulation, proper funding that is ring-fenced and bringing pay and conditions to a level that is deserved by residents, families and workers. Anything less would be a failure of everybody in that sector.

Members, the next item of business on the Order Paper is Question Time. I propose, therefore, by leave of the Assembly, to suspend the sitting until 2.00 pm. The debate will resume after Question Time, when the next Member to speak will be the Minister of Health responding to the debate. The sitting is, by leave, suspended.

The debate stood suspended.

The sitting was suspended at 1.49 pm.

On resuming (Mr Speaker in the Chair) —