The safety of care home residents across Northern Ireland cannot be guaranteed, the Commissioner for Older People has said.
Eddie Lynch has said he has not been reassured by health officials that failings that led to abuse and neglect of residents at Dunmurry Manor, which has since been renamed Oak Tree Manor, cannot be repeated.
It comes more than 18-months after he published his damning report into conditions at the disgraced care home.
Mr Lynch has now completed his Home Truths investigation and has given his assessment on the responses he has received from the Department of Health, Regulation and Quality Improvement Authority (RQIA), health trusts and Runwood Homes, the firm that owns Oak Tree Manor.
He has expressed frustration at the lack of action to address “flaws” in the system, which he said are putting some of the most vulnerable people in society at risk of inhumane and degrading treatment.
“A number of the responses do not provide the assurances needed that action has been taken to ensure that the failures that occurred in Dunmurry Manor Care Home cannot be repeated,” said Mr Lynch.
“We are on a journey and there are a lot of care homes doing a good job, but we don’t have a system where we want to be, where we can make sure that vulnerable people are protected 24 hours a day, seven days a week, 365 days a year.”
He said he has been told that the absence of a health minister has hampered progress in implementing changes that will make care homes safer places to live.
Health Minister Robin Swann acknowledged the commissioner's frustrations and agreed more needed to be done to rebuild public confidence in the system. He said work on reform had been taken forward and that had to be "translated into action".
“As Minister, I want to extend my apologies to residents and families for the failings at Dunmurry Manor. I also apologise for the fact there has been no Assembly in place to bring forward legislative change. With devolution restored, the Executive and the Assembly can now right this wrong," Mr Swann said.
“The reforms I want to see can only be successfully implemented by working closely with all stakeholders, including the Commissioner for Older People and Dunmurry Manor families.”
Mr Lynch said that now the Executive has been restored, work must be carried out urgently to ensure that an Adult Safeguarding Bill is introduced.
He welcomed an acceptance from authorities that “significant flaws” exist in the current safeguarding system.
However, he continued: “Northern Ireland remains the only part of the UK where older people do not have adequate law to protect them.”
Mr Lynch also said measures must be put in place to introduce stronger financial penalties for care homes that do not meet basic standards.
Under current legislation, health trusts can withhold 20% of payments for poor performance, but this has never happened.
In fact, trusts have continued to pay failing care homes millions of pounds for services, while also sending in NHS staff to raise standards.
Mr Lynch is also calling for a ratings system to make it easier for the public to establish which homes are meeting minimum standards.
He also wants authorities to take swifter action when homes do not address concerns and has urged them to take action to ensure this happens.
In the case of Dunmurry Manor, failure to comply notices were issued by the RQIA in October 2016 and remained in place for nine months before concerns were adequately addressed.
He also said it is imperative that changes to the complaint system are introduced as it is not acceptable that relatives are expected to repeatedly raise concerns.
“The experience of the families of residents remains the strongest advocacy for the needs of their relatives and many families continue to be tenacious, resolute, and compassionate in demanding the appropriate levels of care for their relatives living in care home settings,” he said.
“However, as admirable as this is, it simply should not require such persistence to secure adequate care for older people in need.”
Mr Lynch also called on the RQIA, Northern Ireland’s health watchdog, to provide further assurances “that it accepts the flaws in the current regulatory system and that it is fully committed to implementing the relevant recommendations”.
As part of this, he said there should be a requirement for care home managers to provide the RQIA with an exit statement when they leave their post.
Mr Lynch said these should be confidential and not provided to the employer, and would alert the watchdog to potential issues in a home and enable them to carry out inspections where appropriate.
He continued: “The recommendations outlined in Home Truths aimed to address the serious and systemic failures that had permitted inhuman and degrading treatment of older people.
“My recommendations called for reforms that, if implemented, would ensure that families with concerns about any aspect of care would feel empowered to raise their concerns in a responsive and sympathetic environment.
“They also called for changes to how the workforce in care settings are supported so that they can better provide the high-level care that older people deserve.
“I am pleased that the majority of my recommendations have been accepted.
“However, while commitments on paper are welcome, I will only be satisfied that lessons have been learned and solutions put in place once there is evidence that changes have been implemented and been effective on the ground.
“I understand that it takes time to bring about changes to legislation, policy and practice but I remain frustrated with the pace of change in many areas where my investigation found flaws in the system.”
The Home Truths report, which was published in June 2018, raised serious concerns over the way Dunmurry Manor was managed and highlighted harrowing conditions, including residents going weeks without medication or being left with horrific bed sores, resident on resident sex abuse and shocking weight loss of residents.
It emerged that health trust officials had concerns that the conditions at the home amounted to institutional abuse.
Responding to the update provided by Mr Lynch, a spokeswoman from Runwood Homes said the company “immediately and efficiently addressed all of the applicable recommendations highlighted by the Commissioner following the Home Truths report published in June 2018, and provided responses and evidence required, as was assured, by October 2018”.
She continued: “We are pleased that the Commissioner’s consideration report states that our actions to improve the Dunmurry service were deemed adequate, providing all parties with the confidence that all recommendations were critically tended to.
“Operational management at Runwood Homes continues to firmly monitor and review all services in order to further develop and proactively improve overall performance, for the benefit of service users as well as staff; meeting people’s individual needs and wishes in a dignified, kind and respectful manner at all times.
“The core of our organisation is to provide good quality care, 24 hours a day, in a comfortable and safe setting, and we are committed to evidencing our high quality care delivery throughout all of our residential care and nursing homes.”
Health Minister Robin Swann added: “The independent review of the Dunmurry Manor case commissioned by the department will produce an in-depth report on safeguarding very shortly.
“Overall, I want to see a far-reaching programme of change to improve the quality of nursing and residential homes and treatment of older people in Northern Ireland.
“This programme of change must encompass the commissioning of care, the routes by which older people are admitted to nursing and residential homes, the delivery of care by providers, and the workforce issues associated with care homes.
“It is right that systems designed to protect patients and improve the quality of care are continuously reviewed. Practices concerning adult safeguarding, complaints, the regulation of nursing and residential homes, their inspection and the ways in which we ensure public confidence must all be strengthened.
“I also believe the public are entitled to see care home owners and operators held to account when they provide sub-standard care.”