HSE CEO PAUL Reid has said he is confident Ireland will be able to return to ‘normality’ once the pandemic is over, abandoning our masks and hugging friends when we meet them.

“Ireland as a society is one that values engagements and values family and values our interactions with people and I think that’s something you can’t throw out,” he said in an interview with TheJournal.ie.

“Definitely, I’d be certain we’ll get back to that.”

And there is hope now for this return to our old normal, with the likely approval of the Pfizer BioNTech vaccine by the end of 2020. The first shipment to Ireland is contain almost 5,000 doses and the HSE expects to have hundreds of thousands of doses by the end of February.

Reid said he does see some elements of the measures introduced in over the last ten months being maintained in the future.

“Honestly when you look at what we did through the middle of a flu season in the past, we were all coughing and sneezing on the Luas. I think there’ll be greater recognition of transmission. I think we have to take some elements of the good out of all of this.”

He said he doesn’t foresee policy implementations every winter telling people to wear masks, but it may be something people decide to do, knowing it can help.

“Certainly when you think back to a heavy flu season, wouldn’t you rather see everybody jumping on the Luas with a mask? You probably would.”

Nursing homes

If he could go back in time and tell the Paul Reid of February 2020 anything, it would be a warning about Covid-19 transmission in nursing homes.

“The one that breaks my heart, the one I’d really love to be able to tell is about nursing homes and elderly care. That stands out for me as one I’d really like to have known better.

“Because our focus, and not just ourselves … all the scenes [internationally] were in acute hospitals. It was actually sometime later in Spain where it began to emerge around elderly care and nursing home impacts. That would be the one – you’d love to know different.”

Over the course of the year, but particularly in the early part of the pandemic, there were a number of significant outbreaks at nursing homes. In August, an expert panel set up to examine the situation in nursing homes recommended a number of both long and short-term changes. 

This included a recommendation that the health system and nursing homes – the majority of which are privately owned – be more closely aligned.

At the time nursing homes accounted for 56% of all Covid-19 related deaths.

Reid acknowledged a need for a dramatic policy shift in nursing home care – away from congregated settings. 

“From my own local governemnt background, we were dabbling in it a bit, constructing housing schemes for elderly care. I think it’s something we have to up our game on, where you provide integrated care in a very different setting to a nursing home,” he said.

“A congregated setting is not the way to deal with people at that stage of their lives. 

I think it does need a really strong committed governemnt policy change, I don’t think it will naturally change. Personally I’d like to see it in a programme for governemnt, that our strategy direction in the future is different. It will take a long period of time but I think we have to get on a different roadmap.

Another big change required relates to the governance model for the nursing home sector, he said.

“The HSE came under a lot of challenge and criticism, that’s understandable, but at the same time we’re not the oversight [body] and we didn’t have a natural relationship with nursing homes. That was a gap of responsibility and accountability and I think that was a factor, still is a factor,” Reid said.

Through the work of the Covid-19 Nursing Homes Expert Panel, he said there had been an “interim solution” to get the HSE and the private nursing home sector working better together.

That’s something that should be clarified in time – what’s Hiqa’s role, what’s the HSE’s role, what’s private nursing home’s and owner’s roles and responsibilities? I think we’re still seeing some of the impact of that gap.

“Even recently, Hiqa went into a nursing home, Oaklands nursing home [in Listowel, Co Kerry], they say it’s not fit for purpose, we take it over, the owner backs away. It just seems an odd process.”

Outbreaks in meat plants

Another sector that experienced significant levels of transmission was food manufacturing – again with some significant outbreaks, particularly in meat plants.

Last month reports released by the Health and Safety Authority detailed a number of issues identified during inspections of these plants, including staff working “face-to-face” with ill-fitted masks, a lack of social distancing and tightly-spaced locker rooms. 

“We have to look at the meat plants from two points. One is the technical aspect of how the virus spreads and the situation within the plant itself. But we also have to look at the wider societal [part], and the workforce and their living arrangements or transport arrangements.”

He said public health teams who went into plants saw “congested workspace” in some cases, with a lot of shouting because of the loud machinery. Air circulation in the plants is also believed to be a factor in transmission.

“Now I should say, the meat plants responded quite well with us. It was a learning for them too,” he said.

But I think it would be remiss to step back from some of the wider implications for workforce and for society because many of the staff lived in high congested settings, many of them transported to work together, many of them couldn’t afford to take days off work in terms of pay issues.

“And many of them were reluctant to stay out of work so [they were] going to work symptomatic. And indeed many were reluctant to pass on contacts or even make contact with others, potentially putting someone else out of work.”

Concerns about Christmas

Covid-19 case numbers continued to rise over the last week, with the government warning it is likely the country will face new restrictions before the New Year.

Taoiseach Micheál Martin has said he is “very minded” to accept NPHET advice for a pre-New Year closure of the hospitality sector. This morning, government sources gave indications that restaurants and gastro pubs would be asked to close their doors again on 30 December. 

The exact restrictions are to be decided by Cabinet when it meets this coming Tuesday.

Reid said he is worried about the knock-on impact on the healthcare system in January.

“The impact of one positive case is in complete disproportion to normal events, so it has the capacity to close a ward very quickly, it certainly will close a bed very quickly for a period of time.

So looking right now, we’re beginning to see rising trends at a time when we’re going to have more reduced restrictions. In normal times, I’d be concerned about post-December anyway for the hospital system.

“Now we have to layer in normal concerns, people come forward with chronic illnesses, people with COPD effects, and layer onto that positive Covid cases,hospitalisations and impact on some of our bed capacity, that would be a concern.”

He said the health service is in a stronger position going into the new year than it normally would be, with the trolley count down 55% on last year.

Future pandemics

Reid said Ireland has to build a “national pandemic capacity capability” that can dial up or down as needed.

“That means, public health and the role of public health teams and doctors, that needs to be strengthened. There’s plenty of other roles they can do when there isn’t a pandemic so public health doctors will always have value. We have to strengthen and value more that workforce.”

He said an operating model for testing and tracing will also need to remain in place.

“It’s hard to imagine that will always be a fixed workforce. My direction on it would be something you scale up and scale down as needed, but you need to keep a base level. So that can be a fully HSE in-house system or something you can build and contract in future,” he said.

The health system will also have to strengthen its ‘pandemic skills’, he said.

So, where do we go for ventilators, where do you go for supplies of testing reagents kits, how do you build up resilience on the island for PPE, how do we invest so that companies can recalibrate their business?  It would be a very wise investment to be able to produce PPE here, as opposed to buying it overseas or China.

Reid said he believes there has been a “huge recognition” of the investment needed in the healthcare system in Ireland.

“But it’s not just about money,” he added. “It’s about where the money is invested and I think we need to make a step change in care outside the hospital so that the emergency department is not the first port of call.”

“A number of people have said to me over the last year ‘has it set back the reform plan for the health service?’ but I actually think it’s strengthened it hugely. It’s given the system confidence to be able to make changes, and do them, and not having to design them to the nth degree.”