Official Report: Minutes of Evidence

The Chairperson (Mr Gildernew): I welcome the officials from the Regulation and Quality Improvement Authority (RQIA): Mr Dermot Parsons, interim chief executive; Ms Emer Hopkins, interim director of improvement; and Ms Elaine Connolly, assistant director of assurance. I ask members who are not speaking to place their phones on mute, as that will help to reduce the static interference in the room. I invite RQIA to make a presentation.

Mr Dermot Parsons (Regulation and Quality Improvement Authority): Thank you for the opportunity to address you in relation to RQIA's role as part of the wider health and social care (HSC) response to the COVID-19 pandemic. First, on behalf of RQIA, I want to extend our sympathy to all those whose lives have been directly impacted by COVID-19. I also want to commend the staff across health and social care, including our own dedicated staff team, who are working tirelessly to ensure the safety and well-being of those in receipt of care.

RQIA is Northern Ireland's health and social care regulator. It is responsible for the registration and inspection of almost 1,500 care services across Northern Ireland. On 20 March, as part of the health and social care response to the COVID-19 pandemic and to minimise the risk of spreading infection to the most vulnerable people in society, the Department of Health directed RQIA to step down its regular inspection programme. This is consistent with the approach of health and social care regulators across the UK and Ireland, including the Care Quality Commission (CQC) and the Health Information and Quality Authority (HIQA).

While there is not a routine inspection programme, of course, RQIA can assure the public that our team of inspectors, including registered nurses, social workers and pharmacists, continue to regulate health and social care services and to respond to any specific safety concerns in these services. During this time, RQIA has continued to respond to concerns in regulated care services and, where necessary, we have taken enforcement action. We continue to monitor the health and social care trusts' statutory duties. We continue to undertake our duties under the Mental Health Order as well as the Ionising Radiation (Medical Exposure) Regulations (IRMER) legislation governing radiation services, and we continue to support medical governance in independent hospitals through our responsible officer role.

Following the declaration of the pandemic, Dr Michael McBride, Chief Medical Officer (CMO), also repurposed RQIA to provide enhanced support to health and social care services. This change reflected the recognition that the threat to safety and quality of provision for residents posed by COVID-19 was the greatest threat to safety at the time, requiring new specific guidance that would be unfamiliar for providers.

With a team of around 40 inspectors available at any one time, our regulatory response always involves judgement about where we intervene at a particular time. In this situation, the deployment of RQIA staff has reflected prioritisation of COVID-19 work as the highest risk priority.

Over the past six weeks, RQIA, on behalf of the Department of Health and the Public Health Agency (PHA), has issued the latest regional direction and guidance on a range of issues crucial to the safe management of care homes, domiciliary care services and independent hospitals and hospices during the pandemic. We have issued more than150 separate pieces of guidance to services, many of which have been lengthy documents and which have focused on: personal protective equipment (PPE) and dress code; human resources and staffing arrangements; testing; medicines management; palliative care; training resources; and comprehensive care home guidance. This guidance is detailed, and key elements have changed and evolved as the pandemic has developed. Twice daily, on behalf of the Department of Finance procurement branch, RQIA has published details of PPE suppliers to support providers in sourcing additional supplies.

In March, we established a service support team, made up of inspectors and senior staff, to provide advice and direction to nursing homes, residential care homes and domiciliary care services, in managing their services during this particularly challenging time, in line with the latest guidance from the Department of Health and the Public Health Agency. We also developed and introduced a smartphone app, which allowed services to contact our service support team directly.

During this time, RQIA became a seven-day-a-week, 8.00 am-to-6.00 pm, single point of contact support for care homes and domiciliary care agencies. However, RQIA support has been far from being a call-centre service. Our expert inspectors have provided focused and professional guidance, based on their understanding and experience of the sector, to support quality care provision, and infection prevention and control (IPC) practice in care homes regionally.

Since late March, there have been around 3,000 contacts — telephone calls and emails — between services and our service support team. Around three quarters of those involved care homes, with the remainder being from domiciliary care services, including supported-living services. This is an unprecedented level of contact with homes. Around 60% of contacts are from services seeking advice or wishing to share information with us. Some 40% have involved RQIA proactively contacting services in response to intelligence or to offer support and guidance. Through this work, we have played a major role in embedding the guidance across the sector to support good practice. In the initial phase of the pandemic, much of this contact related to PPE and COVID testing arrangements. Recently, key issues include infection prevention and control, staffing challenges and issues around visitors to services.

Much of our contact with providers has been highly focused. In early April, RQIA inspectors contacted every care home and domiciliary care service to offer support and provide details on how to contact us to access this support and guidance. Over the Easter weekend, we contacted some 400 providers to check how they were dealing with the situation at that time and to offer specific assistance. In late April, our inspectors contacted domiciliary care services to provide advice on donning and doffing PPE when entering and leaving clients' homes and on the correct PPE for supported-living services. Over the past week, our inspectors have phoned all nursing and residential care homes that are not experiencing a COVID-19 outbreak to risk-assess their preparedness and offer support. This week, we have started a programme of visits to services, where our inspectors are providing advice and guidance on infection prevention and control practices.

In addition, throughout this time, we continue to receive calls through our duty desk, where an RQIA inspector responds to calls from service providers, care staff and concerned family members. We have had calls directly to the named inspector for services and emails from providers and the public.

A critical point is to recognise that we have not stopped inspecting. Where we become aware of risk, we react as usual, making risk-related inspections as necessary. We have, for example, carried out inspections in three care homes with significant COVID-19 outbreaks. We do not hesitate to take enforcement action where appropriate. Yesterday, we issued a failure-to-comply notice to a service where a whistle-blower revealed that that service, despite assurances to us, was not using PPE safely to protect service users and staff.

In the last fortnight, on behalf of the Department of Health, we have introduced a further reporting app for care homes. The app gathers information daily about the health status of residents and, sadly, deaths, and staff. That aims to ease the burden on care homes that were previously reporting to different public bodies. It has also allowed RQIA to provide information to the Department, the Public Health Agency, trusts and the board to inform regional responses alongside the trusts' support and RQIA support to individual homes.

We recognise that COVID-19 infection is, sadly, likely to be present in care homes for some time. Therefore, we are adjusting to that reality, and there is a need for an increase in the level of assurance on the "normal" types of risk in social care. Consistent with other health and social care regulators in the UK and Ireland, we are preparing to adjust to that changed state for the imminent future. We are liaising with the Department of Health to agree an inspection approach that is consistent with the Chief Medical Officer’s guidance on reducing footfall in homes, which is achievable in an environment where homes are facing additional challenges. That is likely to rely on the increased use of technology. We continue to support those services to make risk-assessed and evidence-based decisions using their professional judgement and their knowledge and understanding of the people in their care.

As always, the safety and well-being of everyone in receipt of health and social care services across Northern Ireland is of paramount importance to RQIA, and we continue our regulation activities to ensure that management arrangements are robust and in the best interests of those receiving care.

The Chairperson (Mr Gildernew): Thank you for that presentation, Dermot. I will start off with a couple of questions, and I will then go to the members on the phone, in the order in which they phoned in, and I will then come to members in the room for questions and answers.

You mentioned at the outset of your briefing, Dermot, that the Department of Health advised RQIA to suspend inspections. Who took the actual decision to suspend those, given that you are an independent regulator? Who made the decision?

Mr Parsons: To clarify that point, this was not a suspension of inspections. We were directed by the Department, under its powers to issue directions to RQIA, to reduce our statutory inspection frequency. It is not a cessation or a suspension of inspections.

The Chairperson (Mr Gildernew): Did you challenge or agree with that approach?

Mr Parsons: Our approach towards that was agreement. We had been in discussion with the Department before the issue of the direction to us about what appeared to be the most significant risks in the sector at the time and about how RQIA could best use its resources to support the response to the biggest threats that existed in care homes at that point.

The Chairperson (Mr Gildernew): You indicated that you played a key role with PPE. Given that there was a very clear failure to provide care homes with PPE at the critical time and in the quantities and of the quality that was required, what is your assessment of how that failure came about? What lessons have been learned to prevent any recurrence of that error?

Mr Parsons: Going back to the first part of your question, RQIA's role has not been to provide PPE. From the start, our role has been to get the guidance that was being produced by the PHA, ensure that it was circulated in the sector and try to embed good practice with providers around PPE.

In the earlier parts of our work with the service support team, we found that there was a significant number of issues where providers were reporting difficulties in getting full PPE. Where there were challenges, we reported that to the trusts, to the appropriate senior network, depending on the nature of the problem, to ensure that the issue was resolved.

The other element of the work on that, as I described in my presentation, is that we wrote to providers and made them aware of a place on our website that was not publicly available and provided them with access to the details of that. They could access information that has been provided from the Department of Finance about currently available sources of PPE that they might wish to order. In the early part of the pandemic, that resource seemed to be regularly and heavily accessed by providers. The use of that resource has since dropped very heavily to, I think, the last report was that it was down to single figures, which would indicate that providers can now source PPE through other routes.

The Chairperson (Mr Gildernew): OK. As regulator, can you assure the Committee that the issue of PPE at present and in the weeks ahead has been addressed satisfactorily and that staff will be protected?

Mr Parsons: It is not entirely our role to give you that assurance. What we can assure you of at this point is that we are not hearing from providers about the challenges that they were having in accessing it previously. We do not know about the issue of future availability.

The Chairperson (Mr Gildernew): Are you concerned about not knowing that? When I talk about staff being protected, I also mean residents being protected through the proper use and provision of PPE.

Mr Parsons: What we can say is that we know that, in accordance with the regional guidance, it is critical that the correct PPE be available for use by staff for the protection of service users and the staff themselves. I would not expect the RQIA to have information about arrangements for future supply.

Mr Easton: I have just one question that has been worrying me. The vast majority of deaths have been in independent nursing and residential homes. Why are those residents not being taken to hospital? Have staff been advised to treat those people in the nursing homes? Is there any reason that you know of?

Mr Parsons: It certainly is the case that, in some situations, people living in care homes who have the COVID-19 infection are continuing to live and be supported in the place that they live in. Other people with infections are receiving care in hospitals. That really is on the basis of individual professional assessment of the best way to provide care to those individuals. I do not think that it is related to any particular policy position.

In respect of the impact that has on reporting the situation, that point was made yesterday by the Commissioner for Older People in his observation that information about people who sadly die is divided between information about people who die in a care home and people who die in hospital. I do not think that it is particularly something that has engaged the regulator.

Ms Flynn: When do you plan to restart your regular inspections?

carried out

you mentioned and enforcement when necessary. In the context we are in at the moment with the care homes [Inaudible.]

planning on reverting back to regular inspections? [Inaudible.]

how many inspections were carried out? What were the reasons for any of the enforcement that has been put in place?

The Chairperson (Mr Gildernew): I will go to the panel now, please. Members, there is a noise there; I am not sure whether it is something scraping on a table. Will all members who are not speaking ensure that their phone is muted, please? I will go to Dermot for a response to Órlaithi's question.

Mr Parsons: The date at which we would be able to reinstate an inspection programme similar to the one that we had before is probably some way off. That relates to the nature, I suppose, of COVID-19. I will illustrate that for you. During a normal inspection programme at this time of year, we would expect that an individual inspector might inspect two homes a week. During the 14-day period in which a COVID-19 infection could be incubating, that could take the inspector to four separate homes. Consistent with the guidance from the Chief Medical Officer, I do not think that any of us would be comfortable carrying out inspections that involved inspectors going into homes and talking to people at close quarters in the current circumstances.

The public health advice also suggests to us that, for a considerable time, there will continue to be a considerable cohort of homes where there is a COVID-19 infection. We need to make sure that the actions of our inspectors do not run the risk of being vectors for infection. In some instances, where there is acute infection, it could be impossible to carry out the type of inspection that we normally carry out because of the nature of the care being provided under pressure. At this point, consistent with other regulators. I join a regular call with the regulators from the UK and Ireland. We are trying to develop an alternative approach to taking assurance, which probably relies less heavily on actual footfall in the homes for a regular inspection programme, while continuing to go on-site nto services where there is a suggestion of practices that could be placing people at risk from unsafe care.

We do not think that there is a value in automatically inspecting homes simply because there is a COVID-19 outbreak. It may be being managed perfectly well in accordance with good professional guidance. You asked about the inspections that we have done to date. Just thinking about the most recent ones that we have done: we had two inspections carried out late yesterday evening, both of which were in relation to allegations — or concerns, really — about possible poor practice relating to COVID-19. Thankfully, the concerns were not substantiated on inspection. We have two inspections under way today, one in a nursing home and the other in a residential care home. Again, we are pursuing issues round practices related to safe care with COVID-19.

You asked about the enforcement actions that we have taken. We have issued one failure-to-comply notice this week and, as I was saying, the issue there was with the safe use of PPE. We found that the practice was contrary to assurances that we had been given by the provider.

Ms Flynn: Thank you very much.

The Chairperson (Mr Gildernew): Are you there, Pat?

Mr Sheehan: I am indeed, Chair, thank you. I just have a couple of short questions. First, I want to know whether the inspections

relate only to care homes, because it also relates to places like Muckamore Abbey. Secondly, I have been lobbied by a number of care home providers who, in the context of the pandemic, have had to rely heavily on agency staff. What is the RQIA doing to ensure that agency staff are not moving from one home to another and inadvertently introducing the virus to homes that they are moving about in?

Mr Parsons: I will ask my colleagues to pick up on the first part of your question; I will deal with the second part. The guidance from the Chief Medical Officer discourages excess footfall in homes, and, in our work with the sector, we have been encouraging homes to maintain as stable a staff team as possible and to draw on bank staff where possible. However, in the course of a pandemic, the reality is that staff teams will have been weakened and depleted and there have been, and will continue to be, situations in which there is a reliance on agency staff.

Clearly, the idea is to consolidate the regular booking of agency staff for particular homes to create stability. The key is that any staff coming into a home, wherever they come from, are required to comply with the good infection control procedures recommended by the PHA. That is what we are working on with providers.

I will ask Emer Hopkins to pick up on the first part of your question.

Ms Emer Hopkins (Regulation and Quality Improvement Authority): On the other kind of non-care home inspections that we would normally carry out, the direction given to us by the Department has allowed us to make judgements in areas where we have concerns, particularly where there was ongoing enforcement or escalation action and we had intelligence to suggest that there was a role for us.

Over the past six weeks, we have undertaken evaluations and, for want of another word, desktop-type inspections. We evaluated compliance with improvement notices in the Northern Ireland Ambulance Service and undertook close scrutiny judgements in following up on the improvement notices at Muckamore Abbey Hospital. We keep very close and continued engagement with those services. While we are unable to undertake inspections, we have, up to this point, been able to get the assurances that we need through a range of other means —.

Mr Sheehan: Emer, if you do not mind my interrupting, I brought the matter up because some 27 members of staff at Muckamore have tested positive for COVID-19 over the past couple of weeks. Does that level of infection, and the threat that it might spread to some very vulnerable patients in Muckamore, not prompt concern in the RQIA?

Ms Hopkins: Yes. Thank you, Pat. Fortunately, we have very good information coming to us from the trust about patients in Muckamore. A very small number have tested positive. We have scrutinised the management, isolation and cohorting of those patients and have reviewed the number of positive staff. At this point, we are not concerned about that, but that is a very vulnerable group of people, and, as always, we will want to continue to be assured that best practice is adhered to. Where we are not assured, we will not hesitate to visit the site safely.

The Chairperson (Mr Gildernew): OK. Thank you, Emer.

Mr McGrath: Panel, thank you very much for your presentation. To begin with, will you clarify when you stepped down your inspection program? What date was that?

Mr Parsons: Again, I want to be clear that the inspection program has not been stepped down; we continue to carry out inspections. The Chief Medical Officer directed that our routine inspection programme should be reduced on 20 March, and we took that step immediately on receipt of that direction.

Mr McGrath: OK. Thank you for that, Dermot. I used the term "stepped down" because those were the words that you used when you wrote to me on 24 April.

Mr Parsons: OK. Yes.

Mr McGrath: So it did not step down?

Mr Parsons: It has been reduced. With the way that you put that question, I was concerned that there could be a suggestion that we have ceased inspections. We have not ceased inspections; we have reduced our routine programme. Our routine programme has been stepped down. Our inspections overall have not been stepped down.

Mr McGrath: Right. The letter was certainly quite clear about it, but I will take your word for it now.

You mentioned that the RQIA has conducted inspections in two care homes and that both of those were in the past week. Is that correct?

Mr Parsons: No. I described inspections that have happened in the past couple of days. We have done more inspections than that over that time. I am just counting them up. We have done 12 care home inspections in the past few weeks. We have done two on-site support visits and done a number of other engagements with homes that have not necessarily had us crossing the threshold.

Mr McGrath: You have been completing inspections, but, for the purpose of today, you were just illustrating the fact that there were two conducted in the past week.

Mr Parsons: No. I did not say that there were two in the past week. In fact, two inspections are going on today, and two were carried out yesterday.

Mr McGrath: OK. This is getting a bit confusing. I cannot quite work out what you are saying. If the inspections have happened in the past couple of days, that means that they have happened in the past week. Is that not correct?

Mr Parsons: In the written statement that we provided in advance, we talked about carrying out inspections in two care homes that had significant COVID-19 outbreaks. OK?

Mr McGrath: Yes.

Mr Parsons: Today, we have two inspectors in different homes carrying out inspections, probably as we speak. We had two inspectors out in homes last night as well. Those are both in this week, but, if you like, the situation has progressed, in that we have carried out two inspections at extremely short notice in the past 24 hours.

The Chairperson (Mr Gildernew): Pam has a supplementary question.

Mrs Cameron: On the back of Colin's question, can you clarify whether all the inspections that you have referred to — say, those conducted in the past month — have been physical, on-site inspections?

Mr Parsons: No. They are not. Some of them are, and some of them are not. We have carried out 12 in total: eight were on-site inspections and three were remote inspections.

Mr McGrath: Afterwards, perhaps we can word correctly the information that we are looking for, and then you will be able to take the time to come back to us. There is a bit of confusion even in the room as to what an inspection is and what an on-site inspection is. You say that you did 12, but eight plus three is 11 in my book. We will give you the opportunity to come back to us with the specific information.

Do you maintain an at-risk or special measures list of homes when you go out to inspect them? There are some 450 care homes. Are there some that you go out to inspect and say, "Look, we are going to have to keep an eye on there", or do you go back and forward? Do you keep a separate list?

Mr Parsons: It is probably not quite as simple as that.

Sorry, I will just clear up the confusing figures. To be clear, we have had nine inspections on-site and three inspections that we carried out remotely. Consistent with my answer to your colleague earlier, in our forward programme, we know that we will have to develop approaches to doing more inspections remotely.

In normal times, we inspect according to the Regulation and Improvement Authority (Independent Health Care) (Fees and Frequency of Inspections) (Amendment) Regulations (Northern Ireland) 2011, which stipulate that residential homes and nursing homes should be inspected twice a year. We therefore have a baseline number of inspections that we do for that purpose. Over and above that, we inspect where we have concerns about services. The inspection might be in response to things that we found in earlier inspections. It might be on the basis of information that we have received, either from members of the public or from professionals involved with the home. Where there are concerns identified that we substantiate when we go out on an inspection, we may take enforcement action or identify areas for improvement and seek assurances from the provider. Where we are not content that a good level of provision is present, we are more likely to return sooner, if that is what you mean. We have a tool for nursing homes that has been developed in association with Professor Brian Taylor from Ulster University. It is a risk-adjusted, dynamic and responsive inspection framework, referred to as RADaR, that helps us determine the necessary frequency of inspections in homes.

We also have an internal IT system in which we log all the concerns that we receive about homes and all the notifications that we get from homes. We keep information about outcomes of previous inspections. The key important professional judgement area is this: each of our inspectors has an individual caseload of homes. They are required to scrutinise all the intelligence that we receive about services and to be familiar with the outcomes of previous inspections, and that supports them in determining what the appropriate future inspection regime or services will be. Over the past year, and it continues to be the case, an increasing proportion of our inspections have been responsive inspections that have been triggered by concerns identified to us about services. We have gone out on the back of concerns about people's well-being, or factors that might contribute to people's well-being, in services.

Mr McGrath: I have a final, short question. To paraphrase what you have said, if you are not content with an inspection in a home, you will then line it up for some special attention. You stepped down your programme on 20 March. How many deaths have there been in those homes that you were not content with?

Mr Parsons: To be clear, there is a difference between circumstances in which we might not be content with, say, management or environment arrangements and factors that might be linked to COVID-19 or to care related to COVID-19. As the pandemic has continued, we have carried out an exercise to try to see whether there is a correlation between services where we have taken enforcement action and services where there has been a COVID-19 outbreak. We are clear that there is not a correlation between services where we are taking enforcement action and services where there is a COVID-19 outbreak.

The Chairperson (Mr Gildernew): Thank you. In common with many of the organisations that we are dealing with, we have further issues to raise with you. As this develops, there will be other matters that we will be looking to come back to.

Mr Carroll: Thanks for the presentation. Before I ask my question, can you clarify whether it is the case that there have been only nine physical inspections in the 450 care homes?

The RQIA, in conjunction with the Patient and Client Council (PCC), set up a service support team on 26 March in your headquarters. According to the Department of Health, from 26 March to 30 April, 2,434 contacts were made between the support team and service providers. Of those 2,434 contacts, 1,500 were raised as concerns and issues. From those 1,500 concerns, can the panel give us examples of what the issues were over a four-week period? To me, the number seems to be very high. Is that abnormally high for a so-called normal period?

The Chairperson (Mr Gildernew): I hand back to the panel.

Mr Parsons: Yes, I can confirm that we have carried out nine on-site inspections during that time, and that is consistent with the guidance issued by the CMO instructing us to reduce footfall in homes, where possible, and to respond to circumstances in which there was identified risk, rather than carry out our standard programme.

Our IT system has a module on which we have classed as a concern any contact that we have received about COVID-19. We have been contacted by services at this time predominantly to clarify matters relating to the guidance that has been issued to the sector, which has changed during the time. In the early days, we were contacted about arrangements for accessing PPE. Consistently throughout the time but probably increasingly in recent times, we are having discussions about infection prevention and control measures. A good number of the contacts have been us contacting homes ourselves to go through checklists with them to ensure that good arrangements are in place. Staffing has particularly been an issue in services where there is or has been a COVID-19 outbreak, but it has been a general issue across the sector during this time, as staff availability has lessened.

Mr Carroll: I have a follow-up question. Does the RQIA detail the figure for the cost of staffing and PPE items distributed? Who is paying for that?

Mr Parsons: Will you repeat the end of your question, please? I did not quite hear it.

Mr Carroll: Who is paying for the PPE and extra staff for care homes?

Mr Parsons: OK. I am afraid that the RQIA would not have information about who is paying for PPE and staffing.

Mr Carroll: OK.

Ms Bradshaw: Thank you very much. You mentioned that you do not hesitate to take enforcement action, through your issuing of failure-to-comply notices. I am slightly concerned about that, based on the experience of Muckamore, where failure-to-comply notices were submitted, or whatever the proper term is, yet it took months and months for the conditions to be met. How are you going to ensure that the enforcement action is followed through on very quickly?

Secondly, a lot of the contact that you spoke about was with care home management. How is the process of dealing directly with whistle-blowers among staff being managed?

Mr Parsons: I am sorry, but will you repeat the last bit, please? I am afraid that I did not pick it up.

Ms Bradshaw: It was about how you are engaging with the front-line staff, even through to whistle-blowers, to hear what they are experiencing, because I am concerned that you may be hearing from management that things are all going very well, yet the reality is that the people who are having to deal with the pandemic are feeling a lot more under pressure.

Mr Parsons: The failure-to-comply notice that we issued yesterday to a service is linked very much to the question that you are asking, in that the concern was brought to our attention by a staff member who contacted the RQIA to whistle-blow that the practice in the service was not as had been instructed by management. That led us to carry out an inspection. In fact, if staff members contact us highlighting the fact that the practice is different from what management are outlining, that is one of the things that is likely to trigger an on-site inspection.

On the question of how long things are going to take to be corrected, the compliance notice that we issued yesterday stipulates that full compliance is required by 27 May 2020, and we will carry out a further inspection at that point to determine that that is the case.

Ms Bradshaw: OK. To go back a bit, there has been a high turnover of staff in care homes. I should declare an interest, because my daughter now works in one. A lot of young, inexperienced people are being put on the front line. How are they being advised? I do not think that a lot of them would know that the RQIA exists.

Do you not think that giving until 27 May is a little bit long for the service to address some of the issues?

Mr Parsons: The date is 14 days from the issuing of the notice. We were given an assurance by the provider at the meeting that the practice would change immediately. When we go back, we will need to talk to staff to determine what their experience has been in the intervening period so that we can verify that the correct practice for PPE is now being followed. If we gave a shorter time, I do not think that we would be able to gain adequate assurances that the practice had changed consistently.

The Chairperson (Mr Gildernew): The other part of Paula's question concerned how, beyond just phoning management, you are engaging with staff to find out how they are coping with the COVID-19 crisis. How are you engaging with staff? More importantly, how are you ensuring that staff who have concerns are engaging with you?

Mr Parsons: Sorry. I should have picked up on that. The route for staff to engage with us is through the contact arrangements that we have for people to contact us.

We have taken hundreds of calls from managers and staff, relatives and members of the public, during that time. We are highly responsive to the concerns that staff raise. We have also had contact from trades unions and other representatives of staff, who have highlighted practice concerns that we have, in each instance, gone back to the service or the arrangements for the service in the most appropriate way, according to the individuals concerned. We have made sure that the issues that were raised were dealt with.

Last night's inspections that we carried out also involved contact that had been made with us by a person who was a whistle-blower. I think that the circumstance that you describe around people contacting us to raise concerns, who will be members of staff or members of the public associated, are highly influential with us in determining how we respond to a situation.

Mrs Cameron: Thank you very much for your presentation. In it, you say that:

Late April was just over two weeks ago. Have you a precise date for that? It seems very late in the day. Have you given the same support and advice to care homes? If so, what date would that have taken place by?

Mr Parsons: Yes. The guidance around that was issued at the start of the pandemic period, and it has been —.

The Chairperson (Mr Gildernew): I am sorry, Dermot. We missed the start of your answer. It was not clear.

Mr Parsons: Yes, we have been raising these issues with providers from the very start of our current role. Engagement with providers on the appropriate use of PPE has been a key element of what the support team has been doing from the start.

The reason that we contacted, quite intentionally

each of domiciliary care agencies at that time was because we were concerned that awareness in that sector might not be as robustly measured as it might be. We carried out very structured discussions with providers at that point. We wanted to reinforce the message. In particular, in relation to supported living services, there was an interpretation point in the guidance that had been issued by PHA, we were very keen to make sure that supported living providers understood the distinctions that were made in different parts of the tables of guidance that were issued at that time.

Mrs Cameron: OK. You mentioned that you have had hundreds of calls from managers, staff and relatives. What percentage of those calls is related to PPE provision and the use and knowledge of how to don and doff PPE?

Mr Parsons: I do not have a precise figure, but we could break down the information and provide it for you.

Mrs Cameron: I would appreciate that. Thank you.

Mr Chambers: I do not know whether this question is within Dermot's area of responsibility, but I will throw it out anyway. We all welcome the news that the Health Department is to ramp up testing in the care home sector. Do residents of care or nursing homes, or their next of kin, have the right to decline to have a test done? Are there residents in the sector who are simply not physically fit to be tested?

Mr Parsons: I am afraid that that really is a policy area outside the RQIA remit. I am sorry that I cannot answer that.

Mr Chambers: That is fine. I thought that it might be so.

The Chairperson (Mr Gildernew): I have no other indications from members, but I have one question about the pandemic. Can you describe your relationship with the Department and the PHA as a regulator? Are there issues around independence, given the issues that have arisen?

Mr Parsons: I think that our relationship with the Department is just as normal. As I said, there is a good information flow between ourselves, the Department, the Public Health Agency, the HSC Board and the trusts. I suppose that the difference at this time is that the direction that Dr McBride issued to us has temporarily changed the emphasis of our work. However, as I said earlier, we are engaging with the Department to determine how we can get back to carrying out a more normal regulatory regime. It is really within the policy direction of the Department to give us a further direction on that. Dr McBride's letter refers to us being issued with a further future direction.

It is important to point out that the RQIA is quite a small organisation. It is important to point out that the RQIA is quite a small organisation. We are part of the whole-region HSC response to COVID-19 at the moment. This is such a huge issue and, in particular, it is such a huge challenge in the care home area. However, we recognise, in working with the Department, that the areas around what you might call — I hate using the phrase — the normal concerns around social care are still there. We need to work with those and find a way back into a regulation programme that is not only risk-responsive.

The Chairperson (Mr Gildernew): OK, thank you. What is your view of the Minister's statement yesterday that the care home sector is not fit for purpose, given your central role in ensuring that that sector is fit for purpose?

Mr Parsons: All that I can say to that is that, clearly, the policy for social care provision sits with the Minister and the Department. Our role is to work to ensure the safety and quality of services for people who are being supported and cared for. We will continue to do that within whatever framework prevails at the time.

The Chairperson (Mr Gildernew): Again, if you are working within a framework that is prescribed for you, does that provide a challenge to the independence of the regulator?

Mr Parsons: Essentially, we operate within the framework of the legislation that established RQIA: the Health and Personal Social Services (Quality, Improvement and Regulation) (Northern Ireland) Order 2003, the Health and Social Care (Reform) Act (Northern Ireland) 2009, and the individual sets of regulations for the different services that we regulate. Some legislation gets reviewed and changed, and we then operate within that different framework. The core purpose of RQIA is to focus on the quality and safety of care for people in whatever model of care will be provided.

The Chairperson (Mr Gildernew): OK, thank you for that. I am conscious of time. I know that our first session ran over and that there is an Ad Hoc Committee session later that many members will be taking part in. Thank you for your presentation and your answers. This is an area that we will return to, given the very serious concerns in the care home sector, but, for now, we wish you all the best. Thank you.