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Dáil Éireann debate -
Thursday, 2 Apr 2020

Vol. 992 No. 5

Covid-19 (Health): Statements

Ordinarily, I welcome any opportunity to update the House but today I cannot do so. We are living in extraordinary times and what we ordinarily do is no longer a choice we can freely make.

On this day, World Autism Day, I think in particular of those who most depend on routine in their lives now finding a way to cope with their families in what are very strange and difficult days as they seek to play their part in this national public health emergency. I think of the people who are at home and adjusting to a very different way of living. Like them, I believe democratic accountability can operate at a distance and that there is no reason it cannot do so effectively. Other parliaments around the world are doing so. Yesterday, many members of the Opposition again questioned the HSE remotely at a briefing. Many of them will rightly question the Taoiseach and me in the same way later this afternoon. I will not dwell any longer on this issue. Days in which we do not lead by example are days we should regret.

I express my condolences to the family and friends of all those whose lives have been tragically taken by this terrible virus. It does not just steal lives, it steals from us the very cherished ways in which we grieve. Twenty-two days ago, there was the first death from Covid-19 in Ireland. As of last night, 85 men and women in Ireland had lost their lives to the virus. This should give us a singular focus. We must protect the most vulnerable members of our society.

Earlier this week, the Government moved to strengthen support to people in nursing homes and other long-term residential care settings and people working in or depending on home care. I have reached out to organisations which represent other vulnerable groups, including those living with cancer, addiction or poverty. We are all affected by this crisis but some are more affected and vulnerable than others. Our watchword must be that no one will be left behind. This national effort must be driven by our instinct to look after each other. That is what we wish to do as Irish people and it is how we will prevail. We can all help to protect our loved ones, families, colleagues, friends and neighbours. Many of the ways in which we usually show our love and support are currently closed to us, but we must open an opportunity to make a real difference. The Irish people are already making that difference. When the HSE first started to trace the contacts of confirmed cases of Covid-19, those infected had been in contact with approximately 20 other people. Two weeks ago, that number had reduced to ten. One week ago, it had reduced to five and, today, it stands at just three. The truth is that the number of cases will continue to rise.

It is also true to say the rate of growth in new cases has gone from 33% to 10%. Let us be clear that this is still too high but we are showing, as a people, that we can do this and we can do more. We can see already some of the impacts of the measures the Taoiseach announced on 13 March and on 24 March but we have not seen the full impact of same and it is too soon to see any of the impacts of the extremely difficult and restrictive measures we announced last Friday. The message people need to hear is that they are already making a difference and if we all redouble our efforts, we can lower the growth rate more and save more lives.

I want to send a clear message to the Irish people and the Chief Medical Officer believes this and states same clearly. There is no doubt that through the countless efforts of so many people, lives have been already saved in our country. The work people are doing by sitting at home today, not going into work, having the children off school, restricting their movements, washing their hands well and practising good cough etiquette is saving lives. Lives have been saved already and we can do more. Our Chief Medical Officer is clearly telling us the number of cases is far fewer than it would have been in an unmitigated epidemic but this should not in any way confuse any of us about what we need to do because there can be no occasion for complacency. Rather, it is a call to arms to keep at it, to do even more if possible, to stay the course and to stay at home.

We all have to help our health service in planning for what lies ahead. Our health service staff are making huge personal sacrifices in the face of this virus, along with many other workers on the front line. I know the House will want to join me in again paying tribute to our health service personnel, including our doctors, nurses, ambulance personnel and paramedics, care workers, cleaners, porters, caterers, medical scientists and all of those working on the front line response to Covid-19. I also pay tribute to those who are working on the front line in keeping our supply chains going, keeping us fed, keeping production going in our country and keeping vital public transport going to get workers to and from work.

I will update the House on some of the key actions being taken as we step up our efforts to contain the spread of the virus and mitigate the consequences across society and particularly in our health service. We are making sure we do everything humanly possible to prepare our acute hospital system to deal with the increased demand that undoubtedly will be placed on its capacity. Deputies will be aware that the City West facility is open. It is a self-isolation facility with 750 beds. There will be also 450 step-down beds at this facility and we are opening similar facilities in other locations across the country. The work the HSE did in securing this hotel and in putting in place this system so quickly is incredible. It had its first 16 patients check in last night.

This week, we also concluded an important agreement with our private hospitals, which will increase the capacity of the health service in Ireland by 17%. It provides us with an additional 2,000 hospital beds across 19 hospitals, including a further 47 ICU beds, more high-dependency beds and 194 more ventilators, which are crucial.

The HSE is engaging, on a daily basis, with domestic and international suppliers to secure additional ventilators to meet the anticipated surge in demand for same. Procurement of these and other essential supplies is an ongoing challenge for all health systems, given an unprecedented global demand. This is a global pandemic and every country is looking for the same products and supplies. Therefore, Ireland has decided to join with other member states in the European Union, as part of a centralised joint procurement of medical supplies. The European Commission is preparing contracts for each member state to distribute the supplies in the coming weeks.

I am conscious of the focus on testing, which is understandable but I have to reiterate the advice of our public health experts. If one has symptoms, one should self-isolate for 14 days and members of one's household should do likewise. One does not need a test to follow this advice. Having a test does not affect one's need to self-isolate. The purpose of testing is for public health surveillance and tracking purposes. The test does not change one's treatment, which should and will be based on the advice of one's GP. As Members know, the national public health emergency team, chaired by the Chief Medical Officer, recently recommended a change to the case definition being used to identify people suspected of having Covid-19. This decision was based on a need to more carefully target our testing regime to ensure we are testing those who are most vulnerable and to help prioritise the testing of our healthcare workers. This has been somewhat effective as we are seeing the rate of those testing positive increase from 6% to 15%. In other words, we are having a more targeted approach and we are finding the virus more often. While we have more than 40 testing centres in the community, in recent days it is clear that testing capacity has been constrained due to a number of challenges. These are challenges we have in common with every other country and which the HSE is working hard to address.

It is really important to stress that we are still testing more than most other countries. At 6,000 tests per 1 million people in Ireland, we are near the very top of the league of countries in the amount of testing being done. However, we will ramp this up further. That is the right strategy.

The HSE has indicated that it now has sufficient test swabs and more orders will be delivered in coming days. The HSE is also making every effort to procure other stock including sourcing domestic production of reagents. It also plans to expand testing capacity. In addition to the national virus reference laboratory, 12 hospital laboratories are also now testing for Covid-19 with additional facilities due to come online. The expansion plan will also focus on increasing lab capacity in other settings. Plans for this expanded capacity are well developed and arrangements are being put in place with the Department of Agriculture, Food and the Marine for the use of its laboratory space. Current laboratory capacity stands at 1,500 samples per day but it remains our national aim and intention to expand to up to 15,000 tests. We will continue to provide regular updates to Members of this House and to the Irish people as these operational matters move further as well as to our wider work. I want to recognise in the House that a testing system that has to be sustainable, not just for today or tomorrow but also the weeks and months ahead, has been set up by the HSE in rapid time. It is true that there have been pinch points from time to time, but the HSE is working flat out to address them. These are challenges that are shared with other countries but I am happy that additional capacity is due to come on stream.

We have also moved to strengthen our support to nursing homes, other long-term residential care facilities and home support with focused actions to enhance the protection of staff and residents. These actions include infection prevention and control teams which can go into residential care settings and help to support the work of staff, prioritisation of staff in these settings for testing, active screening of all staff, including temperature checks twice a day, ensuring personal protective equipment is supplied to long-term residential care settings and home support providers and the development of a preparedness plan across the sector. The National Public Health Emergency Team, NPHET, has a specific subgroup on vulnerable people to provide oversight and assurance on the actions being taken to protect vulnerable groups and representatives from other agencies and voluntary providers of services to vulnerable people ensure that an integrated approach is now being taken. NPHET will meet again tomorrow when I expect it to receive a further update on the implementation of these new measures for long-term residential care settings. This is a very big public health issue which we must get right. Some of our oldest and most vulnerable residents are living in nursing homes and other residential settings. We must make sure that the safeguards are in place to protect them and also to ensure that we do not see the risk of infection spreading from there into the community.

Covid-19 continues to pose a very serious health threat in Ireland and across the world. This is a public health emergency. Our response to that emergency is being guided by the best international evidence and advice available. I thank my colleagues in the Government for the efforts being made in their Departments to support our efforts. I sincerely thank the Chief Medical Officer, who is back in work today and doing an incredible job on behalf of all of us and the country, and all his team working with him. I thank all Members of this House for a genuinely constructive approach and the support which has been shown by Members for the public health measures. We all know that this has not been easy but people are answering the call to help our country through this crisis. We have been overwhelmed by the offers of assistance, the voluntarism, the community spirit, that famous Irish meitheal. We thank the people who are coming to work on the front line despite the risks to themselves and, most importantly, we thank those who are staying at home to lessen the risks to those people and to everyone else.

We cannot stop this virus but we can slow its spread and we can flatten the curve. Phrases that were unfamiliar to us just weeks ago are now a national catch cry that unites us: flatten the curve. They are phrases that are now so over-familiar that we wish we could all stop saying them but we cannot: wash your hands, cover coughs and sneezes, keep your distance, stay apart, stay at home. Some day, they tell me, we will get back to normal life and I know we will. We also know that we will not get there unscathed. On that day, when we look back, we will look back at what we did and I hope that we can say that we did our damnedest for our country but, most importantly, for each other.

I am sharing time with Deputy MacSharry. I begin by expressing my deepest sympathies with the families and friends of those who have passed away already because of Covid-19. Losing the people we love is always difficult but losing them in these circumstances, where there are restrictions on hospital visits, on funerals and on the ability of people to come together to help each other through that loss makes it an awful lot harder.

I join the Minister in expressing my deep gratitude to those who are on the front lines and are putting themselves at risk to keep the rest of us safe. They include healthcare professionals in our hospitals and communities. They also include a group of women and men who are spoken about less, but who are also very much on the front lines. In our healthcare facilities they include cooks, porters, administrators, cleaners and everybody else who is working to help healthcare professionals. They include home care and nursing home workers who go out every day out to directly support those who are the most vulnerable to Covid-19. Many do so despite being on very low wages, without medical training and, right now, without personal protective equipment.

The HSE, the Department of Health and the Government are working flat out on Covid-19 and some things are working well, including the opening up of private hospitals, testing centres, step-down facilities and more. I acknowledge that good work. We are struggling in other areas and I want to use my time to highlight two such areas.

The first is the need for much more urgent support for home care workers. The lack of personal protective equipment, training and support for them is very concerning. Yesterday, a home care worker in Dublin tested positive. She sees approximately ten elderly people every day, and every day those people change. She could see 50 elderly people each week. She lives with eight other home care workers who also see about ten people per day. It is entirely possible, given that 50% of transmissions occur when people are asymptomatic, that this healthcare worker, unbeknownst to her, may have infected some of the vulnerable people she looks after. It is also entirely possible that the other home care workers with whom she lives have now been infected and have done the same thing. The HSE told us yesterday that as of yet no personal protective equipment is being provided to home care workers. We know they are not getting medical training and I strongly urge the Government to move on this more quickly. We know resources are tight, but this seems like an area where very bad things could happen very quickly.

The second area I want to talk about is more support for nursing homes. I listened carefully to what the Minister said. I am not trying to criticise him, but yesterday we had a detailed briefing with the HSE and the level of supports and actions which the Minister outlined in his speech do not marry with what the HSE told us is actually happening. Yesterday, I was told that in one nursing home 70 of its 200 staff have tested positive. At the time I received this information, I was also told that 19 of the 100 residents had tested positive and four had passed away. In addition, three of the home's kitchen staff and several cleaning staff have gone. It does not know where it can get help, given that no agency staff are available. I imagine every Member in the House has been contacted with similar stories. The Minister will be aware of these cases. The situation is very serious. Nursing homes cannot get the staff they need, particularly in areas where additional skills, such as palliative care, are required. They cannot get their hands on personal protective equipment. They are receiving small amounts but that is not enough.

I know the HSE is trying to deploy its staff to try to plug some of these gaps, but much more is needed. We support the decision to deploy vast sums of money to build capacity in our healthcare system. However, it does not seem right that we would spend all of that money getting our healthcare system right so that when people get sick they can be helped without making the same efforts and investments for vulnerable people, home care and nursing homes in order to stop people getting sick in the first place. There needs to be urgent movement on that.

I would like to raise many more issues, but we are short of time. Perhaps the Minister and I could pick up the questions I have raised, which have come from nurses, doctors, scientists and families. Why are only 1,500 tests a day being done? Why are healthcare workers waiting so long for test results to allow them to get back to work? Why is Ireland running out of reagent when we have such a large chemical industry here? Why are clinicians still being told not to wear masks at work when many working in hospitals feel they should?

Why is the modelling work on projected cases being withheld from the public? Why is it not being made public? Why are private consultants being brought into the HSE temporarily being paid more than some of the HSE consultants? Why is the HSE not able to say yet how many cases it feels it will be able to handle on a given day.

I offer my condolences to all the families who have lost a loved one in recent times and I pay tribute to all our frontline workers, predominantly in the healthcare area but also those manning our supermarkets and all essential services throughout the country. They are heroes all. I congratulate the Minister for Health and the Government on their work so far, and the efforts they and all the officials are putting in, and every Member of this House because there is a non-partisan approach and full support for the measures being taken, notwithstanding that anomalies have arisen. I can appreciate fully the phrase coined in recent weeks that speed trumps perfection in many of these issues but as anomalies are coming up they need to be highlighted. One such anomaly is that GPs, their staff and surgeries are not being prioritised in the 24 hour turnaround for testing. They need to be included in that 24 hour turnaround, whether they are secretarial assistants manning the reception, nurses in the practice or the GPs themselves because they pose a risk. While the clinical hubs where GPs can refer people are a good initiative to keep Covid-19 away from GP practices, this measure will be required while normal GP services resume. The PPE issue for care workers travelling to homes and nursing homes and those being cared for at home is a requirement. While I appreciate that good advances have been made recently with flights from China, I learnt that on Monday fewer of those flights took place than should have done due to some visa issue. I hope we are liaising with the Chinese authorities to ensure that does not happen again.

I know these statements are on health but I want to mention some anomalies on the payment of social welfare. I am sure the Minister for Health will not mind passing them on to the Minister for Employment Affairs and Social Protection. I represent a Border county. Those people who live in the North of Ireland and work in the South and pay all their tax here do not qualify for the Covid-19 payment. I am aware that under EU regulations a person claims in the state in which he or she resides but that payment is substantially higher here than in the North. The converse is that those who live in the South but work in the North are entitled to the full payment here even though they pay their tax to the Queen. We need to examine that because it is not fair. People aged over 66 years who are self-employed are not entitled to the €350 payment because they are in receipt of something that is deemed to be a primary social welfare payment, the contributory pension of €248 a week. The Minister needs to consider paying the difference between those sums. Another problem is that people who choose to work part time for lifestyle reasons are entitled to the full €350 per week but people who are on half-carer's allowance to care for a loved one at home and are working part time as substitute teachers are not entitled to the Covid-19 payment. They are some of the anomalies I am coming across and which I would appreciate the Minister's taking on board.

In a broader economic sense, I am sure we in this House are agreed that some sort of a Marshall Plan will be required to kick off the economy. While I appreciate that the Marshall Plan was not being drawn during the D-Day landings, we must have a team of people who begin to focus on that. On a Europe-wide basis we will have to find a mechanism to set aside or warehouse the vast cost associated with fighting this nationally and Europe wide because all countries are in the same boat. This country cannot have another period of austerity to pay the bill for this. We are all agreed that whatever it costs it must be paid but we must find a way to set it aside, warehouse the cost to ensure we invest in the economy to get everybody back to work and get the economy moving again.

I will try to be as brief as I can. I offer my sincere heartfelt condolences to any person who has been bereaved as a result of this virus. I wish a fast and full recovery to those who are ill with the virus at home or in hospital. I would like to ask a number of questions about the situation as it stands, particularly on behalf of medical professionals and the medical and scientific community. Some of my questions have arisen in my constituency office and in the offices of my colleagues.

We have an opportunity today to put to bed some of the myths that have been circulating. Some elderly people in my constituency are at home and do not want to let anyone into their houses. They are normally visited by home help personnel. They are very anxious. I am not talking about people who do not need home help. They need these services, but they do not want to have people coming into their houses. That is why it is absolutely vital that we can make a statement here today with regard to the personal protective equipment, PPE, that can and should be provided to home help workers. Such a statement would put at ease the minds of constituents who need home help but are very anxious about allowing people into their houses. Of course they are very worried. They are doing what they should be doing. They are cocooning and trying to stay away from contact, but they need their home help. They need to hear from the Minister that PPE will be provided and that their home help providers will be able to visit, where appropriate, in a safe way.

I know that home help is going to be curtailed. We spoke about this yesterday. In light of the many debates we have had in this Chamber about the home help waiting list, the Minister will be aware of how much people value the home help service. We need to hear directly from the Minister about what will replace the services that are curtailed. We need to talk directly to people watching at home who need home help and have home help assigned to them. Many home help workers want to be able to do their work but they need the PPE to be able to do so. At this point in the proceedings, every worker in the health service is on the front line. There is no such thing as a non-front-line worker now. There is no differentiation between grades. Every single person in our health service is on the front line and every single person who is on the front line needs to have the PPE to do his or her job.

It has become evident in recent days that a lack of the reagent used in the Covid-19 testing process has led to significant delays for patients who are waiting to receive test results. As a result, the number of people being tested each day has been significantly lower than the number that was previously planned or announced. An international shortage of the extraction material used in the testing process is causing significant disruption to Covid-19 testing here and elsewhere. This is a global issue. As this crisis grows day on day, the international demand for this material will grow with it. This will put further pressure on the testing regime here. Dr. Cillian de Gascun has said that the extraction material used to extract the viral RNA in the testing process is proprietary, which means that strict patent laws govern who can and cannot manufacture it. The lack of this material is now causing delays here.

At what stage are the Government's engagements with the pharmaceutical companies that are located in this country regarding the development of test kits for domestic use here? It is clear that the international market cannot meet the demand that is going to be required. All options, including the compulsory licensing of intellectual property, should be considered in an effort to maximise production. We have a world-renowned and long-established pharmaceutical sector. The operation in this country of the top ten pharmaceutical companies needs to be utilised fully. Given that we have thousands of highly skilled workers in this sector, there is no reason we should not be able to manufacture test kits and materials here. We cannot sit back and hope the international market will deliver, because it will not do so in these circumstances. My colleague, an Teachta O'Rourke, and I have drafted some suggestions in this regard. As Deputy O'Rourke is a medical scientist, he has much more expertise in this area than I do. We have drafted a proposal and sent it to the Minister. Our aim is to be constructive. We must all make this effort together.

I know the Minister and the HSE have been working very hard to source additional PPE supplies from China and other countries. We have heard from Mr. Paul Reid that other large states with deep pockets are active in the market and thereby pushing up the prices. New supplies have been arriving, as we have seen, and more supplies will come. That is welcome, but we must ensure we have a continuous supply of domestically produced PPE, which is absolutely vital. I reiterate that there is no grade, group or category of worker in the health service that we cannot call a front-line grade, group or category. Every front-line worker needs the PPE to do his or her job. This is going to be absolutely vital.

What is the situation with regard to the refocusing of domestic capacity and manufacturing? What stage is the Government at in engaging with the domestic manufacturing sector? How much PPE can be produced here? When can it be produced? How soon can we get it out to people? People are asking these questions and they need to know that this is being worked on, that there is a realistic timeframe and when that equipment is going to arrive. On the matter of accommodation for front-line healthcare workers who have found themselves without somewhere to live due to the Covid-19 crisis, I note that there have been discussions with hoteliers and bed and breakfast owners. I heard yesterday that a list of available accommodation would be circulated. That is welcome but that list needs to be updated. I have had cases come to me of people who have lost a place to live simply because they are working on the front line. They have housemates who may be vulnerable. Nobody, and certainly not anyone on the front line in this crisis, should find themselves homeless or without any form of accommodation. That list needs to be published and made known to all healthcare workers.

Will the Minister elaborate on the public-private hospital agreement? How did he arrive at the decision to pay consultants from the private hospital network more than existing HSE consultants, namely, those who are new entrants? This is an issue that will cause unnecessary distress. Not much of the agreement has been made public but one of the stand-out details that we have seen is causing concern. It is unfair to perpetuate pay inequality in this new agreement. It is not fair to the people whom we are asking to go out and do a tremendous job in the coming weeks. Moreover, I ask for details of how much this will cost. I know that when the Taoiseach spoke about it, he was very clear in saying that we do not know how much it will cost because we do not know how long it will go on for. That is grand but there is a daily rate. We may not know how many days it will take but we certainly should know how much it will cost per bed or per hospital. There is no commercial sensitivity at play here because it is all public now, as the Minister told me. We really should know what this will cost.

The nursing home sector has come to the fore in recent weeks. There are a number of clusters of the virus in nursing homes. I know the HSE and medical professionals are doing sterling work to try to stop the spread and treat people as well as they can. I ask the Minister to do two things. The first is to make sure that staff working in nursing homes have the necessary PPE. Will he also ensure that they have the necessary staff? We all saw the call to be on call for Ireland and people have responded. On call for Ireland means being where one is needed, whether in a nursing home, in the community, in an administrative role or in a field hospital, step-down facility or clinical hub. On call for Ireland means being where one is needed. Our nursing homes absolutely need a steady supply of staff to keep the residents safe. We all know that staff in nursing homes are contracting this virus and have to take time off, but the residents still need to be cared for.

Will the Minister look into the situation relating to student nurses? I was contacted by a nurse the other night who has lost her SUSI grant because she volunteered to work on the front line and is no longer eligible for the grant. I fully appreciate that this is an anomaly and an unintended consequence, but it needs to be addressed. We cannot have people who sign up to work finding themselves in a situation where they are losing money. Likewise, student radiographers and other students who are signing up to go to the front line are finding themselves in a situation where they are either not being paid or they are losing money.

The situation regarding those who are in receipt of medicinal cannabis needs to be clarified. I think the Minister has some information about that and I know that work was done on it, but that needs to be shared with us.

I have tried to be constructive in my questions to the Minister. We have tried to be constructive at every step of the way. I have offered solutions and suggestions. The Minister has our support in the efforts that are being made, but we need to get some answers on the public record. Every healthcare worker is on the front line now. There are no grades, groups or categories. We also have to thank those who work in supply chains and keep them going and the men and women working in administration in the background. All those people are going beyond. We have been inundated with requests for information. People want to know what is going on, what the plan is, where they stand and what will happen to them. This is our opportunity to put the facts into the public domain.

There are many myths and the Oireachtas must ensure it can counter them. I have tried not just to pose questions today but also to offer some solutions and ensure we remain open in our dialogue and frank with people. We must put out all the available information. I ask the Minister to examine the issues around testing and consider Sinn Féin's proposal. We will work with him to ensure we can get those tests. Testing is key, as the World Health Organization has stated. All the medical and science communities have indicated we must test, test and test again and trace and isolate but we must test first. As I indicated, we made a proposal in that regard and I hope the Minister will have time to consider it.

I join other Deputies in offering condolences to all the bereaved families and giving our full support to front-line workers. I will speak to a couple of other matters that may not have been addressed.

As the emergency rolls on and people live the pattern of the new normal, we are aware that despite the creativity and humour engendered by social distancing, this pandemic has the potential to take a toll on our collective psyche, mental health, well-being and resilience. The pressure keg of self-isolation and partial lockdown on the average household can be immense. We can add to the mix women and families experiencing domestic violence, Travellers on halting sites and people who are homeless or simply alone, with nobody to talk to, or in a vulnerable age category. I reiterate the calls from my colleague, Deputy Roderic O'Gorman, for increased resourcing of domestic violence services like Women's Aid, the rape crisis centres and other women's refuges. I welcome the announcement from An Garda Síochána yesterday that its members will place a specific focus on families and individuals living with domestic violence in this period.

With regard to those in the trenches on the front line of this battle, we cannot imagine the incredible strain that people feel with the daily intake of those who have fallen to the coronavirus. They know that they are also at high risk of infection and they may face the prospect of going home and not being able to hug their loved ones. It is important that a full complement of supports is in place across our health system so that staff can be debriefed as they come off shifts and they can have access to online counselling, peer support and other support services if required. I ask that all staff working in our hospital settings, as well as those in section 39 providers, nursing homes and other settings, be included in this. It is my understanding that access to such services is very limited when we consider that healthcare workers are trying to manage childminding, home schooling and the maintenance of their own family's health through this crisis.

Occupational health departments are completely immersed in logging, reporting and directing towards isolation staff who are displaying symptoms of Covid-19. Previously offered counselling and support services are not accessible. A dedicated service that is accessible 24-7 is vital to the mental health of workers. There are workers on other front lines. These are in retail, pharmacies, delivery and postal services, and I appeal for employers to ensure they check in on staff regularly, with procedures put in place to keep staff safe, as they are dealing with very worried or distressed people.

My colleague, Councillor Maria Dollard, wrote to the Minister for Health, Deputy Harris, earlier this week about the plight of section 39 care providers and nursing homes. We note with concern the emergence of clusters of Covid-19 in such settings and I appeal to the Minister to ensure all services for people with disabilities, including intellectual disabilities, older people and other care settings, both day and residential, are afforded the same access to personal protective equipment and hand sanitation facilities as those in the public system.

There are anomalies in pay parity between section 38 and section 39 providers and this must be addressed as a matter of urgency, as must the differential in cost of care between public and private nursing homes. Section 39 providers have been left high and dry by successive Governments through pay inequality and funding cuts. This position has been made more acute by the imposition of efficiency measures in recent years that have left them at a point where they are begging for basic supplies of PPE. These organisations nonetheless provide an exceptional level of care beyond a basic social care model for service users.

I have some final points, with the first concerning bereavement support. Families grieving loss of a loved one caused by Covid-19 or an unrelated cause of death are being dealt the double blow of not being in a position to properly come to terms with their loss. It is often said that the Irish way of saying goodbye is, culturally, among the most empathetic and comforting in the world. Families are being denied that comfort due to the necessary restrictions imposed on funeral services for the duration of the health phase of this crisis. For many, that denial delays or holds back the grieving process, including the ability to come to terms with or celebrate the life of a loved one. I am sure there are similar services as the example in my constituency, Kilkenny Bereavement Support, which is giving voice to those who are silently grieving. Ours is an exceptionally professional but entirely voluntary service and it is important that bereavement support, counselling, suicide prevention and mental health charitable services are supported by the State at a time when the opportunity for voluntary fundraising has largely dried up.

Finally, I ask for some clarity from the HSE and the Government on the use of masks by the general population as a means of reducing infection. Several weeks ago a group of people in Kilkenny began making homemade masks from simple materials according to a template found online. The HSE issued a statement saying that masks are not effective in reducing infection, yet evidence from Thailand and Vietnam, where they are probably more culturally acceptable, has shown that masks did have an impact. Masks are now mandatory in Austria and the Czech Republic and the Cuban Government has recommended that people make them at home. People have lots of time on their hands. I note that the Irish Countrywomen's Association, ICA, is starting to make them. With a widely circulated template we could go into mass production of homemade masks. I would welcome clarity on this issue.

I thank our Minister for Health, Deputy Simon Harris, and the Government for their ongoing work in leading us through this crisis and the co-operation and collaboration of all parties and Independents in the House. In particular, I wish Dr. Tony Holohan a speedy recovery. There was a collective sigh of relief across the country when he was back at his desk again this morning. We welcome that.

While I agree that all our health employees are on the front line, there are some who are more visible and of whom we think more quickly. My thoughts turn to those who are often less visible but deserve support in protecting their health so we can keep their services running. One thing that comes to mind is the child protection services, which are under unique pressures at this point as many of the supports for children at risk, such as teachers, coaches and youth workers, are not present in children's lives any more due to social distancing. Tusla has introduced some changes to work practices, but many home visits still have to happen. Social workers are reporting a huge difficulty to me - the Irish Association of Social Workers has commented that its members are also having difficulty - in accessing personal protective equipment, PPE. This does not necessarily mean the high-tech stuff one would see in hospital settings. They struggle to get such simple things as gloves or hand sanitiser. While I understand that Tusla has engaged with the suppliers, clear timelines and supply routes must be identified to ensure that these services can continue by keeping the staff healthy.

There is also a wide variety of community groups, NGOs, volunteer organisations, homecare providers, carers and family carers that provide help and support to a wide variety of vulnerable people who rely heavily on that support. These organisations often fill a gap in health provision left by the State. Now more than ever, we cannot abandon them again. We must ensure they can continue to support these vulnerable people. I welcome the efforts the Minister mentioned at the beginning.

My colleagues, Deputy Neasa Hourigan and Mr. Sean McCabe, have been dealing with this. While we welcome the efforts thus far, there must be clarity on where the supplies of PPE are coming from and when they will be available. There must be clear supply routes and schedules for these people. Many of these groups receive little or no funding from the State and as such might be invisible to the HSE. It is imperative that a needs assessment is carried out for those in the community who are supporting vulnerable people, no matter where they are based, so we can get a clear picture of what is needed and how we can get it out to them. If these people are not linked to the HSE or other sources of State funding, they may be invisible. It is very important that we capture family carers and home carers and ensure they have the PPE needed to protect their health so they can continue to support the health of the people they are caring for. It is also imperative that the HSE issues improved guidance specifically for the people doing this kind of work. Much of the available guidance is generic public advice for non-clinical settings, but this kind of work involves very close contact. Support and information will really help the people doing this kind of work.

Has any Covid-19 related funding been set aside for these kinds of groups? As my colleague, Deputy Noonan, stated, many section 39 organisations are struggling with funding cuts at present. Many other groups operate on a shoestring budget. The current difficult times are really placing them under a lot of stress. Specific Covid-19 related funding should be identified for these groups. This has become quite pressing with today's reports that some home carers will be redeployed to nursing homes.

This makes the situation for carers even more acute. What plans have been put in place to backfill this need that is being created? Getting a homecare package can be a struggle. The lack of replacement for those who are to lose them will be devastating for them. Many of these are people who in the best of circumstances may, without a homecare package, end up in an acute hospital. The last thing anybody needs now is extra pressure needlessly being placed on our acute hospital system. What is being done to backfill homecare supports and packages where people are being forced into self-isolation, people are becoming sick and carers have been redeployed into a nursing home to support the crisis in that sector?

I too would like to express my sympathies and the sympathies of the Social Democrats to those who have died during this Covid-19 pandemic in our health system. There is one particular time when people want to be around somebody close to them and that is when the person is dying. I know from my own experience of having been with my both parents when they died that there is something very comforting about that in the future. It is regrettable that owing to the restrictions around funerals people will have terrible regrets for a long time. It is only when one attends a funeral in another country that one realises the importance of the funeral process here.

There was a discussion regarding today's sitting and essential workers. I have been contacted by several family members of workers and workers themselves questioning why they are deemed to be essential when they are not health care workers. In some cases, these are people working in warehouses to provide for shops that are not open. I am trying to rationalise this. I even had a conversation about it last weekend with an official to try to understand it. There are people who are very upset that the restrictions in this regard are not being fully adhered to. There is no rationale behind some of the sectors that remain open. It is important to put this on the record. I am sure I am not the only Member who is receiving calls on this particular issue.

As part of our work as public representatives we are not only meeting here, we are also working remotely problem-solving, linking people to services and acting as one-stop-shops gathering information, inputting that information and linking services. All of that work is happening. We are also raising here concerns that the public are raising with us. We need to be able to do this. It is reassuring for the public to hear their concerns being raised. This is one of the reasons it is important for us to meet. There is no doubt that there is frustration regarding our ability to do our job. There is an expectation on the part of the public, on the basis of the telephone calls and emails we are receiving, that we need to be able to do that job. I welcome the commitment that there is to be a scaling-up in the Departments' ability to respond to queries because we have lost some of the helplines that would have been available to us. People are raising general issues such as the number of tests being carried out, the time it takes to get result and personal protective equipment, with the quality of what has been provided of particular concern. There is also concern about nursing homes, social welfare issues, domestic rents and, increasingly, commercial rents. The crises that existed heretofore still exist such that we are still dealing with issues related to homelessness and other issues.

I acknowledge that people are working differently and remotely, including civil and public servants. Many people have been redeployed to, for example, the Department of Employment Affairs and Social Protection where there has been a sudden surge in workload. None of us is expecting business as usual.

There is great appreciation of the efforts being made across the public and private sectors.

There is a high degree of co-operation between all parties and groups in this House. Government is not under the kind of normal scrutiny one would see because we realise this is an exceptional situation. However, we need to be able to have a two-way engagement. Often it seems that one inputs information but it takes a long time to come back. It is often not a two-way engagement, which is quite frustrating.

I have heard concerns expressed yesterday and today over batches of personal protective equipment, such as gowns and masks, that are not usable. It may be that there are bad batches and I realise that this was a consignment that was delivered very quickly. If that is not sufficient to protect people, we must address that issue. We must ask if there is capacity to scale something up here domestically. What can be done about it? That has been raised with us in a very serious way and we cannot ignore that issue. We need to see if it can be manufactured differently. It may only be that there are some bad batches within the consignment delivered. Will the commitment be fulfilled? If not, how do we deal with that issue? Can anything be sourced domestically? There have been very good examples of companies coming forward with material that has been used.

By and large people have been fantastic in getting behind the advice to stay at home and take the relevant precautions. The best way to ensure that continues is by being very honest with people about the challenges. I heard the Taoiseach talk about bumps in the road regarding testing. That is not enough. He should come out and say exactly what the problem is in some considerable detail. This is not just about the current crisis. Every week will be different. As we get past the point where, for example, we might be filtering people back to work, there is a concern that we would have a regime in place and that we would not have a new outbreak or an increase in cases by virtue of not having that regime in place. We need to know what the problems are. As has been said already it is really important to follow the World Health Organization advice to test, test, test and then identify the contacts.

Dr. Gabriel Scally made a very interesting contribution yesterday about an all-Ireland approach. This is not a political issue; this is a practical issue for managing the next stage. We cannot emphasise enough that we need an all-Ireland approach if we are to get control of this virus until a satisfactory vaccine is identified. Even if it is not today, I ask the Minister to give us some detail about the equipment.

It is important to hear something very constructive about the tests. I completely understand this is not about a diagnosis, but about a management. It is very difficult to figure out how we were planning to have many more tests and then all of a sudden, we discover it is not possible to do them because of a shortage of reagent and possibly for other reasons. We need to see the actual position plotted out over a period of time.

It is absolutely legitimate that front-line healthcare workers are tested first. We are hearing of people being frustrated that they cannot get back to work; they want to be back at work.

Intensive care beds are not just about a place in a hospital. They are about equipment but they are most of all about the staff who are the ones who will deal with them. We cannot even factor what the number of ICU beds will be if we cannot ensure that people can get back to work. It is really important that this issue is addressed in a thematic way where we prioritise those who need to be prioritised.

On nursing homes, this is something people are really upset about. There have been really restrictive access to nursing homes for many weeks now yet there are outbreaks in the nursing homes. It is right that HIQA is in and doing an evaluation. I have been asked on several occasions if there are arrangements that people could live closer or within nursing homes. That kind of thing is being talked about. On registration charges, someone told me they were asked to pay €350 to re-register even though they did not intend to be a nurse again. Can we make sure there is nothing like that included in respect of other allied expertise? We should not be hearing that kind of thing.

I add to other voices to wish Dr. Tony Holohan well. His illness was very public and I hope he will be fine.

On behalf of People Before Profit, I pass on my deepest sympathies and condolences to anybody who has lost a loved one, whether in this country or elsewhere. We have to do absolutely everything we can to minimise further tragedies of that sort as quickly as possible. I also want to pay tribute to health workers and other essential workers who are providing the services and protection we need in fighting this virus, and to all of those who are staying at home. That will become an increasingly difficult thing for people to do but in doing so, they are protecting public health and helping to fight the transmission of the virus.

I want to comment on the debate about the appropriateness of the Dáil meeting. The Government has said it is acting on public health advice in most of its decisions. The list of essential workers, I assume, was drawn up by the National Public Health Emergency Team, NPHET. It included public representatives and journalists as well as many of the other front-line workers. There is a very good reason for that. Public health medicine is unequivocal about the need for decisions in situations like this to be taken in an open and transparent manner and for the public to have the maximum amount of faith in the decision-makers as we move through the crisis. Democracy is not an optional extra in that; it is critical to maintaining public compliance and public confidence in the decisions. It is worth saying that intellectual studies on this matter have made it clear that the countries that did best in previous pandemics are those that are the most open and the most democratic, not those that are most repressive. That is what the intellectual and scientific evidence shows. That is why it is critical that the Dáil sits, whether remotely or in a different venue or whatever. It is essential because Deputies are being contacted by people in direct provision centres who are terrified because they cannot adhere to social distancing. Urgent action is needed. People in homeless hubs and hostels or in overcrowded family conditions impacted by the housing crisis cannot do social distancing. If they become symptomatic, they cannot self-isolate. Therefore it is an urgent matter to air those messages and concerns as they come in and for us collectively to do something quickly.

For example, we need to get hold of empty apartment blocks in every area in order to provide suitable accommodation such that people are not living in overcrowded conditions. Last weekend, I was contacted by a teacher who works for an English as a foreign language school. Some of its 700 students contacted him because they cannot get the Covid-19 payment as they are not working although they have work-study visas. They came here this year and many of them are living in desperately overcrowded conditions with people who are symptomatic but cannot self-isolate. They are scared and have no money. Deputies must be able to raise such concerns.

I have before me a list of 40 questions drawn up by doctors and scientists, some of whom are working on Covid-19 research. The questions address issues of concern to them, such as reagents, shower facilities for health workers, the testing regime and so on. I have been unable to put those questions to the Government because we do not have a system for so doing. It is critical for Members to be able to ask such questions in the interest of public health. It is critical that the House be able to scrutinise the arrangement with private hospitals whereby, rightly, their capacities have been taken under public control. However, we do not know precisely how that will be managed or how much it will cost. The Government has made pronouncements on it being a temporary arrangement.

There are many other issues that I do not have time to raise, such as what is happening in nursing homes and so on. It is critical that Members have the opportunity to ask the Taoiseach and Ministers these questions in the interests of public health and working together to defeat Covid-19.

I wish to start by expressing sympathy for all those who are sick and offering deep condolences to all those who have lost loved ones in recent weeks.

On the Order of Business, during a national emergency the accountability of Government is more important than in normal times. Allowing the voice and concerns of constituents to be heard is more important during a national emergency than in normal times. I am open to the idea of remote meetings but the Dáil should meet next week.

I wish to raise the issue of the tens of thousands of workers who continue to be called into work even though they believe their work is not essential and that company profits are being put before workers' lives. Workers at Ferrero in Cork continue to be called into work to make Tic Tacs, while workers at DePuy Synthes in Cork continue to be called into work to make artificial hips and knees in spite of the fact that elective procedures have been cancelled, the company's competitors have shut down and product is being stockpiled for future use and profit maximisation. Workers who find themselves in such situations have options. Relentless social media campaigning by the construction branch of the Unite trade union this week forced the closure of the construction site at the national children's hospital. A trade union campaign to get workers to contact the Health and Safety Authority en masse forced the closure of Stryker at Carrigtwohill in Cork. In other countries, workers have shut down their workplaces by walking off the job. It may be only a matter of time before that starts happening here. I urge workers in such situations who want good help and advice to contact the "Workers SpeakOut Covid19" Facebook page.

I welcome the fact that the State will have the use of the facilities of 19 private hospitals for the next three months. The private hospitals, such as the Beacon Hospital owned by Denis O'Brien, the Hermitage Medical Clinic, Blackrock Clinic or the Bon Secours chain, should not be compensated for this. The two-tier health system should not be dismantled this week and re-established in three months' time. Rather than develop these points in the limited time available to me, I wish to ask why the deal between the State and the Private Hospitals Association is, for the most part, a secret deal.

When the State does a deal with workers and their representative organisations, the details are usually published online, they are published in the newspapers and they are subject to scrutiny and public comment. However, when the State does a deal with billionaires and wealthy corporations in this instance, the details are being kept secret. Why is that? Is it because the deal has not been signed yet? Is it because the hospital association is insisting on commercial secrecy? Is it because the Government thinks there may be public criticism of the sums involved? The details of the deal should be published immediately and the secrecy around it should stop.

Extraordinary powers have been granted to the State by the Dáil and they are in evidence over this two-week period of lockdown. The overwhelming majority of the population is complying and will comply with restrictions in the interest of public health. However, we should not blind ourselves to the abuse of Covid-19 special powers in other jurisdictions, nor should we blind ourselves to the abuse of special powers in this jurisdiction in the past. This situation needs to be carefully monitored by organisations that defend the interests of workers, young people and oppressed groups and by those who defend civil liberties. As a workers' representative, I will do my best to help monitor this situation in the weeks ahead.

I want to raise issues I have been asked to raise by two groups of workers. First, the student radiographers went into the hospitals on Monday for their clinical placements. They will be doing chest X-rays for Covid-19 patients as part of their work. Many have had to give up accommodation for health and safety reasons and many have had to give up part-time jobs. They receive no pay or travel allowance for their placements. They should be paid. Second, the bus drivers at Broadstone garage have been involved in a dispute with Bus Éireann for the past few days because most of the busses do not have protective screens. The drivers have been stopping at the bus stops, asking passengers to stand back, getting off the bus themselves, allowing passengers on and then boarding the bus again without collecting cash. Rather than entering into a dispute with drivers such as these, who are frontline workers, the public transport companies should follow the example of the drivers and waive fares for the duration of the crisis.

I am sharing time with Deputy Verona Murphy. I would also like to express our sincere condolences with the families that have been bereaved as a result of Covid-19 and I express our solidarity with people who are attending hospital.

Public representatives have both a duty and a responsibility to represent the needs of constituents when national policy is being discussed. On the criticism from some quarters of the Dáil sitting today, I believe my presence is required to speak to the needs of Waterford and the south east. Therefore, I make no apology for it.

Among the many recent concerns highlighted by the Minister for Health, increased emphasis has been placed on the management of our nursing home sector, where a large proportion of residents are deemed as vulnerable or as being at risk of contracting Covid-19. In the south east, for example, we have 66 private and voluntary nursing homes, managing more than 3,000 beds and employing more than 3,600 people. These health concerns face significant challenges in resourcing and in-patient management with respect to planning for Covid-19. Primary issues in this health emergency are the supply of PPE, the retention of staff - and most acutely in the south east nursing home sector - the extended delay in returning Covid-19 tests. This is placing inordinate pressure on managing patient isolation and staff well-being. Testing delays are contributing to the loss of healthcare personnel, who must self-isolate while they await confirmation of possible Covid-19 infection.

Happily for the south east, for the Minister and perhaps for the country, I can propose an immediate solution to this problem. The regional pathology laboratory for the south east at University Hospital Waterford provides all microbial testing for the south east region's hospitals. In addition, it provides 24-hour turnaround Covid-19 tests for hospital inpatients and staff on site. I ask the Minister to resource and direct University Hospital Waterford laboratory to undertake testing of all nursing home swabs in the region. This would immediately and dramatically improve turnaround times and offer significant relief to nursing home managers and caregivers. I also ask that for the duration of this emergency, the Department of Health allows oxygenators to be placed with nursing home managers without the requirement of sign-off from a hospital consultant so that, where necessary, nursing homes can provide appropriate and immediate palliative care to those requiring it.

I also ask the Minister to direct human resource departments in the HSE not to seek or target recruitment of health care workers working in nursing homes and community nursing units.

In addition to nursing homes, and the challenges they face, we must also remember those working in the community and voluntary services. These healthcare professionals provide indispensable services to many families and individuals living with disabilities and special needs as well as practical and emotional support to family care givers. Section 39 care workers provide exactly the same services and shoulder the same, and often additional, care burdens as their section 38 counterparts yet they receive less support and remuneration from the State. This discrepancy in pay has led to a 25% turnover in employees in the community and voluntary services sector and there is also a challenge with recruitment. There must be pay parity across the services. The time is long past for the Minister to ensure there is equal pay and funding for this sector.

The Minister outlined his concerns about the potential for cross infection between healthcare workers sharing accommodation. Given the availability of university residences in our largest cities, perhaps the Minister could prevail on the educational institutions to shoulder some burden and make accommodation available to healthcare personnel thereby reducing risk of contamination and cross infection.

Beyond this, the Oireachtas must look forward and consider the rehabilitation of our national economy and the HME sector which faces a slowdown that cannot be allowed to cause stagnation. Our economic future cannot continue to be charted by a caretaker Administration. I urge the leadership of the main parties to renew efforts to form a Government so that new economic planning can begin. In light of the current challenges, the voters have the right to see the leadership shown by our front-line healthcare services reflected here. They have the right to question politicians on the delay in serious engagement on Government formation and they have the right to expect a renewed national programme and commitment to our most precious resource, namely our people. Duty calls, and some are ready and willing to answer that call.

I give my best wishes to Dr. Tony Holohan for his own health and all those who suffer from the coronavirus. I pay my condolences to those who have passed away as a result of the virus. I pay tribute to the front-line staff in hospitals and throughout our medical services as well as to those front-line staff who are not so recognisable in our pharmacies, supermarkets, at checkouts and those in the supply chain - in factories, drivers making deliveries, farmers and fishermen - for continuing to supply the food we eat. There is much talk of the Government and the great job it is doing but I commend the people of Ireland who are so focused on flattening the curve and abiding by the measures which Dr. Holohan has recommended be put in place. They are the people responsible for keeping the numbers of infections at bay and I thank them.

Covid-19 has the potential to take over our entire intensive care capacity and possibly our whole hospital system. While I commend the policies and recommendations which are being implemented, it cannot be at the expense of our essential services. Many suffer with other serious illnesses, such as cancer and mental health problems. We cannot allow a situation to develop where the second-line affects are more detrimental because of front-line actions. In Wexford, an election promise to open Arden House, the proposed new mental health facility, has not happened. The rooms in the current facility in Summerhill are so small it has had to close because it is unable to meet the recommended social distancing measures. It is only dealing with current patients by phone, on a 9 to 5 basis. I was called last Friday by a very distressed mother. She told me her 16 year old son had told her he wanted to kill himself. As it was out of hours, she called Caredoc and was advised to attend a hospital emergency department, but to ring ahead because of the virus. She was told by the emergency department that no one was there to deal with her son and advised her to go straight to the psychiatric unit in Waterford, but to ring ahead because of the virus. When she rang there, she was told under no circumstances was she to present with a child, they were virtually in lock down and that Wexford General Hospital had a duty of care.

She spent all night watching her son to ensure he stayed alive, which was her only option as there were no mental health services available to him. This situation is not because of Covid-19. Mental health services in Wexford have been neglected for years. Last Sunday, a beautiful 17 year old girl who died by suicide was laid to rest. Her friend who was laid to rest only a week before, and was also 17 years of age, died by suicide. Their very vulnerable friends were unable to attend the funerals to say goodbye because of Covid-19.

We are in unprecedented times, but situations where a child takes his or her own life are unprecedented for parents and families. Mental health was a major issue before the election, and is now an even bigger issue. More people's mental health is being compromised because of poor domestic situations, which have been exacerbated due to people staying home as required. This is leading to an increase in the incidence of domestic violence. Those who are worried about other life pressures, such as having no job and bills to pay, and those already in the mental health services system are also suffering.

I understand the politicians who say it is important that we take care of our mental health. It is important to go for a walk, but walks do not deal with mental health issues, self-harm or suicidal tendencies; psychiatrists do. That is why we are all listening to the Chief Medical Officer, Dr. Tony Holohan, about how to handle Covid-19 and the measures that need to be implemented to stop its spread.

Today, I ask the Government to listen to Dr. Kieran Moore, a consultant paediatric psychiatrist. He said it is now a matter of urgency that the HSE set up an emergency service for children who normally attend CAMHS or other child psychiatry services and cannot now go to accident and emergency departments. He said all outpatient child psychiatry and CAMHS staff must work differently and be available on rota 24-7 by telephone to deal with patients directly as required. Mental health is like all other medical services; it cannot be shut down. We do not need an increase in deaths due to other illnesses because of Covid-19.

I am here today because I cannot get answers to these questions. The lack of accountability leads to a denial of citizens' rights. I should point out that we are following all of the recommendations and are not putting our health or that of anyone else at risk.

I too would like to say how important it is for us to acknowledge the sadness and heartache endured by families throughout the country who have lost friends and relatives over the past number of days and weeks. We are so sorry for that. Our thoughts, prayers and consideration are with people who are ill, either at home or in our hospitals.

It is right and proper for us to be here today in this organised and proper fashion. I could not agree more with those who spoke at the beginning of the session that this is only right and proper. If we carry out our business using a rota system, people from different groupings can come into the Chamber and voice their concerns in a proper, orderly and safe fashion, as people throughout the country are behaving in terms of obeying the rules, and we can do our best to combat the awful difficulty we face at this time.

I will raise one of the consequences of the pressures on our health service. It is an issue I raised earlier, which came to light yesterday morning. I refer to the complete withdrawal of, rather than a reduction in, home help services for many older people in our communities. I can only speak for people from County Kerry because they are the people who have contacted me. I am sure other Deputies are aware of the same issues in their constituencies, and it is for them to speak about it. This matter has to be highlighted here today.

I acknowledge 100% the pressures and constraints on the system and was grateful to have had a conference call for nearly two hours yesterday with senior people in the HSE, with whom I raised this issue.

I understand the difficulties the Department of Health and the HSE are having in trying to manage the resources they have. We are aware of the excellent people who have put their shoulders to the wheel and come back, whether they were retired or abroad, and have said they are here to work and to serve at this difficult time. In spite of that, HSE management has decided to completely withdraw services.

I was told during the conference call yesterday that it affected people of a low dependency. On Radio Kerry this morning, I asked what is a low level of dependency. I know elderly people who are wheelchair users and are completely bedbound. It is not acceptable for a son living nearby to come to a lady aged between 70 and 90 years to deal with her private matters, getting up in the morning, showering and getting ready for the day. That will not work. There are things that boys or men cannot do for their mothers, aunties or grandmothers. Another person needs to help to give that type of personal care. These are people who are highly dependent. I plead with the Minister for Health, the Department of Health and the HSE not to attack elderly people by leaving them without their home help. I know nobody wants to do this.

Whatever way the help is going to be managed there are excellent people to provide it. There are excellent carers who work in our communities. They are the backbone of our communities. There are individuals who may have two, three or four people in their care. They have been doing everything to assist them over the years and all of a sudden they are getting a telephone call to tell them not to visit Mr. or Mrs. So and So. It is a complete withdrawal of services. We cannot allow that to happen. If we do that, those people all of a sudden will not be able to stay at home. Something will go wrong perhaps in their houses or with their health. They will finish up in an acute hospital or in a community hospital. That is exactly what we do not want at this time. The safest, happiest and best place for a person to be, if it is humanly possible for them to be there at all, is in their home and nowhere else. I am sure the Government and the Minister for Health realise that. It would be a very mean person who would stand here and be critical of the Minister for Health or any other Minister at this time because as far as I can see every one of them is doing their genuine best in this matter. That has to be acknowledged. Let us work together and do the right thing by everybody.

I too sympathise with all those who have lost family members over the past three or four weeks, for whatever reason. It has been a very difficult time for them because nobody can assist them, grieve with them or go to funerals. I knew a 91 year old man who, when he knew he was dying, said to his son, "Goddamit, there will be no neighbour or anyone coming to the funeral." The son is bothered to this day about it because his father was a grand man. It is hurting many people and families that nobody can help them to grieve or start the grieving process as was the tradition in Kerry and all around the country, where neighbours went to help families grieve and survive. I sympathise will all of those.

I thank all the front-line staff, the nurses, doctors, kitchen staff and cleaners who are vital in all our healthcare facilities, whether in hospitals such as Tralee General Hospital or Killarney or Kenmare district hospitals, or nursing homes around our county. All those involved deserve any accolade we can give them.

We will ensure we will fight for whatever PPE they need to keep our health services going.

I join Deputy Michael Healy-Rae in raising the home help service. Those Deputies who were in the last Dáil will recall that day after day, I raised the need for home help services to enable people to stay in their homes for as long as possible. I assure the Minister that anyone in County Kerry who receives home help had to fight to get it. It is not the case that some of those who get this help should not be getting it. They are entitled to it and they have it. I ask the Minister to let them continue to get it. It is a case of robbing Peter to pay Paul. If these people do not have home help workers coming to see them, they could die of other causes in their own homes. I beg the Government to do something to ensure there is a change in the current approach. It is valuable for us to be able to come in here today to raise this issue, which is so important for elderly people around County Kerry. I would like to mention as another example of the importance of this issue the case of 72 year old man who went into a shop the other day and was accosted by some nosy parker who said he should not be out getting his messages. We cannot trap or isolate elderly people entirely.

I have to raise the issue of the air ambulance for the south west that was promised in the last programme for Government. It will close tomorrow evening due to funding difficulties. I contacted the office of the Minister, Deputy Harris, early in March, but I heard nothing back. I have since been in contact with the Tánaiste's office. I beg and implore the Government to keep this vital service going. The air ambulance is vital for people who manifest with cardiac failure, stroke and various other illnesses and who are far away from where they need to go.

I thank the Government and, in particular, Dr. Tony Holohan, for the massive work they have been doing. I see that the Taoiseach thanked the Chinese for giving us the PPE stuff we need. I have to say I would thank the Chinese as well if they had kept their virus. If that had happened, we would not need the gowns and the equipment we are looking for now.

I would like to share time with Deputy Harkin.

I begin by extending my condolences to the families of the people who have passed away from the coronavirus over the last while. It is important that we should extend our sympathy to them. We should not forget those who have passed away under normal circumstances because it is not normal for their families to have to make funeral arrangements like those we have seen in recent weeks. It is difficult for families as they begin the grieving process. We should extend our sympathies to them as well.

It is vitally important that we are meeting here in the Dáil. I think we should continue to meet here. I believe we are critical workers. We have a duty to be here, to bring the concerns of our constituents to the notice of the Minister and the Government and to bring messages back to our constituents. The vital importance of this sitting was really brought home to me when I was leaving the house at 6.30 this morning and I met a delivery man who asked me for directions to a house.

Are we saying that we are more important than a delivery person, such that we can stay at home and look after ourselves but they cannot do so? Should we expect them to go out and put themselves at risk? There is no doubt that there is a potential risk involved in us being here. That is what we are here for. It is vitally important that we are here to convey our message and have our say. That role should not be underestimated and should not decrease through this crisis. It should be increased and enhanced because we have an important message to deliver.

The Minister said there were numerous ways to pass on messages and information. We have Skype messages, WhatsApp and so on. I cannot remember the names of them all but I have used a few of them. They are useful and important and one gets information from them. However, information does not come back. It is like talking into a vacuum. We had a meeting last Wednesday. We got feedback about issues that we raised the following Tuesday afternoon. That does not make sense. I accept that people are under pressure. There is no doubt about that. These are exceptional circumstances. However, we are working under pressure too and trying to keep people up to date on what is happening, but we cannot get the necessary information. That makes it even more important for us to be here and the process to continue.

Maybe the Minister and the Government will give proper information. I am sorry that the Minister has left the Chamber. The information he gave in his speech is different from what we got in a briefing on Skype yesterday. What is the story? The Government seems to be intent on conveying a good message all the time. Irish people are mature enough to deal with messages they need to deal with and to hear how things actually are, rather than how we would like them to be. It is important for people to have the full message and the right story.

Mental health services in Donegal are being put on the back burner according to members of staff to whom I have spoken. I raised this issue with the health team. Mental health is critical, now more than ever. It should be maintained and staff should be working harder to maintain mental health because that will be important throughout this period of isolation. I call on the Minister to make sure that the HSE in the north west maintains that service.

I am truly sorry for all those families who have lost loved ones due to Covid-19. I know all Deputies share that sentiment. I send our best wishes to those who are ill right now. As many Deputies have said, it is great to see Dr. Tony Holohan back at his desk. It gives us confidence.

I am annoyed by an earlier comment. This is not a Chinese virus. It is a virus. A virus knows no borders. Those comments are inappropriate in this House and anywhere else.

We had a discussion earlier about whether we should meet here today. There are arguments on both sides. Apart from the significant issues of accountability and transparency, during a time of crisis, people need to see that systems work. So much is uncertain and they like to see some certainty. The democratic system is important. I thank the staff in Leinster House for facilitating us today because they are facilitating the democratic system. Their role today is just as important as ours.

The issues I specifically want to raise revolve around health care in congregated settings and health care and care in the home.

Like others I will speak of home care staff, who are a vital element in dealing with this crisis. Many of these staff have seen their hours decreased from 15 or 20 hours per week to three or four hours per week but they are ineligible for any Covid-related payments because they were not working full-time. I understand that at lunchtime today the HSE issued a circular committing to pay home care providers at March levels up to 19 April, which is good, although it is a temporary measure. Other workers have three months of certainty and home care workers need this as well. Will the Minister for Health put in contingency measures to support this often invisible army of home care workers? They are critical now and they will be critical in future. They need more certainty with regard to incomes and matters such as personal protective equipment, as well as other emergency supports. Ultimately, these are the people who will help keep many older and vulnerable people out of hospital.

There is another issue with family carers. For example, if a person cares for a family member and works ten or 15 hours in a week, that person cannot cease working because of fear of bringing the virus home and how this relates to receiving a Covid-19 illness payment. Workers who have young children may be able to make that choice and receive a Covid-19 payment. I fully support the decision relating to child care but the same support must be in place for family carers, as they are protecting the elderly and helping keep people out of hospital.

My second concern relates to congregated settings, including care homes, respite centres and refugee centres. We have already seen how crucial it is that these settings are safe both for those who live and work there. We also know it is critical for the wider community because every person who becomes ill and needs a hospital bed means there are fewer available resources. This is both a private and public health matter and we must learn from our mistakes.

I have serious concerns that best practice is not being followed in refugee centres. National and social media have reported significant inadequacies in certain centres, and particularly in one in my constituency. The Department has recommended that these centres provide hand sanitisers and latex gloves but my information is that this is not happening. Residents must also be able to eat in their rooms or else meal times should be staggered. I am not sure this is happening either.

Like many others, I express my personal gratitude to those on the front line. They are our safety net and we are truly grateful to them.

The Minister for Health departed the Chamber to attend a briefing of all party and group leaders on Covid-19. The Minister for Culture, Heritage and the Gaeltacht will conclude the debate for the Government.

I appreciate the Acting Chairman's explanation. I thank the Deputies for their contributions. However, the Members here today who have insisted on this Dáil sitting have shown a complete disregard for our national fight to contain Covid-19. Shame on you. They have forced us to stray from home rather than stay at home, which is completely contrary to public health guidelines and nothing to do with any public representative shirking his or her responsibilities. As the Minister, Deputy Harris, said, there is no reason we could not have done this remotely. We have already seen the European Parliament achieve that. As he said, with a little ingenuity, it could be achieved. I just wanted to say that at the outset.

We are learning more about Covid-19 but there is much we do not know.

In particular, we do not know how long this public health emergency is going to last. As the Minister for Health, Deputy Simon Harris, said earlier, many lives have already been cruelly taken by this virus. I would like to express my condolences to all of those who have been bereaved. We are focused on minimising the impact of Covid-19 on our society and our economy. We have had to take a number of very serious and difficult decisions concerning our everyday activities so we can take appropriate public health measures to limit the spread and impact of the virus insofar as is possible.

The modelling work which is being done by the subgroup of the national public health emergency team has shown that the public health measures taken to date have had a very significant effect. The number of cases we have had is lower than it would be in an unmitigated epidemic. However, that is no reason to be complacent. In fact it urges us to ensure we carry on listening to the advice of our public health experts. Our efforts to mitigate the impact on everybody living in Ireland and on our economy and society must continue.

I will allow a brief comment.

I am in the middle of speaking.

My understanding was that the wrap-up would include answers to questions raised by the House. In the time left, will the Minister actually address any of the questions we have come here to ask?

I think the Chairman made very clear that the Minister for Health, Deputy Simon Harris, is with the Taoiseach at present-----

Deputy Madigan has been here.

-----and with all the leaders of Opposition parties and groups. He has been giving them a briefing on Covid-19 since about 3.30 p.m.

Is Deputy Madigan going to answer anything that has been raised?

As Deputy Donnelly knows, the Minister, Deputy Harris, was here. He was here when Deputy Donnelly spoke and he was here for every other speaker except for a few. I have taken notes of those concerns for him. He has taken detailed notes of all the Members' concerns and I am satisfied that he will get back to them with comprehensive responses on everything.

Is Deputy Madigan going to address them?

It is a bit opportunistic, when the Minister is in a very important meeting-----

I am not having a go at the Minister for Health. I am asking if a Government Minister is going to answer any of the questions raised by the Parliament.

He will come back with answers to all the Members' concerns.

Is Deputy Madigan going to answer any of them?

I can only go that far. With respect, I am not the Minister for Health and he cannot bilocate. Deputy Donnelly can appreciate that.

Deputy Madigan is not answering anything that has been raised.

I will continue with the remainder of my submission, if it is all right with the Acting Chairman.

I just wanted a clarification on that.

The Minister has a minute and a half left.

I want to acknowledge the incredible response of the staff of our public service across Departments and agencies, particularly in the health sector, but also in social welfare and other sectors. These front-line staff have stayed in their posts and have gone above and beyond what we could reasonably expect of them in making sure our public services can function to the greatest extent possible. For example, my Department has put in place a range of measures to support the arts sector during this very difficult time. I will elaborate on these tomorrow.

The changes described in the national action plan on Covid-19 are not optional changes of lifestyle. They are an absolute necessity to halt the spread of Covid-19. It is a matter for all of us to act responsibly in our day-to-day lives and listen to what our public health officials, international health organisations and trusted media tell us to do. Together we can all make a difference in the impact this virus will have on Ireland. The national public health emergency team continues to meet on a regular basis and is keeping the situation under review at all times. We can all follow the main advice from our public health experts; stay at home, avoid unnecessary travel, carry on washing hands properly and regularly with soap and water, cover the mouth and nose with a tissue when coughing or sneezing, and avoid touching the eyes, nose and mouth. I was interrupted, as the Acting Chairman knows, so I will finish my remarks.

I take the opportunity to thank all Members of the Oireachtas for the constructive way we have worked together in the recent past. The Minister for Health, Deputy Simon Harris, has also acknowledged that. I urge Deputies to continue to help us to get the message out that all of us working together can do more than any of us acting individually. I would like to finish by paying tribute to our health service personnel. All of those working in the health service, on the front line of our response to Covid-19, are doing everything they can to minimise the impact of Covid-19 on our country. We should recognise and thank them for the work they are doing to protect everybody living in Ireland. I am sure Deputies will join me in expressing our deepest appreciation to them for everything they are doing.