This is another of my now regular updates for members on the COVID-19 emergency situation as it relates to the work of your organisation and to charities, community and voluntary organisations, and social enterprises in general.
From our special survey of members last week we know that the current crisis is impacting many members in relation to uncertainty about 1) any statutory income members may have, and 2) a general collapse in fundraising and earned income from trading. Many members are looking at making very difficult decisions in relation to their ability to keep staff on payroll in the light of this uncertainty. They are also experiencing continued uncertainty about whether they will qualify for the very welcome Wage Subsidy Scheme and, if they do, whether this scheme will substantially address their many concerns.
I have some important updates for you relating to these matters below. Further updates can be found on the dedicated COVID-19 section of our website.
If you are in the category defined by 3 (c) above, please email email@example.com with the following information as soon as possible:
I would like to thank you for all of the work that your organisation is doing for the public good, both here and internationally, in these times of crisis. We at The Wheel are working tirelessly to ensure that our vibrant and unique community and voluntary sector can continue to play its very important role in helping people during this emergency, and remaining healthy and strong in order to play a leading role in what we all know needs to be done once this is all over.
Please contact Ivan Cooper (firstname.lastname@example.org) or myself about any of the matters in this email, or just generally. We are very much in listening mode with our members. Remember to link to our website for our latest updates and resources.
Deirdre Garvey, Chief Executive Officer | The Wheel
The Dept of Health has published an Ethical Framework for Decision Making in a Pandemic. This high-level framework is intended for policymakers and healthcare planners and providers in acute and community settings. It is also designed to assist clinicians in implementing the ethical principles set out in the framework in their clinical practice.
It is not designed to guide individual clinical decisions but to assist healthcare workers in thinking through the difficult decisions that will need to be made. The Framework was developed by an Ethics Sub Group of the National Public Health Emergency Team (NPHET) and involved clinical, ethical, legal and public interest representatives. Sage Advocacy participated in the work of the group.
The Ethical Framework states that “Decisions should be principally based on the health-related benefits of allocation mechanisms. Thus, the starting point for any rationing decision is to consider which patients are most likely to benefit from the intervention. Consideration of the patient’s premorbid health status, their will and preferences (if known), the presence of co-morbidities and their frailty status (independent of age) are all relevant in this context”
On Friday evening, An Taoiseach Leo Varadkar announced new emergency measures to curb the spread of COVID-19 in our communities. These measures include restrictions to the movement of non-essential workers and ‘cocooning’ for the most vulnerable people in society.
In parallel with this, the government announced a series of supports that will be rolled out across the country to support those most affected. Among these supports is COVID-19 Community Outreach (CCO), which will be coordinated by The Wheel and Irish Rural Link, and funded by the Department of Rural and Community Development.
CCO will link and support the work of community and voluntary organisations across Ireland who are responding to meet the needs of communities during the COVID-19 crisis.
We have already deployed a Community Champion in each of the 26 counties. As members of your local authority’s COVID-19 forum, the Community Champions will play a key role in coordinating local community supports.
Our champions have strong links within their local areas, existing experience of engaging with community organisations and volunteers, and are already in contact with the people that the programme ultimately seeks to support.
If your organisation is currently supporting vulnerable people in the community, or if you are planning to do so, we urge you to contact your local Community Champion as soon as possible.
Visit www.wheel.ie/covid-19-community-outreach for your local Community Champion’s details.
Let’s connect and make sure nobody gets left behind.
Deirdre Garvey | CEO of The Wheel
‘That 60,000 people answered Ireland’s call and signed up to support the health services in the face of the biggest public health emergency since 1918 is a triumph of solidarity’ according to Sage Advocacy.
Executive Director, Mervyn Taylor, described the HSE’s ‘On Call for Ireland’ as a great national resource but he said that people signing up for it needed to be used wherever the need is greatest. ‘This includes not only acute hospitals but also congregated settings such as nursing homes as well as in people’s homes’.
‘The reports we are getting from our staff and our network of volunteers and supporters around the country is that, with a few exceptions, most people who should not be in acute hospitals have either been transferred to nursing homes, or have returned to their own homes with support. However, we are concerned that the necessary level of nursing staff in nursing homes to deal with outbreaks of Covid-19 may not be sufficient. We are also seeing shortfalls in home care arising from increased hospital discharges to the community and the closure of day centres, reports of home support services being withdrawn in worrying situations, as well as home supports being refused by older people for fear of becoming infected with Covid-19’ Mervyn Taylor said.
Identifying a need for maximum flexibility and the best use of available health and social care resources, Mervyn Taylor asked that the healthcare needs of residents in nursing homes, many of whom are extremely vulnerable, be given as much consideration as the needs of people in acute hospitals. ‘There is an impression out there that because they are called nursing homes they are largely staffed with nurses.
This is not the case’ he said. ‘There is an urgent need to look at the levels of nursing staff with relevant skills to help nursing homes meet the challenges of this public health emergency. The consequences of understaffed nursing homes facing outbreaks of Covid-19 are grave’ he said. ‘We now have a great national resource through ‘On Call for Ireland’. Let’s use it to focus on wherever the needs are regardless of whether or not the current provider is public, private of voluntary’ Mervyn Taylor concluded.
For more information contact: Mervyn Taylor. Executive Director. 086 8227998
Health Bill 2020
(Preservation and Protection and other Emergency Measures in the Public Interest) (2020 Bill)
Safeguarding Ireland understands that it is necessary to have legislation to make exceptional provision, in the public interest, to control the spread of the Covid-19 virus but in doing so it is necessary to ensure that actions do not allow for abusive practices to be visited on the most vulnerable.
It is proposed in Section 38A(7) of the 2020 Bill to incorporate some of the provision contained in Section 38 of the Health Act 1947.
Section 38(2) provides that where an order is made to detain a person certain information and documentation is given to an ‘appropriate person’ and Section 38(3)(c) provides that ‘where the patient, being an adult person, is for any reason unable to act for himself – the person for the time being in charge of the patient’ shall be the appropriate person. This provision is not at all appropriate in 2020.
The legislation must provide that were a person lacks capacity, or whose capacity is in question or who needs support to understand the implication of such an order being made to detain him or her must have access to an Independent Advocate.
This will ensure that fair procedures are followed and in the event of the need to exercise the right of appeal against the order as provided for in Section 38A (5) of the 2020 Bill, and to ensure that a review does take place as necessary that the voice of the person is heard.
A person in charge of a place of detention is likely to be conflicted in such circumstances and certainly would not be in a position to act independently for the benefit of the person being detained.
Safeguarding Ireland also has a concern about the very wide powers being given to a ‘medical officer of health’ and requests that clear safeguards are set out in the legislation as to oversight in this regard.
Ronan Cavanagh, Safeguarding Ireland / Cavanagh Communications: (086) 317 9731.
Safeguarding Ireland in an independent agency to promote safeguarding of adults who may be vulnerable, protect them from all forms of abuse by persons, organisations and institutions and develop a national plan for promoting their welfare. www.safeguardingireland.org
Cavanagh Communications I OfficePod 18, 6-7 Marine Road, Dun Laoghaire, Co. Dublin, Ireland. A96 R2N4.
Urgent new public health legislation called the Health (Preservation and Protection and other Emergency Measures in the Public Interest) Bill 2020 has been approved by the Cabinet and is awaiting process through the Oireachtas. Sage Advocacy believes that, though necessary, this legislation requires close scrutiny, more checks and balances and a ‘sunset clause’ so that it lapses at the end of the current public health emergency. Any such future legislation can then be subject to further scrutiny by the Justice and the Health Committees of the Oireachtas.
Executive Director of Sage Advocacy, Mervyn Taylor, has expressed concern regarding Section 38A which gives a medical officer of health considerable powers with regard to the detention of people who are considered a potential source of infection or are a potential risk to public health. ‘A key passage states that a medical officer of health who makes an order (under subsection (1)) shall ensure that a medical examination of the person who is the subject of the order is carried out as soon as possible and in any event no later than 14 days from the time the person has been detained. This has the potential to provide cover for vulnerable older people, in particular, to be placed in congregated care settings for reasons of convenience rather than simply public health’ he said.
‘Clearly, in an emergency the preservation of life must occur so that liberty can later be exercised. However, as the Court of Appeal made clear in another context (AC vs CUH case) the power to detain will “doubtless be for good clinical reasons. In other instances, however, this decision could be simply for reasons of convenience and, perhaps in a small minority of cases, for even less noble motives”.’ Mr Taylor added that ‘The ruling of the Appeal Court and the subsequent ruling of the Supreme Court point to the need for legislation for the Protection of Liberty in Places of Care. This, we understand, was under consideration by the Dept of Health before this current emergency arose’.
‘Sage Advocacy, as a support and advocacy service for vulnerable adults, older people and healthcare patients, is all too aware of how vulnerable some people currently are and of how the approaching public health crisis is likely to effect our clients; not to mention our staff, our volunteers and their families. Many of our volunteers have a background in health and social care and some of them are already helping out the national health effort behind the scenes.
Mr Taylor said that ‘Sage Advocacy recognises the gravity of the current situation but we ask legislators and their advisers to consider the following:
Sage Advocacy is already aware of people who have been detained in hospitals – people who in some circumstances could be living at home with supports rather than occupying a valuable hospital bed. By all means legislate but equally SCRUTINISE the legislation and put some checks and balances in place for the future’ he concluded.
For more information contact:
Mervyn Taylor. Executive Director. 086 8227998
12th March 2020
Sage Advocacy will continue to operate and support clients, family members and service providers wherever possible during the C-19 public health emergency. Our National Office will operate on a 'virtual' basis (from home by phone and internet ) from Friday 13th and every effort will be made to maintain our Information and Support / Rapid Response Service. The service can be contacted on 1850 719 400 between 8:00 and 22:00 and on 01 5367330 between 9:00 and 18:00 on the mainline.
There are increasing difficulties in gaining access to some clients in congregated care settings such as nursing homes and hospitals. Sage Advocacy has written to Nursing Homes Ireland expressing understanding of the need for visiting restrictions but requesting that they remain aware of the right of residents to access independent advocacy; particularly with regard to planning ahead and putting affairs in order. Read the letter here.
During this time of unprecedented national challenge Sage Advocacy asks everyone to be alert to the needs of vulnerable adults, older people and healthcare patients with underlying conditions. A time of crisis is always a time of opportunity for the strong and powerful to abuse and exploit the weak and vulnerable.
Sage Advocacy will work closely with the HSE and NGOs, such as ALONE, whose work complements our own work and we would ask all our volunteers, former volunteers and supporters to remain in contact with us as new needs are identified that will require innovative responses.
Ar scáth a chéile a mhairimíd.