I call on the Taoiseach to make a statement under Standing Order 55. He has five minutes.
Health (Covid-19): Statements
I welcome this opportunity to discuss the actions being taken to respond to the Covid-19 emergency, to answer questions and to exchange ideas with leaders about future actions to rebuild, revive and renew our country. I am very sorry that Deputy McDonald is not yet back in this Chamber, but I know she will be once fully recovered. Our thoughts today, and every day, are with all of those affected by Covid-19, with all of those sick or recovering.
I also welcome Deputy Kelly as the new leader of the Labour Party. I wish he were taking over in happier circumstances for our country, but I know from personal experience that he will bring his unique drive and determination to his new role. I also extend my best wishes to Deputy Howlin. I believe that history will record how he helped to rescue our country from some of its darkest economic times. I know his wisdom and experience will be of great benefit to his party and to our country in the time ahead.
Before I continue, a Cheann Comhairle, I want to take this particular opportunity to express my condolences and those of the House to the families and friends of the 444 people who have died as a consequence of coronavirus in Ireland to date. Four hundred and forty-four people - not statistics, but citizens, people with families, with friends, with lives, with stories, with people who will remember them, people who will mourn. We mourn for them too.
I particularly want to mention the two HSE staff members in St. Luke's General Hospital in Kilkenny who died in recent days. It reminds us how healthcare workers and other essential workers put themselves at risk every day to care for their patients and keep us safe and why we must stay at home.
Since Covid-19 emerged globally only a short time ago, we have been presented with an unprecedented set of challenges. There has been no rule book, no roadmap, no manual as to how this country or any country can deal with a crisis of this nature.
Our response is focused on three broad areas: first of all, building capacity in our health service to respond to new public health requirements such as testing, contact tracing, social distancing and quarantine, and also a potential surge in demand for our health and social care services - beds, staff, ventilators; second, finding a way to protect those most of risk - the old, frail and chronically ill, those who the virus targets - and to deal with the challenges that present to those who we have asked to cocoon and restrict their movements; and third, developing policies and programmes to mitigate the impact on our economy and on employees, to keep businesses alive, to keep people on the payroll, to ensure income support for those who have been laid off and to prepare for a rapid economic recovery when the time comes for that.
Our overriding priority in the days and weeks ahead is the protection and survival of as many people as possible to minimise the loss of life. I believe we are united as an Oireachtas in that objective. I am grateful to party leaders and politicians in this Chamber for their critical engagement with the different measures being proposed and enacted. Everyone has played his or her part.
In the times ahead, there are three questions we need to consider as an Oireachtas. The first is when we can begin to lift the current restrictions and start getting things back to normal bit by bit. The second is what we need to do to get people back to work and revive and rebuild our economy. The third is how we can take what we have learned in recent weeks and some of the things we have done to build a better society in the aftermath of Covid-19, how we can honour the sacrifices made in every community in our country and renew our society by developing a new social contract between citizens and State.
The answer to the first question is being developed as we speak based on expert opinion. We have the advantage of being able to look at some other countries that are a few weeks ahead of us and seeing how their strategies are working or not. I do not yet know whether we will be able to relax restrictions on 5 May, but I do know that, if we can at all, it is going to be gradual and will happen over a number of months. As we know from Asia, they may even need to be reimposed again, because only a scientific breakthrough - a vaccine or an effective anti-viral medicine - will truly allow life to go back to being as it was.
Other breakthroughs, such as a reliable antibody test, could really help though and I am optimistic about the capacity of the brilliant minds in our international pharmaceutical companies and universities to deliver.
The second and third questions are ones that must be answered by the new Government and every person in the Oireachtas will have a role to play in shaping those responses, whether as part of the Government or by playing a constructive role in opposition.
I welcome the opportunity to hear from all sides of the House today. Do not be afraid to ask the hard questions. If we can answer them we will and if we cannot we will say so but please understand that in an evolving situation it is not always possible to answer all questions in real time. We simply just do not have all of the information and there is so much going on. Do please share your ideas as to how we can respond better to this emergency. No party has a monopoly on wisdom and we will need good ideas and good input from all parts of the House.
Our first thoughts must be with the families who have lost loved ones during this emergency. In addition, the inability of their friends and communities to participate with them in acknowledging and celebrating the lives of their loved ones is an added burden they have to bear. Yesterday's figures are a reminder that Ireland has succeeded in substantially reducing the potential spread of the virus but it is still spreading and causing immense damage. We continue to rely on the incredible work of health professionals and support staff in every community throughout our country.
I extend our best wishes to Deputy McDonald. The unacceptably long wait for test results she experienced must have been almost unbearable for herself and her family and I hope she will be well enough to return here in the coming weeks.
I also welcome Deputy Kelly in his capacity as leader of the Labour Party. I have already congratulated him on his success. I also pay tribute to Deputy Brendan Howlin, who has a long-established record of genuine committed public service to the country. He is also a great parliamentarian.
In the short time available to us in this session, I will focus on a number of the major issues that have arisen in the past fortnight concerning current policies and future planning. Before I do so, I want to put on record the strong view of the Fianna Fáil parliamentary party that Parliament continues to have a role to play and that democratic accountability is not just legitimate but essential at a time when we all have agreed to give such strong powers and support to Government and State bodies. Particularly given the difficulty some journalists have experienced in getting direct and timely answers to legitimate questions, we should agree before next week a system for greater parliamentary oversight. This must not interfere with the response or put staff in harm's way but there are parliaments in many places that have found other ways of working.
In the more than half a century during which academics have been studying crisis response as a separate discipline, the single most consistent finding has been that the public can be trusted with the full truth. In fact, it is when the public loses confidence that it is being kept fully informed that unease and a refusal to follow advice are most likely to grow. This is why I believe in full transparency on where outbreaks and clusters, which we can see in our nursing homes, are happening. The research on public health emergencies in particular is absolutely consistent on this, as it is on the need for challenging voices to be respected and to be open and transparent in acknowledging weaknesses. Any response to an unprecedented and rapidly moving emergency will always involve errors. What matters is to look for them and deal with them. When this is eventually over, a systematic approach to learning from mistakes or oversights will be central to making sure we can respond even faster and more effectively to future crises.
We all know that nursing homes are now at the forefront of the spread of the virus and a large number of virus-linked deaths. Today, we will seek greater clarity on a number of essential points. Unfortunately, I must report to the House that I know of a case in which relatives of a person in a nursing home have been informed the nursing home has been told by the Department that it should not give out information about the number of cases in the home. This information will come out anyway and it would be much better to help the nursing homes through showing them how to communicate information and the reassurances families need that their loved ones are being protected as much as possible.
Clearly, Ireland is not ready to begin reversing the main restrictions introduced in the past month but we are certainly in a position where we should outline the key decision points and how the process of lifting restrictions will be implemented. Many countries have done this in the past week and, as the Taoiseach said, we can learn lessons from how their situation evolves but it is a sensible approach to providing structure to a debate which could otherwise involve poor decision-making.
For Ireland to open up we must permanently address the critical issue of the capacity to rapidly test people both for the virus and, ultimately, for antibodies. Only when we can actually achieve significant community testing will we understand the level and impact of the virus here. We want to hear from the Government about the concrete steps that are planned to get Ireland to a place where more people are being tested, results are returned much faster and new cases are rapidly traced. That is the essential foundation for having confidence in lifting restrictions. Full transparency is required.
The particular burden borne by our health and care professionals, and support staff, has been incredible. Again, the degree to which they put themselves in harm's way manifested in the two deaths in Kilkenny over the past number of days. We want to hear in concrete terms exactly what the current assessment is about basic personal protection equipment, PPE.
The Irish people have shown time and again that they are committed to doing everything possible to control the virus and to help our country get through this terrible period. It is our job here to make sure that they have all of the information they need to understand what is happening and what has to be done. Transparency and accountability are more important than ever and, hopefully, today's session will be held in this spirit.
Ar dtús báire, cuirim mo chomhbhrón agus comhbhrón ár bpáirtí in iúl do gach aon duine a fuair bás mar gheall ar Covid-19 le tamall anuas, dá gclann agus dá gcairde atá ag fulaingt ag an am seo. I want to begin by expressing my sympathies to all of those who have lost their lives to Covid-19 - to those who lost a loved one, a friend or a neighbour as a result of this pandemic. The past number of weeks have undoubtedly left deep scars on families and communities across this island and our thoughts and our prayers are with all those who have been affected.
I also want to express solidarity with those who have contracted the virus, including our party president, Deputy McDonald, who is thankfully on the mend after several weeks of being very ill. We all look forward to her being back with us here very soon, and I thank the other party leaders for their words in this regard. Her words on Tuesday summed up the necessity to heed the public health advice that has been issued when she said:
Stay safe, stay home, stay apart. You do not want to get this virus.
I also pay tribute to all those who have been working on the front line at this time - doctors, nurses, carers and all of those working in our health sector from cleaners to the cooks and other support staff who are playing a blinder at this very difficult time. We will forever be in their debt for the work they are doing for all of us.
I also want to pay tribute to others who are making a massive contribution including the workers in our shops and supermarkets, those who are delivering products including the drivers, public transport staff and many more. All of them are doing an exemplary job in the most difficult of circumstances and they are all worthy of our praise and our thanks.
There are a number of important issues that I and my colleagues want to raise today. I will get to some of them in more detail when we have an opportunity in terms of the question and answer session. Before I do so, it is important to recognise that this House has a major part to play over the coming weeks and months. I want to recognise the presence of Deputy Alan Kelly as leader of the Labour Party and congratulate him, as I did privately beforehand.
While there has been broad political consensus in how we deal with the crisis, there are a number of important issues of public interest that need to be teased out here in the Dáil today. On the topic of the health crisis, which is the most pressing matter facing us as a nation at this time, I welcome the deal that has been struck between the HSE and the trade unions so that health staff can be redeployed to deal with the spread of Covid-19 in nursing homes. That is important. Despite that, however, the fact is that there is a massive crisis in the nursing home and care home sector. We are told that 200 clusters have been identified in nursing homes and residential institutions and that 245 people have died in care homes. That is over half the deaths in the State as a result of Covid-19 so far.
Some nine people died in Maryborough Centre for psychiatry in Portlaoise at the weekend alone. We can all agree that it is absolutely shocking to see those figures in that centre. Our thoughts are with all of the bereaved families at this time. However, the most regrettable thing about all of this is that the crisis in the residential care setting could have been foreseen. In fairness, Nursing Homes Ireland foresaw some of this. That body introduced visitor restrictions to nursing homes off its own bat on 4 March, but let us remember that in doing so it was criticised by the Department of Health for moving too fast. It was not until ten days later that the Department of Health gave its approval for such measures. It is fair to say that this has proved to be a monumental error and a fatal one for many of our most vulnerable citizens. Nursing Homes Ireland has stated publicly that it made numerous requests for a meeting with the Minister for Health and his officials in the early days of this crisis, but such a meeting was not forthcoming. I would be glad to hear what the Minister has to say on this. We must accept that the decision of the Department of Health in this regard has proven to be the wrong one. We need to have full clarity on what exactly is happening within our care home and nursing home settings. Hopefully a full report, with all the available information, can be provided to the House in that regard.
In the here and now, we all need to look at what we can do to ensure that those in residential care settings are protected and cared for. That means fast-tracking the implementation of agreed packages of measures in respect of staffing and improved access to personal protective equipment, PPE. A survey of its members carried by Nursing Homes Ireland last week showed that nearly a third of facilities, some 29%, were still awaiting PPE supplies. A quarter of facilities reported that PPE they had received so far was not fit for purpose. We need to get to the core of this issue. Staff at the Maryborough Centre in Portlaoise raised concerns about PPE two weeks ago. There were passionate pleas for the community to respond because equipment was not forthcoming. Unfortunately, as we know, eight people have now died in that centre.
This issue needs to be addressed. I would like to add that Dr. Jack Lambert of the Mater Hospital made a very valid point on the radio today about the redeployment of healthcare staff from across the healthcare system. He said that this needs to happen today. The question is whether that urgency will be injected into the system to ensure the outcome we all want to see, namely, that everyone in a residential setting, an acute setting or a care home setting is protected in any possible way. Can we ensure that the appropriate urgency is injected and staff are deployed to these nursing home sectors as soon as possible?
Our thoughts and prayers go to the families of those 444 people who have died and to everyone who is currently suffering from this virus in hospital, particularly in intensive care, or in any other setting. Our thoughts go out to Deputy Mary Lou McDonald. We wish her a very speedy recovery and look forward to seeing her back here. Our best wishes go to Deputy Alan Kelly and to the Labour Party under his new leadership.
My sense is that the Irish people are still acting very strongly, collectively and with real solidarity in response to this threat. There was much discussion in the early stages as to whether there would be fatigue in terms of the response. I do not have a sense of that. It is very hard to have a collective sense because we are all locked down in our own areas, but speaking from Dublin Bay South and the areas within 2 km of it, my sense is that we are all still really committed. The vast majority is engaging in a huge exercise of solidarity to protect our people. I hope that gives encouragement to the people working at the front line of this crisis. I include all the officials, the HSE, the Chief Medical Officer, Dr. Tony Holohan, every nurse, doctor and care worker and every person working on the front line in every retail store, who is not locked down because of the nature and importance of their jobs. We have to thank them for the work they are doing.
Maybe one of the reasons there is still no fatigue is that the numbers in the last week were - I will be honest - slightly disappointing. In the previous week it seemed that they were coming down and we were on the right track, but they bumped up by a certain amount in the last week. The critical issue of the number coming into intensive care units, ICUs, which we really need to look at, is still holding good. But we see the numbers of people dying.
There was confusion and delay in our testing system which did not help public confidence. That has reinforced a sense of commitment to the next two and a half weeks of lockdown through which we must go.
I advise the Government that it is vital that we get testing, tracing and isolation mechanisms in place because they are needed if we are to be able to open things up. We can fixate on exact numbers but we need a target of having 15,000-plus tests a day ready to go, in place, and provide a rapid response and follow-up. We must get contact tracing and isolation right in the next two weeks so that, if we are to start loosening restrictions, we know we will have the ability to dampen down outbreaks of the virus where they take place.
I have one suggestion to make without in any way trying to second-guess officials or others, which is that the widespread wearing of masks is advisable as we start to loosen restrictions. That seems to be part of the equation in other countries. The German Government is advising that all people wear masks in public places. We should start thinking about that. If we are to open restrictions in two weeks' time and people begin leaving their homes, we must prepare and the wearing of masks should be a part of our armoury in tackling this horrible virus.
I echo the various commentators who have suggested that, in making decisions about economic recovery, we should favour our young people as best we can in a variety of ways. We must look for certainty about the timing of the leaving certificate examinations and I hope they will happen sooner rather than later. We also need certainty about attendance at colleges at the end of this year and the start of the new term. We should also identify areas in which young people are working - the construction sector, for example - and favour the reintroduction of young people into the workforce. That will help lift all our spirits. My sense is that young people have played their part during this time. They are self-policing and acting responsibly. It is appropriate that we try to get those young people back into ordinary life this summer, as best we can.
I am pleased that the Government has today joined ten other countries in supporting a European green deal. I support the comments made by the Tánaiste yesterday regarding the disgraceful decision by the US Administration apparently to withdraw funding from the World Health Organization at this time.
I turn to consider care workers and front-line workers. We need to learn and make sure we come out of this crisis with changed economic values in our approach to the economy during the period of economic recovery. People in supply chains, from the farmer to the person putting food onto our shelves and making sure that we have basic needs, have been critical and heroic. Their work has allowed the rest of us to stay at home. We must recognise that and ensure that we pay those people properly in the new economy as it grows.
I call on Deputy Kelly and congratulate him, on behalf of all Members of the House, on his election as leader of the Labour Party.
I never realised I was so popular in this House until today. It might be a product of the political environment we are in at the moment, but I thank the Taoiseach and other Teachtaí Dála for their good wishes. I also pass on my best wishes to Deputy McDonald.
A total of 11,497 people have been diagnosed with Covid-19 and 444 people have, sadly, passed away. I pay tribute to all of those who are recovering and have recovered, and pass on my thoughts and those of the Labour Party to all those who have lost cherished loved ones.
I have repeatedly said, since the beginning of this crisis, that our front-line healthcare workers would be our heroes in all of this and they have been. They have put their lives on the line every day in order that all of the rest of us can stay well. I pay tribute to them and to the two heroes who lost their lives in St. Luke's General Hospital, Kilkenny, in the past couple of days.
The Taoiseach asked for suggestions. I will give him one. With the approach of May Day, the day of the worker, the day we celebrate workers and all they contribute to society, we need, as a collective and as a House, to examine how we can celebrate the work of our healthcare workers in a more practical way. Today, considering the unique circumstances, we in the Labour Party are proposing to the Taoiseach and other Members of the House that we pay all our healthcare workers a one-off solidarity payment of €1,000 as a gesture on 1 May. We know all these workers are going way beyond anything they have ever done before or anything they will ever do again. It would be a gesture to show our appreciation. I ask everybody in this House to support the proposal. I ask everyone in the country to support us also.
We know that some sectors, such as the retail sector, are offering bonuses to staff who are working at this time. Workers in our health service should see some kind of similar tribute for their work in their payslips on 1 May. This gesture would show healthcare workers that we appreciate their putting their lives on the line. We know they are going above and beyond anything they have ever experienced before, in many cases exposing themselves to Covid-19. Many are isolating themselves from their families. This brings about practical extra costs when it comes to accommodation, childcare, transport and meal provision. The staff do all they are doing so they can continue to treat patients while working extra shifts. As I know from quite personal experience, they sometimes do so without adequate personal protective equipment. I ask the Taoiseach to take that on board.
I acknowledge all the other workers across the country, including gardaí, firefighters, staff in An Post and all in retail who are ensuring the continuation of our supply chains.
In the time remaining, I want to ask the Taoiseach to do a few things. The people of this country are going through a lot and showing great solidarity. By and large, everybody is rowing in and agreeing to all the measures that are being put in place. We need, however, a vision from the Taoiseach as to how we exit this. I am not asking that he get everything right. In fact, he will not. I do not believe anybody here would say one word against him, but the people need hope and a vision. Grandparents need to know that one day they will hug their grandchildren again. Businesses need to know that circumstances will change. All of us collectively need to be part of helping the Taoiseach to achieve this. People need a vision and need it in the next ten days. The Taoiseach might think about that.
During the question and answer session, we will get to deal with a range of other issues. I have concerns over how banks are behaving. On the leaving certificate examinations, we need greater certainty. In particular, we really need to deal with the issue of personal protective equipment for healthcare workers. Up until last night, we were down to our last 1,000 gowns. A aeroplane landed yesterday evening that has ensured we now have a supply of gowns. We are just barely getting through and we need everybody to work harder to ensure we get the personal protective equipment. I know people are doing so.
I have repeatedly asked for something and do not know why it has not been delivered. We have a lack of capacity to hold the Government to account in these strange times. I am referring to there being no parliamentary questions and to the circumstances in which we have to work. Let me say, for the fifth or sixth time quite publicly but this time in this Chamber, that the Government has to publish the deal that was done involving it and the private hospitals. There are many components to this. What was agreed is quite confusing. Were consultants part of the mix? The cost is quite large. We need transparency on this issue, and we need it now. I have been asking for this repeatedly. Collectively, can we see what has been agreed so we can all look at it for ourselves and determine how best we can move forward working with the sector?
I congratulate Deputy Kelly and wish him well in his new role. I send good wishes to Deputy McDonald.
On behalf of the Social Democrats, I extend our deepest sympathies to the families of all of those people who, sadly, have been lost to this deadly pandemic. Again I pay tribute to our public health officials, to all of those people working on the front line in the health service, in supporting the health service in its important work, in the retail sector and in the delivery sector, and to all of those other key people who provide such important services to us at this very difficult time.
The public health officials have provided very good and sound advice to the Government, which the Government has followed. The Opposition has been happy, across the board, to support the Government in following that advice. It has proved to be very good advice. We are, however, moving towards a point at which we will need to involve other people in the advice and decision-making relating to those areas that go beyond the strict public health issues. I will talk about those in a moment.
I also want to take a moment to talk about what is happening in our nursing homes. I hope that, in the next session, the Minister for Health will respond with facts in respect of the questions we put down. It has to be a matter of serious concern when one of our leading consultants, Dr. Jack Lambert, refers to what is going on in nursing homes as a national catastrophe, and he did that at lunchtime today. There is no doubt we are exposing many very vulnerable citizens through a response that is not adequate at the moment, and that must be addressed as a matter of urgency.
When we look at the figures that we hear every evening, there is no doubt that those headline figures are slightly encouraging. They are beginning to steady a little bit, and we draw comfort from that. However, there is no doubt that, as the curve is somewhat flattened, it raises other questions about the strategy that is being pursued and in respect of testing and tracing. There is no doubt that strategy is not operating satisfactorily. The reason for that is there is a logjam at the level of the laboratories because of the shortage of the required reagent. Everything that is based on that strategy, including the 50 test centres, including the new test centres, and all of the staff who have been mobilised, is not being used at the moment because of this logjam in the laboratories. That is why there is a need for an intervention.
That intervention should take place at the highest political level in terms of engaging with the pharmaceutical industry and addressing the fact that this reagent is a proprietary material. The fact that it is owned by particular commercial interests when the world is trying to respond to a deadly pandemic is shocking and a disgrace. There needs to be intervention. We have many pharmaceutical companies in this country. There needs to be serious, high-level intervention with those companies to establish how we can secure adequate volumes of that reagent and, more importantly, if we can secure access to the chemical formula for that reagent, because we know there are many laboratories in this country that could produce large quantities of it if the formula was made available. It is entirely unacceptable that commercial interests are preventing that from happening.
The second area where I believe there needs to be intervention is in securing access to adequate personal protective equipment, PPE. I have already called for a forum on medical supplies to be established. We have a lot of manufacturing capacity in this country. Nobody has yet explained to me why we cannot produce large quantities of PPE, especially gowns, which are in such short supply at the moment. Again, we need to put such a forum together and to bring in all of those commercial interests. The HSE is working might and main to secure such PPE from different parts of the world, but we need to look seriously at what can be produced here and at what can be done domestically.
The third area I want to raise is the question of, as we get to a point where the curve is starting to flatten, what the exit strategy is going to be.
We have to start thinking about that. There are two approaches, namely, containment or eradication. We have seen where other island countries have had a lot of success by taking the eradication approach. We too are an island, and while the situation in the North of Ireland complicates this matter enormously, we need to do the cost-benefit analysis of restricting entry at our ports and airports. The questions are who will take the key decisions about when we might ease up on the restrictions, the basis on which we would do so, and how we will strike the balance between getting people back to work while keeping them safe. They are questions that need to be addressed in a much wider forum than that of public health. Clearly they need to be informed substantially by public health experts, but we need other people involved in that as well.
That is why I believe we have got to the point now where there is a need for a high-level task force to be established to consider all of those key issues that need to be taken into consideration in planning an exit strategy and to listen to the advice from across a range of different disciplines. It is now time to set up such that high-level task force. It must be led by the Taoiseach and must involve cross-party interests, but it must involve all of those other interests that can feed into this key decision that we have to take now in this country.
On behalf of People Before Profit, I extend my deepest sympathies to the families and friends of those who have lost loved ones to Covid-19. I pay tribute to the millions of people who, through their sacrifice and effort in physical distancing, have substantially impacted on the transmission of Covid-19 to protect the ability of our health services to cope. Most of all, I pay tribute to our front-line health workers and other essential workers who are protecting us and keeping us going. As Deputy Kelly stated, we have also for a number of weeks called on the Government, and I call on the Taoiseach again and the Government, to give specific reward or hazard payments to front-line health workers and essential workers who are risking their health on behalf of all of us. That is the least we could do for them.
I welcome the fact that the Government has accepted the need to answer questions, notwithstanding some fairly disingenuous condemnations of those of us who thought it was important that the House would sit and that Ministers would be subject to questioning at the previous sitting.
I begin my questions with a political one. How do Fianna Fáil and Fine Gael believe they are fit to return to power or that we should believe their promises of a new political departure, when after the previous financial crisis of 2008, they made the same promises but proceeded to savage the staffing and capacity levels of our health service prior to this public health emergency, to the point where we have some of the lowest levels of ICU capacity, GP cover, staffing and hospital beds in the whole of the western world? Is it not the case that the privatisation and austerity policies that were pursued for the past ten years by those parties have contributed to the tragic emergency that is emerging in our nursing homes because of a largely privatised, completely fragmented, under-resourced and undersupported nursing home sector? Is it not unacceptable but a legacy of the policies and priorities of those two parties that 600 private consultants can hold this country over a barrel, as it were, in the face of a public health emergency? It is absolutely shocking. Will the Taoiseach please explain to me the incredible situation where this country has one of the biggest pharmaceutical and medical equipment industries in the world, yet we are suffering chronic shortages of personal protection equipment, vital medical equipment and chemical reagents necessary to bring up the level of testing to that which we need to exit this crisis?
Mr. Paul Reid cites proprietorial issues as an explanation which in layman's terms means private patents and profit-seeking by the companies that own the patents for chemical reagents. Can the Taoiseach explain why a private consultancy with no medical expertise whatsoever was given the job of recruiting from the 70,000 heroic volunteers to Be On Call for Ireland and to integrate them into the health service? From the numbers, the job does not seem to be going too well in terms of integration. I am referring to CPL. Can the Minister explain the extraordinary appointment of a management consultant from the accountancy firm Ernst & Young to spearhead the ramping up of the testing and contact tracing regime, which we desperately need, rather than public health experts, scientists and medics? That same person has now been given the job of spearheading the transition back to "business as usual" rather than the public health experts, scientists and doctors who should be deciding when we lift restrictions, how we do so and how we transition back to the normality that our citizens desperately want, to the so-called "new normal". Those sorts of appointments suggest that nothing has changed in approach. This crisis should lead us on to a recognition that we have to depart radically from the policies of privatisation and of putting profit and commercial interests first that have left our health service completely under-resourced and under capacity in the face of this crisis. It is only heroic health workers and the efforts of our population that are saving us from utter calamity. I conclude on that point. My colleagues, Deputies Paul Murphy and Bríd Smith, will have more detailed questions. These are serious questions for the Government and I look forward to getting actual answers, which we have not gotten for the last four to six weeks in the face of this emergency.
We move next to the Regional Independent Group and Deputy Peter Fitzpatrick.
I welcome the opportunity to speak. First I give my deepest sympathies to the families and friends of all of those who have lost their lives to Covid-19 and give my sincere thanks to all of the front-line staff who have worked Trojan hard over the last number of weeks. There is no doubt we are living in unprecedented times. An invisible virus is attacking us that has no regard for age, race or colour and which does not recognise borders. As a nation we are trying to fight this invisible enemy and I hope we are winning that fight. Once again the people of Ireland have shown their resilience and determination in times of danger.
I wish to put on record my support for the actions of the current Government. I also welcome the support of the Opposition for the Government's handling of this crisis but I feel it is necessary to raise important issues and to hold the Government to account. One such issue is the discrimination against those aged over 66 in relation to the temporary Covid-19 social welfare payments. I strongly believe this approach is not only wrong but is discriminatory. Why should people over 66 be denied this payment simply because of their age? What are the reasons for this? I have received so many emails and telephone calls from people who feel they are being discriminated against simply because of their age. This is wrong and I appeal to the Government to take immediate action to ensure that people over 66 are not treated differently.
Regarding nursing and care homes, I am very alarmed at reports in the news. I do not want to cause any additional worries for families and friends of those in nursing homes by giving any details but I ask the Minister to make a statement outlining the current situation with regard to the safety of both staff and residents of nursing and care homes and the measures the Government is taking in this regard.
Another area where I believe we need to do more is the area of tourism. Tourism plays a major part in my constituency of Louth and in east Meath. To the north of the constituency we have the beautiful Cooley Peninsula and surrounding areas, while further south we have the Boyne Valley area with the seaside villages of Laytown and Bettystown. At this time of the year the businesses in these areas are normally in full swing and ready for the busy summer period. I am disappointed that the tourism industry has not been given targeted specific supports. The very fact that the businesses are seasonal makes them different from other businesses. Usually 80% of their income is earned during the summer months. I urge the Government to look closely at this and put in place specific supports for seasonal businesses.
There is no doubt that the economic impact of this virus is immense. Never before have seen such a dramatic and sudden impact on the economy. It is frightening to see my home town of Dundalk so quiet and to see so many businesses temporarily closed.
There is no doubt that the actions we have taken as a nation are necessary and that we have no alternatives. I wish to take this opportunity to praise my fellow citizens for the action they have taken to combat this virus. It is at times like this that we see what we are really made of, and I think everyone here today would agree with me when I say that the people have once more shown the true courage when needed. I highlight the efforts of those over 70 years who have cocooned in their homes, the efforts of people who have self-isolated, the efforts of those who have had to stay at home because attendance at their workplace was not deemed essential, and the effects on students who have had to continue to prepare for examinations at home. I could go on but I think it is fair to say that the majority of people have put their shoulders to the wheel and worked together to ensure we defeat this virus.
I wish to put on record my support for the actions of the current Government in its efforts to combat this virus. I hope the Government takes note of my comments relating to those over 66 years who are currently being discriminated against in respect of temporary Covid-19 payments. There is no doubt these are unprecedented times and I am confident that, as a nation, we will come out the other side stronger and more united than ever. We have the resources, willpower and determination to beat this. I believe that we are beating it and that we are close to seeing light at the end of the tunnel.
I would like to say a few words on Government formation. I am a member of the Regional Technical Group, and we have been in contact with the main parties on Government formation talks. I am pleased to see that the two main parties have reached common ground on a coalition. It is now time for the other parties to step up and engage in these talks. For us to have a stable Government for the next five years, one of the smaller parties will have to be involved. Speaking for myself as a member of the Regional Technical Group, we have all along shown our willingness to participate in talks that will deliver a stable Government. I urge all small parties to take a similar approach. There is no point shouting from the sidelines if there is an opportunity to make real change from within. Now is a time of real national need, and going forward, that will require strong political leadership and vision to ensure that this great country gets back on its feet.
I intend to share time with Deputy Carol Nolan. Ar an gcéad dul síos I offer my deepest sympathy to all 444 people who have died, to their families and to healthcare workers in Kilkenny. The most trying and testing work of all is the work of the front-line staff who go to work day in, day out.
I want to be associated with the remarks on, and congratulations to, my fellow county man, Deputy Alan Kelly, on assuming leadership of the Labour Party. I wish Deputy Brendan Howlin all the best. He always worked well with us on the Business Committee and was cordial at all times to me. I wish Deputy Kelly the best.
I have nothing against Deputy Kelly's suggestion about May day but it would suit us better if we looked after the nurses and front-line staff and provided the childcare that we promised to them. That is not happening. They are getting accommodation in hotels, and I thank John Allen in Hotel Minella and many others who offered and are giving these supports. We need to provide the workers with certainty for their childcare needs. We need to support and acknowledge our support for An Garda Síochána as well as all the front-line services and community groups throughout the country for the work they have done.
I was appalled and desperately shocked to listen today to Dr. Lambert. It had to happen. The Taoiseach mentioned the most vulnerable, the elderly and the weakest. They are the people who are in there.
None of us knows, any of us could be there at any stage. They have been left short on everything. It is appalling what is going on. Last night, I had a manager telling me on the phone that she was shocked and laughing at what was being said on RTÉ news compared with what she was told at a high-level meeting yesterday morning. They were two different scenarios. At the meeting she was told she was not going to get any support from the HSE staff. There are two things going on. One is PR and one is spin. We need that to be clarified. We need to look after those in the nursing homes and ensure they have the personal protective equipment, PPE. We must ensure there is honesty and transparency because we will lose support from the public which has been gallant so far in this regard.
I am becoming unhappy with the figures. When it takes three weeks to get figures back, how accurate are these figures pronounced every evening? Are they being manipulated? I am concerned about those areas.
Criticism was made of a pharmaceutical business in Clonmel. I salute David Anchell who has succeeded in getting many of the reagents into Ireland. Hopefully, this will be on stream by this week. Where Tipperary leads, Ireland follows.
I express my deepest condolences to all those families of those who have passed away and wish those who are very ill at this time well.
The challenges which our country and communities are facing because of Covid-19 are stark. While they are unlike anything we have experienced before and will be with us for many years to come, I want to commend our hardworking health staff on the front lines in our hospitals and nursing homes, as well as our GAA clubs and volunteers who are playing their part in assisting the most vulnerable in our communities.
I accept and commend the mitigation measures drawn up to address the catastrophic increase in unemployment, the effective collapse of the SME sector and the systematic disruption of the agricultural sector. That does not mean the Government has done everything correctly and got it right. That has to be pointed out, not to criticise but as part of a constructive engagement. Inequalities and anomalies in the new welfare entitlement regime are fast coming to light, particularly in terms of the age discrimination of those over 66 who are not able to claim the payment. Our carers, despite the great work of Family Carers Ireland, also remain uncertain about what payments they can access. That needs to be rectified. I have written to the Minister for Employment Affairs and Social Protection to sort out those issues.
Our nursing homes and other non-acute residential settings are experiencing great difficulties, along with transmission levels which are concerning. My thoughts are with the families of those who passed away at St. Fintan's, Portlaoise, at the weekend. I am calling on the Government to make sure that more protective supports and measures are urgently put in place to protect the staff and the patients at this facility, as well as every other facility across the State.
The emerging evidence from the long-term care policy network has highlighted the scale of the problems the sector is facing. Shortages of PPE materials or deliveries of unusable materials simply cannot go on. We must consider directing or mandating our production sector towards the delivery of PPE.
In the middle of this national crisis, the people of the midlands are facing major uncertainty around the future of Bord na Móna. I have recently been contacted again by many Bord na Móna workers on the timeline for the just transition strategy.
All the problems we faced prior to the Covid-19 crisis remain. Educational inequalities for children with disabilities, housing supply deficits, cuts to the CAP budget still need our sustained attention if they are to be effectively and fairly tackled. Whatever Government takes shape in the weeks and months that lie ahead will need to keep all of these issues on the top priority list.
I have only two and a half minutes, Taoiseach, so will zone in. I gave my support to draconian legislation where absolutely no attempt was made to contextualise such legislation within a human rights perspective or to frame the powers given to gardaí and undefined medical officers in order that such powers would be time limited and used in a proportionate and non-discriminatory way.
I gave my support reluctantly, on the basis of a number of issues. The first was that we would improve the legislation as best we could. The second was that we made it time-based. Third, we insisted that it would come back before the Dáil. The most important reason on which I based my consent is that we would have full and frank disclosure and full information on every issue from the Taoiseach and the Government. Significantly, and unacceptably, that part of the bargain has not been kept. I look at testing and the information on that is totally contradictory. As we all do, I know of people who have been waiting for tests, some for as long as four weeks on Saturday, in the case to which I refer. Another issue of concern is whether laboratories are functioning or not. On 1 April we were told that it was sufficient to meet demand. Perhaps the date is an indication of how we should take that piece of information.
I am absolutely appalled that nursing homes were not number one on the list to have a risk assessment carried out. On 30 January the public health emergency was recognised. On 11 February it was given a name, that is, coronavirus. On 11 March a pandemic was declared by the World Health Organization. I have not heard one simple explanation from the Government as to why nursing homes, direct provision centres and residential centres were not number one on the list given that our most vulnerable people live there or why an assessment was not carried out. I looked through all of the briefing documents prior to coming in here. I have eight from the month of April. Of all those briefing documents, we have two lines on nursing homes to tell us that screening would be introduced and it was never mentioned again. I hear on the radio and the television how many are dying in nursing homes. More than 50% of the deaths from coronavirus are in residential homes. At the very least the Government should keep its side of the bargain. I acknowledge the work the Government has done and thank it, but it is fundamental for democracy that the Government gives us precise and accurate information.
I send my condolences to those who have lost loved ones at this especially sad time. Death when it comes is always too soon, but in the current circumstances it is especially difficult for many of those who die in isolation and for their families, many of whom watch from a distance. Each of those statistics represents a life that is lived, ended prematurely and a family bereaved. We can never forget that. We can breathe a sigh a relief that for now at least, the curve is flattening. That curve represents all of those lives lost.
We can say that the response of hospitals and the acute services has been timely, efficient and of the highest standard. I recognise the great efforts of healthcare staff, support staff in the HSE, the Department and the Minister. I also include front-line staff elsewhere such as members of the Garda, those who work in supermarkets and volunteers. They all deserve our highest regard. However, it has become increasingly obvious that the care home sector, despite the valiant and at times almost superhuman efforts of those who work there, is in the middle of an escalating crisis. We will deal with the specifics later, but it needs to be highlighted in the strongest possible terms in these opening statements that an immediate crisis management plan must be put in place for those settings. The Taoiseach said we have no rule book, roadmap or manual for how to deal with this crisis. That is true, but we do have the experience of what happened elsewhere and we should have learnt our lessons. I do not want to add to the concerns and fears many families and patients already have but we have a responsibility in this House to all of those people, many of whom are invisible and because of their isolation are voiceless. It took people like Dr. Jack Lambert to let us know exactly what is happening. However, as I said, we will deal with that later.
I extend my best wishes to Deputy Mary Lou McDonald. I congratulate my former fellow MEP, Deputy Alan Kelly, on his election as leader of the Labour Party.
That concludes statements. We move quickly on to questions to the Taoiseach. The plan here is to have a minute for a question and a minute for answer. Will we take them one by one, back and forth?
As is often a challenge in this format, it is quicker to ask a question than to answer it. I want to answer as many as I can.
Will we take three questions and come back to the Taoiseach for answers then?
I have jotted down one, two, three four-----
I think we are doing it differently this time.
The proposal is a minute each.
It is like the normal Leaders' Questions.
I am in the Ceann Comhairle's hands.
Does the Taoiseach not get seven minutes at the beginning?
No. This is different.
I have just jotted down six questions that have been asked already.
You have no questions now; you are together.
All I can promise is I will answer as many questions as the time I am given.
We will take specific questions from each of the groups. There is seven minutes for the question and the answer: a minute for the question, a minute for the answer. That is what has been ordered. That is what has been agreed to.
To clarify, is it one at a time?
I am asking you now. Do you want to do them one at a time or do you want to take three?
No, sorry. We have two questions each. Is that it?
There are seven minutes in total for the question and the answer. That is, effectively, three and a half minutes for questions and three and a half minutes for answers.
Among us all?
No, per group. I can take three questions, and four if the Deputy is quick, from the Fianna Fáil group.
The first question I sent to the Taoiseach - we were asked to send them in writing in advance - was around the Government's response to the Covid-19 outbreak in nursing homes in terms of the steps that have been taken on such issues as personal protection equipment. Suffice to say - I would concur with most of what has been said in the House - initially it seems nursing homes were not in the frame or did not get the same focused attention as the acute hospital system did. If the Taoiseach remembers, at the outset the intensity was around the ICT infrastructure, the ICT capacity and what would happen if there was a surge. It seems that the nursing home side was left behind significantly. Notwithstanding that in the last fortnight there have been moves in terms of such matters as infection control, it seems that staffing is the core issue. There is a shortage of staffing. The delay in testing of essential healthcare staff and self-isolation meant staffing became even more critical. On personal protection equipment, PPE, we have all had repeated concerns about the absence or the shortage of PPE there.
Then there is the wider issue in terms of what some have talked about as the privatisation of nursing home care. In the last number of years there has been a reduction in the number of public care beds for the elderly. This has also happened in public healthcare settings. In the most recent case in terms of Maryborough psychiatric centre for the elderly, nine people have died over a three-day period. In Cork, in St. Finbarr's, for example, some weeks ago I called for transparency around that because there was a significant cluster there. There were significant concerns among the staff.
There are wider issues down the road that we have to consider post-Covid-19 but, essentially, on the issue of staffing, all efforts have to be made. Therefore, as home care is being pulled back, some of the providers there could be in a position to provide staffing if, for example, insurance issues and clinical indemnity were dealt with. The underpinning of the staffing issue is now the urgent requirement for many nursing homes. I would put it to the Taoiseach that is absolutely urgent and it is a matter of grave concern to all out there.
In terms of how this evolves, it is fair to say that there is still a significant degree of uncertainty around the virus and how it will evolve. We have talked about flattening the curve from the health perspective. Economists are now talking about flattening the trough of what will be a very significant economic depression ensuing here, Europe-wide and across the globe. The Taoiseach might indicate the internal thinking going on or processes in play in terms of working out how over the next number of months, in parallel with the health issue, the economic issue gets dealt with, notwithstanding, as I say, the challenges around uncertainty on that.
The key issue is testing and capacity to contact trace. There still are nagging doubts out there around all of that because of the various revelations that have happened over recent times in terms of figures, etc. I would appreciate if we could get the up-to-date position on testing and contact tracing.
I will answer as many of those questions as I can in the time allowed.
The matter of nursing homes and care homes is the burning, pressing issue at the moment and was the focus of this morning's meeting of the Cabinet sub-committee on Covid-19. That sub-committee, which was established over a month ago and is chaired by me, is the task force by which the crucial decisions are made on how we deal with this crisis. As the Deputy identified, a month ago there was huge concern about our hospitals and ICUs becoming overwhelmed, and about there being a shortage of ventilators. That has not happened - at least not yet - due, in many ways, to the public health measures that were put in place and the co-operation of the Irish people in flattening the curve. I thank them once again for that co-operation.
Today, the front line of this emergency is not just in our hospitals but also in our nursing homes and long-term care homes - public, private and voluntary alike. In some countries, nursing homes and care homes have been described as the forgotten front line. We need to ensure they are not the forgotten front line in this country, and they will not. They are very much at the front of our minds and actions at the moment. The kinds of things being done to shore up our nursing homes include a package of financial supports; additional PPE; more testing; extra staff, including staff being redeployed from other sectors of the health service; and the provision of expert advice on infection control. That is all happening, albeit not as much or as quickly as we would like. That is just a refection of the scale of the crisis and the amount that needs to be done by a relatively small number of people, who are being asked to do an awful lot.
We need to remember that this virus is in our community. Nursing homes and long-term care facilities are part of our community, and once in the community, the virus targets those who are old, infirm or have underlying medical conditions. For that reason, it is going to exact a significant toll on our nursing home population and the people who live there, as well as in long-term care residential settings. It is our job to make sure we minimise and reduce that toll and impact as much as we possibly can, by doing everything we can. This is a feature across Europe and the western world.
The latest figures show that just under 70% of deaths are occurring in hospitals, and around 30% or 35% in the community. However, many people move from nursing homes to hospitals when they get sick and subsequently die there.
The issue of congregated settings, such as nursing homes, homeless shelters, direct provision accommodation centres, and long-term care residential centres, has been always either on the agenda or been a topic for discussion since the Cabinet sub-committee was set up, and certainly since I have been chairing its meetings. The risks associated with such settings were identified early on, as were ICU capacity, the risk of infections spreading in schools, and travel controls. Identifying a risk is easy, but acting to mitigate it is much more difficult, and this is a very challenging issue. It was a topic for discussion at meetings of the national public health emergency team, NPHET, long before the Cabinet sub-committee was set up.
As the Deputy pointed out, our nursing homes are a mix of public, private, and voluntary. We have trouble in both the public ones and the private ones. I have seen no evidence as of yet that cases are more common in private homes over public ones or vice versa, or that the death rate is higher or lower in either. We need to be careful and responsible in our remarks on this issue because there are people in care homes and nursing homes who are really worried now. They are terrified about getting this virus, their relatives are terrified for them, and we need to be responsible in our commentary around this issue. People in nursing homes and long-term care homes are doing the best they can, but even with copious PPE, good staffing levels and doing all the right things, once a virus gets into such a setting it is very difficult to contain it.
My first question is on the same issue I raised earlier, namely, that of nursing homes. We learned last night that eight people died from Covid-19 in the Maryborough Centre in Portlaoise at the weekend. There are 200 clusters of the virus and more than half of those who have, unfortunately, died as a result of the virus have died in these types of settings in care homes across the State. It is a massive issue, which we need to address, and we need some transparency on it. Staff in the sector have been raising serious questions, relating to PPE in particular, for quite some time. When we speak to HSE officials, they tell us there is nothing to see here, but unfortunately we know from some of the revelations that there is much to see.
The Nursing Homes Ireland survey showed that nearly one third of facilities were still awaiting PPE supplies and a quarter of those that had received them stated that they were not fit for purpose. We know that staff at the Maryborough Centre were raising concerns publicly about PPE two weeks ago.
Will the Taoiseach give us more specifics about what is being done to deal with what is now a massive challenge for us in the nursing home sector? Will the Government publish information on the PPE that has been provided to such settings? Will staff be deployed today, tomorrow or some other time to support the efforts to contain the spread of the virus and to support the staff?
Did the expected second tranche of PPE that the Taoiseach informed us was due to arrive on 12 April arrive? I understand that it might not have done so. The shipment was worth over €60 million. Is it delayed or has it arrived and, if not, when will it arrive?
I am sure Deputies appreciate that some of their questions are going to be very specific and I may not have the answers to them. I absolutely agree with what Deputies have said, that transparency is really important here. If we want to keep the trust of the people, we need to be transparent, but I would also ask for understanding from Deputies that we do not always know the answers to the questions that we are asked. A lot of things are happening in real time at the moment, and one thing we do not want to do is answer a question or put a number or statistic out there only to find out shortly afterwards that it was incorrect. I know in particular that our doctors and experts have a concern around that. They do not want to put statistics and information out there that may turn out to be incorrect. There is so much happening at the one time it can be hard to get the information out there.
As regards decisions that are made on social distancing, on school closures, on visiting nursing homes and hospitals, which Deputy Doherty mentioned earlier, these are all made on the advice of the Chief Medical Officer, CMO, and the National Public Health Emergency Team, NPHET. These are our doctors, our scientists, our experts. They might not always be right - they have to make their decisions based on the science and information available to them - but I do think we should support them, I do think we should trust them, and I do not think that we should say anything that might be perceived to undermine them in any way. The decisions the Government makes on all these areas are guided by the advice from those doctors, those experts, those scientists, and we publish their advice as we make those decisions.
In terms of PPE, this is absolutely essential to protect staff - we all know that - and also to protect patients from getting infected by staff, which can happen too. We have ordered about €200 million worth of PPE. Just to put that in context, that is a 13-year supply of PPE. It is an absolutely enormous amount. Thirty plane-loads from China are coming. It is not all coming from China. Some of it is coming from Ireland, some of it is coming from other parts of Europe. Thirty plane-loads are due, and they are coming one by one. There are delays on and off that are not necessarily under our control. Some Chinese provinces have now brought in customs checks where they want to check the quality of the PPE before it leaves the country. We have been checking it when it comes in, but that change is creating a delay that we would not have anticipated a day or two ago.
In terms of masks, aprons, gloves and all those things, I am told that we have a good supply. Of gowns, less so. We have enough, but a much shakier level of supply. This is a problem that absolutely every country is facing. There is a global shortage. Countries are gazumping other countries, offering to come in and pay cash and buying for a higher price PPE that has already been ordered. There are new companies now getting involved in making PPE, which is a great thing because there has been a massive increase in demand. New companies all over the world, including Ireland, are now getting involved in making PPE, but there are difficulties. That does create problems with quality and delivery. If a company is making something for the first time, it does not always get the quality right. If a company is doing something for the first time, it cannot always honour its commitments when it comes to delivery. That is just the reality of the situation.
We have also had an issue with donations. Donations are very welcome, but unfortunately donations, particularly where they are dropped off at a hospital or dropped off at a healthcare facility, are not always checked and are not up to standard. People have seen that the arms on PPE gowns were only three quarter length. That was a donation.
I believe that is time, Taoiseach.
We are dealing with all of these things in real time, and it is very challenging.
We are pressed for time within the seven minutes. My specific question was on whether the second consignment worth €60 million plus had arrived on 12 April. I assume it has not. Will the Taoiseach give the House an update on when he expects that delivery to happen?
I also asked about the staffing issue.
Let me tease that out a bit. Obviously, there was a major-----
There is no time to tease it out because there is just a little over-----
This is the question. There was a major initiative to be on call for Ireland and 70,000 people responded. We see from some of the figures that more than 1,000 people have been interviewed. How many of them have been recruited and are in position? I know from my wife's experience that she reregistered as a nurse a month ago and received one call from the be on call for Ireland initiative, which was last Saturday. She decided not to wait for that process and to go directly to the HSE to offer her services. Even today, a month later, she has still not been offered a position, despite the fact that nursing homes and acute hospitals throughout Donegal and throughout the State are under huge pressure because of staffing.
This is not an isolated incident. We have many other examples, including one of my colleagues, a Deputy, who also answered that call but has not been contacted to date. Is there an issue with how this process is working? There is a huge amount of goodwill from people who are willing to go back into the service to assist people on the front line but they are not getting a call up at this time.
I am sorry but the Taoiseach has no time to answer. We must move to Deputy Alan Farrell.
A Cheann Comhairle-----
If you consume all the time asking the question, there is no time for an answer. We have ordered seven minutes and the seven minutes have elapsed.
With the indulgence of the Ceann Comhairle-----
No, resume your seat.
-----the previous speaker went to eight minutes, so if the Taoiseach could answer the question with the one minute flexibility the Ceann Comhairle gave-----
The last one did not go to eight minutes.
It did not. I call Deputy Alan Farrell.
Like others, I express my condolences to those who have lost loved ones in recent weeks. I thank the front-line medical personnel who have done exceptional work on our behalf. I have one question, which is on the theme of care homes. It has been covered already but I ask the Taoiseach, and Members of the House, because it is not a question the Taoiseach alone can answer, given the circumstances we are in at present, that a real and lasting collective effort be made to ensure care home facilities throughout the State are of a standard suitable for the treatment of vulnerable persons. I particularly reference hygiene. We have an awful lot of public and private care facilities throughout the State which are in very antiquated buildings and which house our nearest and dearest, who are individuals who have put in a lifetime of effort into the country and their families. It is appropriate that the House would consider how we might support that sector and improve public and private facilities throughout the State to ensure even the annual flu season is tackled in a most appropriate setting, but also most acutely, in this environment during a pandemic, that we are mindful of what investment we can bring to bear as a Legislature in future to ensure these facilities throughout the State are up to a standard with which we as individuals would be happy, never mind the tens of thousands of persons housed in them.
Are there any other questions from Fine Gael Members?
I have two very brief questions. A number of people have mentioned the issue of a co-ordinated response to when we might move out of the restrictions process. Will the Taoiseach detail what engagement he has had with either the President of the European Commission, Ms Ursula von der Leyen, who set out the roadmap, or with the British Prime Minister or Government on how this could be co-ordinated?
With regard to the provision of childcare raised by Deputy Mattie McGrath, will the Taoiseach update the House on what stage we are at regarding the provision of childcare not just for front-line staff but other essential workers who are coming under pressure?
I call Deputy Bernard Durkan.
I wish to make a point. All parties were instructed to have two Members in the Chamber at a time. We could all come in here with our full membership and ask questions in the seven minutes. I will not delay proceedings but for the next time that we meet, I ask other parties, given the predicament we are in, that only two members of each party partake in each session. They should then step out for the next session.
Deputy Ó Snodaigh's point is absolutely valid.
Notwithstanding the major economic challenges that are emerging now and will remain for a considerable time after the virus has been dealt with, can I be assured that we will not take our eye off the magnitude of the health and social issues that will continue for an equally long time?
The Taoiseach has just a little more than three minutes.
I will do my very best, a Cheann Comhairle. In regard to care homes - the nursing homes and long-term care residential facilities - it is important to acknowledge that they are homes. These are people's residences. It is where they live. It is not the same as an acute hospital, for example, but there are standards and it is a highly regulated sector. The regulator is the Health Information and Quality Authority, HIQA, which carries out regular inspections and produces regular reports on how care and standards can be improved in those nursing homes. Some are very new, and the new ones tend to be single room only. Obviously, if they are single room only, just as is the case in any residence, it is easier to isolate and manage infection. However, some are also very old and will often have people sharing rooms and in that scenario it is more difficult to control infection. There is an ongoing programme to upgrade the public nursing homes. The standards for the new private ones are very high.
In terms of EU guidance, there is EU guidance just released yesterday on the steps that a government might take to reverse, release or ease restrictions but the paper, while it gives guidance, acknowledges that it is ultimately down to each member state to make the decisions for itself and each member state is at a different point in the pandemic and each member state is different in many different ways. However, the three areas that I believe have to be looked at, and these are set out in the paper, are, first, the epidemiology data. Are the number of cases coming down? Are the number of hospitalisations stabilising? Are the number of ICU cases going down? Is the death rate stabilising or going down? That elates to the epidemiological data.
The second area that we are called to look at is health service capacity. If the measures were to be relaxed and if there was then a spike in infections, as we have seen in Asia and other places, do we have the capacity to deal with that - the ICU beds, ventilators and all the rest of it? The third area, which is crucial, is whether we have the testing and contact tracing capacity to spot the outbreak or the spike if that were to occur again. Those are the kind of things we need to have in place before we can set out a roadmap towards easing restrictions. Ideally, we would like to do that before the end of the month, or certainly before 5 May, to be able to set out a roadmap to ease the restrictions in very clear steps with clear criteria that people can understand but always understanding that it might have to change because the science changes. This is a virus that only got a name two months ago, as one Deputy mentioned, and has only been testable since three months ago, and we also must recognise that we may have to reverse measures over time.
One advantage I believe we have is that we are a few weeks behind other countries in terms of the epidemic and we can watch what is happening in Italy and Spain, Austria, the Czech Republic, Germany and so on, in the same way Australia and New Zealand, which are probably four weeks behind us, can watch what is happening here. We always need to be very careful about comparing countries because each country is at a different point in the cycle but Deputies will be aware that schools are now opening in Denmark and some shops are reopening in Italy and Austria. We will have two weeks of data from those countries before 5 May, which will help to inform us as to whether those actions have been wise.
I am mindful today that, in raising the matter of the health of front-line workers, in my constituency the lives of two healthcare workers in St. Luke's hospital, Kilkenny, were taken this week by this virus. I would like to extend my deepest sympathies to the families, the colleagues and the friends of the people who tragically died. May they rest in peace. Their passing brings into sharp focus the daily risk faced by our healthcare and front-line workers here and across the world. Many have lost their lives trying to save the lives of others. Their selfless actions need to be met by all of us through collectively acting to stop the spread of the virus in our community. While gestures of solidarity such as shining a light, putting out flags and rounds of applause are important and appreciated by our front-line workers, the most effective thing we can do is to stick rigidly to the plan, stay at home and maintain social distancing.
At a later date, when we leave the eye of the storm, we might consider holding a national day of reflection on the sacrifices of our front-line workers, but for now we mourn their loss and we thank them for their work.
In light of the events of this week I wish to focus on the employee assistance and counselling service, EACS. This is a free, HSE-funded service in the community, hospital and health settings. I pay tribute to the team within the EACS programme, a small but dedicated team that offers a broad range of counselling and psychological support services to HSE staff at all levels. These range from psychological first aid, an important check-in service to front-line workers, to more structured video and telephone counselling in accordance with social distancing. It is clear that the well-being of staff is placed in high regard, not just during this crisis but at all times. It is important that the Minister addresses the gaps that exist in this excellent service. If there are geographic areas not covered by the EACS, it is vitally important that these resourcing issues are addressed. It is important that the hybrid model of staff well-being under the EACS, which draws on the resources of external counsellors to provide 24-7 services, is available and, critically, is communicated to staff in every hospital and facility in the State.
Critical incident stress management is another important area and is core to the interdisciplinary approach to staff well-being. A constant process of checking in with staff seems to me to be very important. It is about embedding resilience in the system to minimise burnout and undue stress.
It is important to highlight the availability of such vital services, to thank all of those involved in supporting their coworkers and to ask for the gaps to be filled and for sufficient resources to be made available regardless of geographic area. The use of local community and voluntary services could be of assistance to those in the wider community. This could be co-ordinated by local community response teams, liaising with community call teams in each local authority area. Local community and voluntary mental health and bereavement support services could offer additional services to families who have been bereaved, either because of the coronavirus or other causes, and are unable to celebrate the life of a loved one due to current restrictions. In advocating a role for the community-based support service I must once again stress the importance of keeping the doors of our voluntary services open, given that fundraising opportunities for such services have all but dried up since the crisis hit. These services are vital if we are to emerge from the health and social care phase of this pandemic.
I also wish to raise the issue of masks. There are now hundreds of groups drawn from Suas, the Irish Countrywomen's Association, ICA, and other community organisations throughout the country who are making homemade cotton masks for free distribution. The World Health Organization, WHO, and the European Centre for Disease Prevention and Control have endorsed the role of masks in reducing infection. Countries such as Taiwan and Vietnam have vastly lower numbers of infections than neighbouring countries, due in some part to the wearing of masks. I am of the view that the wearing of masks could help gradually to ease the restrictions and I ask for clear guidance on this from the Government.
Finally, I continue to wish the Taoiseach and our Chief Medical Officer, Dr. Tony Holohan, and the Government well in their continued work. I appreciate the cross-party support.
I wish to endorse the Deputy's comments about the need to protect the health and mental health of our HSE staff. The points he made were very relevant and well made. They are issues I bear in mind every day, knowing so many people who work in our health service at the moment and knowing the pressures they are under.
Many of us will have been following the debate around the wearing of face masks. There is no dispute that people who have symptoms or are sneezing or coughing should wear a mask in order to reduce the chance of passing the infection on to others. There is no debate about the fact that people in healthcare settings caring for patients with Covid-19 should wear masks and in particular circumstances should wear respiratory masks. There are differing opinions and the experts do not agree on whether masks or face coverings should be worn more generally. Some say it is effective, some say it is not effective. Some even say it can be counterproductive, particularly if people are not changing their masks regularly, do not wash them, hang them around their necks or touch them. The jury is totally out on whether it is a good idea for the asymptomatic population to wear masks in public, but the trend certainly seems to be going that way. Whether that is backed up by science is more questionable. As a Government we will be taking the advice of the national public health emergency team on that question. This week it is once again considering what advice we should give on the wearing of masks. We definitely need to make sure that we do not create a supply problem where masks are concerned. At the moment we have a lot of masks for our healthcare staff and those who need them.
We do not want everyone in Ireland to wear 4 million masks a day because we would then have a shortage of masks for our healthcare workers. We must bear in mind all of these different issues, constraints and priorities.
Deputy Pearse Doherty asked about a particular delivery and I will have to check the details of that. Different deliveries are being made all the time. There are 30 deliveries due from China and I am not sure if one came in last night or not. Other deliveries are due from Ireland and other EU countries. An issue has arisen with deliveries from China as a result of new customs controls that have been imposed by the Chinese provinces to check the quality of products before they go out. That will cause a delay in some of those deliveries which we were not aware of until the past couple of days.
Bearing in mind the time allocations, I will try and make these the best 15 seconds ever. I ask the Taoiseach to consider a mechanism whereby front-line and essential workers who have died due to Covid-19 will be formally acknowledged by the State and a mechanism to ensure that the families of such workers are not left in a worse financial position after the death of their family members. These are people who knowingly and willingly risked and lost their lives for the good of the country, and the Irish people would like the State to give special recognition to these front-line casualties that would stand the test of time. There may also be a role for the Office of the President in this. We have a duty to ensure that the families that those people left behind are looked after.
That is a good suggestion. It is something we will need to address appropriately and at the right time. We will recognise all of those who have died as a consequence of Covid-19, but particularly those who worked in healthcare and put themselves at risk in the way that such workers do every day. There are death-in-service arrangements in place for healthcare staff who pass away as a result of coronavirus and I have asked the chief executive officer of the HSE to review those arrangements and see if there is any way we can enhance them, given the circumstances.
I will go through my questions quickly if the Taoiseach could answer them in the order in which they are asked. Will the Taoiseach publish the deal that has been made with private hospitals? I do not know why there is so much secrecy around this because the deal should be published. Will the Government do so immediately so we can all look at it?
I share some of the concerns about testing that were expressed by others, particularly Deputy Shortall. A number of weekends ago, we ran into an issue about the reagent which has continued. That is a worldwide issue. Can the Taoiseach assure the House that, at the time those issues arose, we had enough of the other instruments and testing kits? I ask the Taoiseach to verify that we had everything else and the issue only related to the reagent.
Issues about staffing and personal protective equipment in nursing homes have been aired on the floor of the House. I agree with the points that have been made. The HSE has taken those issues on board and there was no suggestion that nursing homes, particularly private ones, were being left to their own devices. Can the minutes of all meetings within the HSE relevant to that matter be published?
What plans are in place to deal with the rent debt that will be in place, in three months' time, for thousands of people across the country? Has any progress been made on the deal that has been done between the banks and the Minister for Finance, Deputy Donohoe, about mortgages? Nothing has been happening in some cases.
What is the Government doing to ensure that the insurance sector will pay out for businesses that had to close because of coronavirus?
Has the State Examinations Commission stated when it will mark the leaving certificate examination papers, when results will be produced, when the process under the Central Applications Office will take place and when third level education will begin?
There were pertinent questions there and it will be impossible for me to answer them all in two minutes. It always takes less time to ask a question than to answer it properly. The Minister for Finance, Deputy Donohoe, might come back to Deputy Kelly on the questions about banks and insurance companies.
The Taoiseach has four minutes to respond.
I will do my best to answer as many of Deputy Kelly's questions as I can. The Minister for Health, Deputy Harris, has informed me that he intends to lay the agreement with the private hospitals before the Dáil. I am not sure when he will be able to do that but that is his intention.
On testing, Deputy Shortall said there should be engagement at the highest level of government with the big companies. That has happened and is ongoing. I spent a decent amount of my time over the past couple of days and weeks ringing CEOs of pharmaceutical and medical devices companies asking, imploring and encouraging them to make more equipment available to us. That continues.
On the reagent, although it has been cited otherwise, I am advised patents and intellectual property are not the issue. The issue with reagents, which are made by many different companies in competition with each other, is simply down to massive demand versus limited supply. In the conversations I have had with the HSE and the CEOs, I have learned that patents and intellectual property are not the reason for the lack of supply. It is that the huge demand exceeds the supply.
On testing, we are not where we would like to be, nor where we expected to be at this stage, but things are improving and have improved a lot in the past week or so. Relative to other countries, we are doing very well. More than 90,000 tests have now been completed, covering roughly 2% of the population. We are very much in the top tier of countries when it comes to testing but we are going to test more. The backlog that existed is now largely cleared. There is demand for roughly 3,000 tests per day, which we have capacity to do. There is capacity to do more but the next step will be to widen the case definition again. When the case definition is widened again, we may run into problems again if there is a big spike in demand. We need to be honest with people about that and to be frank that we will have problems on and off when it comes to testing over the next weeks and months.
At various points over the past month, there have been shortages of swabs. At various points, there have been shortages of testing kits, reagents and laboratory capacity. It is almost like whack-a-mole. There are all these capacity constraints, and each time we try to widen one, another one arises. I ask people to bear in mind that this is a virus that did not exist three or four months ago. It did not have a name two months ago. We have been able to test it for only two or three months. This country, every other country and every health system has had to ramp up testing very rapidly in a way that would not normally be done. We are under constraints as a result. We have 90,000 tests done, however. We are very much in the top tier in the EU, or in the top four or five, in terms of the number of tests done per million of the population.
I was asked whether we can publish a catalogue of what personal protective equipment has arrived. If we have that information, we will be able to share it with the House. I have seen tables of what has arrived and what is due to arrive but I do not know how accurate they are. That is just the nature the environment we are in. If we are able to share the tables with Deputy Kelly, I will certainly have no difficulty doing so.
On banks and insurance companies, engagement is ongoing with the banks. The Minister for Finance, Deputy Donohoe, is leading on that. Perhaps he will be able to report on it a little later. The same applies to engagement with the insurance companies.
On the leaving certificate, the Minister for Education and Skills announced last week that the leaving certificate would go ahead but that it would be postponed until late July or early August of this year. The view is that there will be sufficient time then to correct the papers and allow this year’s current sixth year students to begin their college terms. That will probably be late. It will probably be October or November. As soon we have more information and certainty around that, the Minister will put it in the public domain. We very much appreciate that there are 60,000 students preparing for their leaving certificate examinations who have been very badly disrupted by Covid-19, who are very worried about this, and who want certainty about their exams and future.
I will ask my questions first, before the time is gone. I said earlier that the shortage of reagent is the most critical issue to be addressed because everything else hinges on it. I have spoken to people in the scientific community here, and they have been very clear about the fact that two pharmaceutical companies, both of which have plants here, namely, Roche and Abbott, are the companies that possess or own the patent or formula.
It is just unbelievable that should be the case and that it is holding up the response not only in this country, but in others. The Taoiseach has said he has made some contacts; I do not know what they are. Are those companies being approached at a senior level to request that the formula for the reagent be made available? Scientists say that there are many laboratories in this country which could manufacture large quantities of the reagent if they had the formula. That would be the silver bullet. Has the Taoiseach made such an approach and, if so, what kind of a response has he got?
Unless we get to the level of 15,000 tests a day and develop capacity for end-to-end testing with fast turnaround, we will not get to the point at which we can consider lifting the restrictions. This has to be the number one priority. What is the Taoiseach doing about this? What is his strategy for getting to the point at which we will be able to do 15,000 tests a day? When does he expect that day to arrive?
I talked about the need for a task force to start planning the exit strategy. The Taoiseach told us that there was a Cabinet sub-committee and that this was the task force. That is not a task force. I am talking about a high-level task force that would draw expertise from a whole range of areas which would play into the critical decisions that need to be taken. When I talk about a cost-benefit analysis I mean "cost" in many different ways including social cost, economic cost and mental health cost. Many different issues play into this. With all due respect, a Cabinet sub-committee does not have that kind of expertise. We need to start planning for the exit strategy now, regardless of when it will be used. The fact is that it will not be used until we can do 15,000 tests a day, which brings us back to the question of the reagent, showing that all of these things are connected. Will the Taoiseach consider establishing a task force to plan such a strategy so that the country can start working its way out of the enormous restrictions that apply at the moment? As of now, all we are being told is that we are succeeding in flattening the curve but once restrictions start to be lifted that work will be undone. What exactly is the strategy?
It is hard for people to stomach the statement that there are copious amounts of PPE when care workers in facilities right across the country are being put in danger every day because of the absence of adequate PPE. Home help workers and home care workers are also being put in that terrible position because of an inadequate supply and inadequate distribution. The Taoiseach should correct what he said in that regard.
I am not sure of exactly what I said but if I was off-beat or inappropriate-----
The Taoiseach said there were copious amounts available.
-----I do apologise. I am happy to clarify. I believe I said there is a large amount of some items available but that there is a shortage of other items, such as gowns. It is not just a case of having supplies in the HSE's warehouses; they must also be distributed to all the different centres and people and then replenished because, obviously, people use them. Systems need to be in place not only to order supplies and to get them into the warehouse, but also to get it to 3,000 to 4,000 sites around the country. Those facilities themselves need to get it to the different wards, departments and individuals, such as home helps, who may need it. Again, I am not sure what the objection is but I make the point that just having the supplies is not the solution; a whole network is needed to distribute them to the different sites and to individual staff members. These supplies also need to be replenished. An effective system to tell one when stocks are getting low is also needed. It is a huge operation. Given that we anticipate using in the course of a few months what would normally be used in the course of 13 years, the logistical challenge is evident and should not be dismissed or downplayed by anyone.
The issue of reagents is just one of the potential bottlenecks that can occur in testing. Others can be, for example, shortages of swabs, the functioning of testing centres-----
They are not occurring currently. I ask the Taoiseach please not to talk down the clock. Will he answer the question?
-----the availability of testing kits and systems in which to get people their results. There may be a change in the next few weeks, for example, whereby an antibody test may become available. While no effective antibody test is available at the moment, it may become available next month or the month after - nobody knows for sure - and that would move from a swab test to a blood test. Circumstances are changing dynamically all the time, and what was an issue a day or two ago might not be an issue today but may become an issue in a few days time.
On reagents, we have made approaches directly to both Abbott and Roche, which are two of the big companies that provide testing equipment. I am learning a lot about the matter, as many people are, and one thing I have learned is that different machines use different reagents. For example, in the case of one Roche machine, the Cobas 6800, there is no shortage of reagent, whereas for a different machine, whose name I cannot remember, there is a shortage of reagent. We are getting more of the reagent for the latter machine and a new model of the machine for which there is not a shortage of the reagent. One advantage of bringing Enfer, the veterinary lab, online is that it uses a whole different system. It is never in any way as simple as may be represented sometimes in commentary.
What about the task force?
I would welcome a written proposal as to how that would work.
Has the Taoiseach given thought to it? Does he not accept that a multi-disciplinary task force is required? We need to bring in expertise.
If I could answer that question in terms of structures, we already have a lot of structures and they are operating effectively. We have the national public health emergency team, there is an expert advisory group, and we have a Cabinet sub-committee, which has access to expertise. Of course I am willing to consider any proposal for an additional structure or task force, but I would have to understand exactly what it is, how it would work and who would be on it. I am very open to considering that but would need to see some sort of detailed or fleshed-out proposal, or would welcome one anyway. I am sure I could come up with one myself but I would certainly welcome a fleshed-out, considered suggestion.
Does the Taoiseach agree with Dr. Jack Lambert that we have a national emergency in our nursing homes and that leaving individual private nursing homes to be responsible for staffing regimes, infection control and supply of PPE, as the HSE guidelines have done, was a "huge disaster"? Does the Taoiseach agree that it is part of a process of privatisation and of not having nursing homes as part of a national health service, and that the agency staff being underpaid and living in overcrowded accommodation while working in multiple homes is a factor in that?
Finally, will the Taoiseach agree that the Government should provide a procedure for workers in residential care facilities to confidentially report breaches of HSE guidelines to HIQA, and does he agree that the HSE guidelines should be augmented in order that staff will not live in overcrowded accommodation or rotate between different residential care facilities?
I did not have time to jot down all the Deputy's questions so I ask him to repeat them if I miss any. I absolutely agree that the coronavirus is a national emergency. The Government declared the emergency some time ago, and that emergency exists not just in nursing homes and care homes but also in hospitals and the community. It is a health emergency and an economic emergency, and it could yet become a fiscal emergency. I do not believe, however, that the emergency is confined to nursing homes. It is a wider emergency than that.
As for the nursing homes in Ireland, as is the case in most countries and as has always been the case in Ireland, we have a mix of nursing homes. Some are provided directly by the HSE, some are voluntary, while some are private, for-profit nursing homes. I have yet to see any evidence that indicates that the proportion of cases in nursing homes that are private versus public is higher, or vice versa, or that the number of deaths per population in private versus public is higher or lower. I know that people have views on the matter but I like to base views and opinions on facts, and I have yet to see any facts that show that the private or public ones are performing better or worse than the other in terms of the numbers of cases or deaths.
Again, I ask people not to jump to those kinds of conclusions if the facts are not there and to be responsible in their commentary. As I said earlier, there are lots of people in nursing and care homes who are terrified of getting the virus and lots of their relatives and friends are worried for them. We should make sure that what we do and say is entirely fact based.
I will ask the question again-----
Hold on Deputy-----
Does the Taoiseach agree with Dr. Lambert when he says that leaving individual private nursing homes with responsibility for staffing regimes, infection control and the supply of PPE, as the HSE guidelines have done was a "huge disaster"? Does he agree with that or not?
I cannot give the Deputy a straight answer to that because I do not know if that is correct. I would have to check the HSE guidelines. I am not sure if that assertion is factually true. It may be correct but I would have to check as to whether it was left to nursing homes to provide their own PPE. My understanding is that the HSE has been providing PPE to private nursing homes. It is my understanding that there are regulations around staffing schedules; they are HIQA regulations, not HSE ones. I would honestly have to check as to whether those assertions are true or not before I could say whether I agree or not.
I wish to move to the deal with the private hospitals. It is reported in a newspaper today that the estimated monthly cost of the leasing of private hospitals will be €115 million. Is that accurate? Again, I seek a simple Yes or No answer, not a kicking to touch that something will be published at some time. Is it accurate that €115 million will be given per month to private hospitals? If it is accurate, is there a profit margin built into that? In other words, are some people going to get rich off of dealing with this massive health emergency?
That is an estimate so it is as accurate as any estimate can be, if that answers the Deputy's question. It may be right or it may be wrong. It is an accurate estimate but it is not necessarily what the actual cost will be because we will not know that until the end, when the costs are calculated. The agreement made between the HSE and the Private Hospitals Association was that this would be done on a not-for-profit basis; the agreement is for the covering of the costs of the private hospitals
The Taoiseach said on St. Patrick's Day that the bill will be enormous in terms of the immediate health costs as well as the economic consequences that flow from that. Obviously a key question is who will pay that bill. The attitude of the Government and what has happened so far does not make one particularly hopeful, particularly when one looks at the approval of the change by Revenue to the rules governing tax exiles so that they are not discommoded by the corona virus crisis and are able to continue with their status. Will the Government drop its appeal to the Apple tax ruling and seek to access some or all of the €14.3 billion in the escrow account to use in the context of this crisis?
Finally, I will repeat a question posed by Deputy Boyd Barrett earlier. Why on earth is Ernst & Young, now called EY, the former auditor of Anglo Irish Bank, involved in the drafting of a plan to get back to "business as usual"?
The answer to the question on Apple is No. It is a very disingenuous question and solution. The truth is that whether the State withdraws its appeal or not is irrelevant because Apple is appealing the judgment as well. This will continue to be a matter for the courts for many years, no matter what the Government does. The money has been collected but it is in an escrow account controlled by the Bank of New York Mellon. No Government of any colour or any party, led by anyone would have access to that escrow account which is controlled by the Bank of New York Mellon. Those who are claiming that there is some mechanism by which we could access those billions is just being entirely disingenuous. The public deserves better than fake solutions from people.
I missed the Deputy's second question-----
I asked about Ernst & Young.
I will have to revert to the Deputy with the details on that but my understanding is that somebody who works for Ernst & Young has been retained by the HSE. I forget her name but she has been retained by the HSE as a project manager. The view of the CEO of the HSE, Mr. Paul Reid, was that we were asking the scientists and the lab managers to do too much. We were asking the same person, Dr. Cillian De Gascun, a great man who runs the National Virus Reference Laboratory, NVRL, also to project-manage the ramping up of testing across the entire country.
We can only ask one person to do so much. An experienced project manager was brought in from the outside to do it. That is how it came about.
I will not go over many of the questions asked already about the health system and personal protective equipment. I have four quick questions and I will go through them fairly quickly. The Taoiseach might answer them all together.
The small and medium-sized, SME, business sector will be crucial to the kick-starting of the economy. It has been the hardest hit. Almost 1 million people have been employed in the SME sector. What assurances can the Taoiseach and the Government give that everything that can be done will be done to ensure these businesses will be able to open up and rehire their staff when these restrictions are lifted? The same applies to the hospitality sector. In Ireland it has been one of the hardest hit and it is likely to be one of the last to reopen. Hotels, bars and restaurants employ up to 300,000 people with a further 100,000 employed during the peak summer months, most of whom are students. In my native county alone, more than 27,000 people are employed in the tourism and hospitality sectors. A vast amount of revenue is generated in this sector from overseas visitors but it is unlikely to operate to any degree again this year. What specific plans are in place to help kick-start the tourism and hospitality sectors?
My next question was raised earlier. A significant number of people over 66 years of age continue to work, pay tax and contribute to the economy. Many continued to work for financial or family reasons. People who can prove they were working and lost their jobs directly as a result of the Covid-19 pandemic should be allowed to top up their State pension to the rate of the Covid-19 unemployment payment. Can the Taoiseach outline the Government plans to do this? It is a fair question to ask if their pensions could be topped up to €350. I have spoken to many of them and they are agreeable to it.
I know landscapers have written to the Taoiseach; I imagine they have written to many Deputies in the House. They are being told that they cannot cut grass. They tell us that if they are not allowed to do it, then in two or three weeks' time, they will be unable to cut the grass in housing estates because it will have gone out of control. These are usually one-person operations. Could they be included in the essential services list? Those are my four quick questions.
Deputy Grealish referred to people over 66 years who have lost their jobs. They can be included in the wage subsidy scheme. We encourage their employers to keep them on under the wage subsidy scheme. However, they cannot receive the pandemic unemployment payment, PUP, which is an individualised payment. If one examines some of the individual cases - I have examined some, although certainly not all of them - one finds people over 66 years are generally in receipt of a State pension and often in receipt of a State pension for a dependant as well. Often the amount in question is over €400 per week. The PUP is individualised and a recipient gets nothing for dependants. Recipients cannot have it both ways by getting a State pension plus money for a dependant and the PUP. That would be unfair.
We are inviting those over 66 years who have lost their jobs and who have low pensions to approach us individually through the social welfare offices. We will look at individual hardship cases. These would be people over 66 years who have low incomes and no other income that brings them up to the level of €350, if that makes sense. Many will have a pension and a pension for a dependant, which will bring them up to €350 anyway. Since this has been offered, at least as of last week, no one has come forward to the community welfare officers for additional assistance but that offer remains in place.
I will certainly take up the question of the landscapers and whether they can be included with the national public health emergency team. However, a decision was made - and the Government endorsed the decision - not to make any modifications between now and 5 May. The view taken by NPHET, which we endorsed, was that we could send out mixed messages or create confusion if we started tweaking the rules every couple of days or weeks. The rules that were imposed will stay as they are, unchanged, until 5 May. Any change from then on will be announced prior to that date.
Deputy Grealish referred to the SME and hospitality sectors. The only assurance that I can give people working in hospitality and those working in SMEs is that when and as the economy reopens, those of us in this Government - and hopefully the next Government - will do anything that we reasonably can to save those businesses that are viable after this.
We recognise that some businesses may not be viable but we think the majority are. That may take the form, for example, of deferrals of rates, grants or loans. Sectoral plans are being developed at official level. There are so many unknowns at the moment, however. We have no idea when tourism, for example, will return to normal or what a new normal might look like if there are going to be travel and airport restrictions. There are so many unknowns now that it is hard to make any definite plans or to put them in place. Work is being done, notwithstanding all these unknowables, to put plans in place to get those sectors going again as quickly as possible.
Concerning our troops serving in south Lebanon, has there been a decision to delay their return? If so, why? Is it absolutely necessary? What arrangements have been put in place for their families at home? Some of their partners and spouses work in front-line services. They now cannot go to work because they were expecting their partners home. Are there any arrangements for that? It is very worrying and, as they give us a great service, they should be supported.
Several business people in my county have offered their expertise and services. One actually offered robotic services, which is happening in other parts of Europe and all over the world. Is there a fast enough turnaround with the people in charge in the Departments to deal with these kinds of offers, whether they are fanciful or worthwhile and should be accepted?
I wish to ask the Taoiseach about ports and airports. The other morning a man phoned me from Deputy Butler's constituency. This often happens to both of us as we are neighbours. His sister-in-law died in England. He was not going to go to her funeral, but he went online and found that he could book a ticket on a ferry or a flight if he wanted to. Are our ports and airports closed? I know we have to repatriate our people abroad. I thank the Taoiseach for his engagement in helping some students who are abroad in New Zealand and elsewhere, as well as those who want to help in front-line services who want to come home. Is it business as usual for some airports and ports? If that is the case, it is just not acceptable.
The Minister for Agriculture, Food and the Marine has stated that he will continue to liaise with the banks on liquidity for the primary sector and to ensure the availability of working capital assistance to farmers through Microfinance Ireland's Covid-19 business loan. Given existing levels of farm debt, how might that factor impact on eligibility for the Microfinance Ireland loan? For example, average farm debt increased by 10% for dairy enterprises in 2018 to €118,446, according to the Teagasc national farm survey. Overall debt on Irish farms increased by 2% in 2018, although debt and investment varied depending on enterprise. How would this play out?
I have been informed by Rehab that in January, just as the general election was called, service providers were told the HSE planned to make a 1% energy efficiency saving across the disability budget. This amounted to €200 million out of a budget of €2 billion. If implemented, it would mean services would be cut or planned services would not go ahead. It was reported late last year that the funding crisis in the disability sector has become so critical that the future of services for up to 65,000 men, women and children is now at serious risk. Any further cuts would completely destabilise the sector, possibly to the point of no recovery. Does the Taoiseach foresee this cut being implemented? If so, will he consider a suspension, given the scale of the challenge facing the disability sector and section 39 organisations more generally?
Deputy Mattie McGrath speaks quicker than I can write. I think I managed to jot down most of his questions. On Lebanon, given the unprecedented nature of the Covid-19 crisis and to mitigate its transmission, the UN Secretary General in recent days advised all troop contributors and mission commanders of his plans to suspend all rotations and leave for military personnel serving in UN missions until 30 June.
The direction will impact over 100,000 uniformed UN personnel from more than 120 countries serving worldwide. The moratorium on upcoming rotations and leave is designed to ensure the continued operation of essential peacekeeping missions to protect vulnerable populations in conflict zones and to maintain international peace and security. It is also designed to ensure the health and well-being of personnel deployed on UN operations by limiting movement of personnel into mission areas. This is a decision that affects all contingents from all countries and all missions. The main impact for our Defence Forces will be on deployments to MINUSMA in Mali where personnel are due to rotate later this month and UNIFIL in Lebanon where personnel are due to rotate in two rotations on 12 May and 19 May. The Defence Forces contingent in UNDOF in Syria rotated on 4 April and is unaffected by the recent announcement. The UN Secretary General advised that limited exceptions may be considered in extremis where they are required for the continuation of the delivery on the mission mandate and on the basis of strict conditions being applied to prevent the spread of the virus. Decisions on any exception will be taken in UN headquarters in New York following a proposal from the force commander. The Department of Defence and the Defence Forces have been examining the impact of the UN decision on the Defence Forces personnel currently serving with UN missions and the impact it may have on future deployments so as to advise personnel and families accordingly. Personnel deployed overseas have been briefed by their commanders in the mission area and there is ongoing engagement with the mission and with the mission commanders to ensure their rotations can take place as close as possible to the original planned dates and in accordance with the direction of the UN Secretary General. Ireland will continue to meet its commitments to the UN and other multilateral peacekeeping organisations in support of international peace and security through this challenging period. Our aim is to maintain the integrity and operational capability of our overseas contingents in discharging their mandates. Protecting the health and welfare of our personnel remains a priority consideration throughout.
In terms of companies offering to help and to make things for us, everything from PPE to ventilators, all that is very welcome. I am inundated with them and I imagine Deputies are inundated with them too. It is very hard to know whether it is an offer to do something as a donation, for cost or for profit, and then of course different rules apply if it is for profit or not. It is very hard to know whether the companies offering to do these things are able to deliver what they are promising or if they even know themselves whether they are able to deliver what they are promising, but for that reason the mechanism and a website has been set up through which we are inviting companies to make their offer and make their pitch. Science Foundation Ireland and other agencies will assess whether those companies are capable of fulfilling the offer they are making. I extend my thanks to those agencies that have taken on such a new role. The IDA, which was established to get foreign direct investment into Ireland, is now spending a huge amount of its time procuring equipment from multinationals in order to get that into Ireland. Science Foundation Ireland has very much taken on the role of assessing offers from companies.
We are not going to close the airports and ports as we need them to stay open. We are bringing in medicines, PPE and essential supplies, and with those essential supplies are pilots, cabin crews and hauliers. All of those people have to be allowed in and out of the country through airports and ports. Regarding passengers who are not involved in supply, the number of passengers going through airports and ports has gone down considerably. Some of the airports are closed altogether. In Dublin, just to take one day last week, for example, the number of passengers going through was down by 99%. Approximately 200 passenger went through, almost all Irish citizens and residents returning home. A small number were in transit to another country or to Northern Ireland. I confirmed this morning at the Cabinet sub-committee that all passengers are interviewed and advised to self-isolate and to restrict their movement for 14 days after arrival.
I call Deputy Pringle.
On a point of order, we were supposed to keep this debate under two hours because of the public health advice and I think we are well over that now.
We have passed the two hours now. We are ten minutes over.
Okay. Perhaps Deputy Pringle could be very brief.
The virus will not understand our brevity.
All right. I have to take that advice.
I could try to take those questions.
The Minister for Health has offered to take Deputy Pringle's questions if that has the agreement of the House. Is that agreed? Agreed.
I just think we should take our own public health advice.
I hope they are health questions.
That concludes questions to the Taoiseach on Covid-19.
We move on now straight into questions to the Minister for Health. If we move quickly through this time, and I will talk to the Ceann Comhairle if he is back in-----
Does this mean that my group does not get a recognition of any its questions to this? That is not on. The time has been badly managed if that is the case.
With the agreement of the House, we will take Deputy Pringle's question and Deputy McNamara's questions now if that is okay with the Minister for Health. We will have to be quick. I am trying to keep to the time. We are wasting time now.
These are the questions. With all due respect to the Minister, maybe he can answer them. Maybe he cannot. They are questions to the Taoiseach.
This one the Minister might be able to answer is in relation to a number of briefings from the Government in the early days of March. The community health organisations were identified as having carried out investigations of all centres where people were living in congregated settings. I would like the Minister to outline the number of assessments that were undertaken and, where each assessment was undertaken, the ways in which people living in congregated settings were adequately protected.
The Minister probably will not be able to answer my second question; the Taoiseach might have been if he had been here. It has been indicated that Debenhams, which, as the House will be aware, announced its closure in Ireland last week, was not helping staff with the processing or payment of redundancy in any way. Does the Minister believe that it is right and fair for a company to use the Covid-19 crisis as cover to jettison workers and renege on its responsibility with regard to redundancy?
I thank Deputy Pringle. I note the Deputy has some other questions to ask me later as well, which I will endeavour to answer.
On the community health organisations, I do not have details in relation to specific risk assessments that were carried out but I will certainly check, get that detail and revert to Deputy Pringle today in respect of it. What I can tell the Deputy is that HIQA is playing an active role in carrying out risk assessments in community organisations, particularly in the nursing home settings and, where necessary, in making recommendations in terms of how we can safeguard residents in those settings.
As for the issue of the company Deputy Pringle mentioned, which is outside my remit, nobody should be using a global pandemic to in any way renege on the normal responsibilities that an employer would have to its employees.
I call Deputy McNamara and thank him for his co-operation.
Everybody in Ireland has made significant sacrifices to deal with Covid-19, but most of all the young. The young have made those sacrifices, primarily, not to protect themselves but to protect the elderly, because we all knew coming into this that the elderly were most vulnerable. In light of that, I ask the Minister whether that sacrifice was in any way undermined by the advice of the Chief Medical Officer on 10 March that existing restrictions in nursing homes were not necessary, whether it was undermined by the Minister for Health's delay of over two weeks in meeting representatives of Nursing Homes Ireland when it sought engagement on access to personal protective equipment and testing for nursing home staff, and what we can do now to make up for lost time.
Is that Deputy McNamara's only question?
There is a follow-up bit this time.
I thank Deputy McNamara for the question. First, I take the point the Deputy makes in relation to young people but it is my duty to put on the record of this House that this is a virus which can be particularly severe for older people but to which young people are not immune. Indeed, yesterday in our country we had a 23 year old pass away from this condition. I know we all extend our sympathies to that individual's family.
On the issue of visitor restrictions in nursing homes and the comments made by the Chief Medical Officer, I fully support the Chief Medical Officer and the national public health emergency team in this regard. The rationale was that any decisions made in respect of restrictions in clinical matters should be made by clinicians and that we should have a co-ordinated national response in that regard. The Chief Medical Officer never said that visitor restrictions could not be put in place at hospitals or nursing homes, as appropriate, but was also balancing that view with the idea that many older people may have to go many weeks without ever seeing somebody else. The Chief Medical Officer was trying to get that balance right between compassionately ensuring people could see their families and relatives and protecting and safeguarding people. As Deputy McNamara will be aware, the national public health emergency team continuously kept this under review and did, indeed, put in place visitor restrictions. That is the body I follow in terms of public health advice and that is what it does.
While I met representatives of Nursing Homes Ireland in March, I would hate for people to think that was the first engagement we had with it. The CEO of the HSE met it to discuss Covid-19 in February and there was engagement at local level between many HSE personnel and nursing homes in January. I also engage with HIQA, which regulates nursing homes. I have a lot of time for Nursing Homes Ireland. It does a very good job and there has been much work going on this year.
There is a string of emails and letters requesting engagement.
I want to return to the Minister's point regarding Debenhams. I welcome what he said but I wish to bring a similar case to the House's attention. There is a cohort of people in a small local transport company in Clare, and just as the restrictions were introduced, its contract for Local Link services was dropped by the National Transport Authority. We all agree that private companies should not use this situation as a cloak to break bad news and do draconian things to staff members. That is one thing, but it is particularly loathsome for a State body such as the National Transport Authority to use this as cover for bad news and taking fairly draconian steps. The staff who were protesting outside this House last June cannot protest. They cannot even protest at home in Clare because everyone is effectively locked down. It is very worrying and the Government needs to find out from the National Transport Authority what is going on. I have written to and telephoned the Minister for Transport, Tourism and Sport but have received no reply. I appreciate that he is in lockdown, but he is still the Minister.
I thank Deputy McNamara for bringing this issue to my attention and that of the House. I will raise it with the Minister for Transport, Tourism and Sport and his Department and ask that they link back in with the Deputy directly.
The Order of Business for today stated that this session would last for two hours. Why has it been cut short?
It was not cut short. It was just-----
The Deputy still has time.
It was not managed properly. It should have lasted for two hours. That is what was ordered.
I did my best for the Deputy and his colleague.
That concludes the first round of questions. The second round, questions for the Minister for Health, begins now. It shall not exceed one hour and 40 minutes and each party shall have ten minutes for questions and answers. I call Deputy Donnelly.
I will be sharing time with Deputy Butler. I have four questions, which I will give the Minister and we will see what we can get done in five minutes.
First, I would like to hear the Minister's thoughts on the fatality rate. We are all agreed that extraordinary efforts are being made by the State, the HSE, and every individual and family around the country. Unfortunately, the fatality rate for Covid-19 in Ireland is about 90 people per million. We rank tenth compared to other countries in the OECD. While the data are not perfect by any stretch, the fatality rates in Germany, Norway and Finland are about half, one third, and one eighth of ours, respectively. Although the data are not perfect, they are probably directionally correct, in that some comparable countries, in spite of our very best efforts, have significantly fewer people dying per million of population. Are the Government and the Department looking at this? Are we looking at what other countries that have a much lower fatality rate are doing, to see if there is anything more we can do? Are they doing things that we are not? Can we learn from them and get this fatality rate as low as possible?
My second question is a brief one, regarding the current assessment of the reproduction rate. Can the Minister tell us what that rate is, and if he has the information available, can he also tell us where reproduction is happening? For example, if the number is around one, is half of it happening in homes or nursing homes? How much of it is happening through social distancing? Can the Minister give us a sense of where the transmission is happening?
My third question relates to nursing homes. It is clear that nursing homes are in the middle of their own crisis within a broader one. Very important supports have been promised to them. Two weeks ago, the HSE told the health spokespeople that staff would be deployed to nursing homes, including clinical staff. The Minister himself made a big announcement of financial supports on 4 April. Promises were made regarding PPE, as well as commitments to make sure testing happened much quicker for residents and staff and that contact tracing would back that up. To date, in spite of what I am sure are everybody's very best efforts, many of these supports have not materialised. PPE is patchy. One manager described it to me today as a lucky dip; that one does not get what one ordered.
Regarding financial supports, not only has a single euro not arrived at any of the nursing homes, but they are telling me that they have not had any communication from any arm of the State to tell them when it might happen and what the guidelines for those supports might be.
In terms of staff, my understanding is that, in cases of extreme emergency where nursing homes have no one left for a night or day shift, the CHOs are managing to deploy some staff. However, the promise of many staff being made available has not been met. Nursing homes are finding themselves without staff. Yesterday, RTÉ reported that nursing homes were facing entire shifts with no staff.
I am also hearing from nursing homes that it is taking up to two weeks for test results. Over the past two or three weeks, the nursing homes that I have spoken to have said that there has been no contact tracing.
We all want this to happen urgently. Why has it not happened so far? When are the nursing homes going to see a real difference on the ground where they need it?
I wish to raise the issue of the non-Covid-19 fatality rate. New analysis shows that non-Covid-19 fatalities in March and April are up considerably on previous years. This might be happening for many reasons, but I am concerned that we have empty private hospitals. Doctors are telling me about empty operating theatres. Many surgeons and their teams who want to treat people must essentially sit on their hands.
If the Deputy is sharing his time-----
Many HSE hospitals are below par. Can anything be done to start reactivating the health system?
I thank the Deputy for those questions. I will try to deal with them sequentially.
Regarding the mortality rate, the first point I would make is that, in a pandemic, one can often see its flattening lagging behind some of the other indicators. We are now beginning to see our ICU and hospital admissions and our growth rate beginning to go in the right way, but our mortality rate is not. That is, and should be, a cause of concern.
It is fair to say that assessing comparisons of mortality statistics, as the Deputy acknowledged, is not a perfect science and would require considerable analysis of population structures, demographics, socio-economic factors, health service capacity, transmission patterns, pandemic preparedness, etc. It is also fair to say that the reporting of mortality figures differs greatly between countries, including our nearest neighbours in the UK where they only report deaths occurring in acute hospitals. Other countries, including Ireland, report all known deaths relating to Covid-19 regardless of the setting.
It is also acknowledged that, despite the fact that we undoubtedly have testing challenges, we still rank third highest out of 22 EU and UK countries in terms of tests completed as a percentage of overall population. That is according to the Our World in Data website. This factor is likely to have an impact on our mortality figures. We are actively looking for the virus and, therefore, confirming more people have died of it.
I apologise for cutting across the Minister-----
The Deputy is kind of cutting across me.
-----but I am happy to cede the rest of my time because Deputy Butler wants to get in and follow up privately with the Minister afterwards. I do not want all of her time taken.
I am not sure I am happy to have important issues raised that I do not respond to on the record of the House. I will be brief, but we cannot raise important questions and then not seek the answers for the public watching.
That is the purpose of this session.
Deputy Stephen Donnelly asked an important question about the current R number. I do not want to take Deputy Butler's time. Professor Philip Nolan will provide an update this evening, but I would like to share with the House that we now have four different methods for estimating R. The epidemiological modelling group is suggesting that the R number is now between 0.7 and 1. It is encouraging news that it looks like the R number is now at or below 1. We had been saying it was in or around 1. Professor Nolan will present the graphs to back that up this evening. It looks like we are beginning to see it in a plateau in the hospitalisation and critical care cases, but not yet by any manner of means in a decline in new cases. He will also show this evening - it will be important information - that, if our epidemic had continued at an R rate of 2.4, we would have seen 7,800 new cases and 800 people in ICU today and at least 1,700 deaths by this day next week.
Regarding nursing homes, there will be many opportunities to respond, so I will cede the rest of my time to Deputy Butler.
The situation in nursing and care homes needs urgent attention. Due to concerns raised with me by various nursing homes, I undertook a survey between 7 and 9 April. I contacted 80 nursing homes in Waterford, Kilkenny, Cork and Kerry and received a 25% response rate. I asked whether they had sufficient quantities of PPE to deal with the Covid-19 pandemic crisis. Of those that replied, 10% had a three-day supply and 30% had a supply, but 60% had none.
Due to the number of nursing homes, especially in the east of the country, with clusters of cases, it is imperative that all nursing homes have a minimum three-day supply of personal protection equipment, PPE, including goggles, gowns, masks and gloves. This should be implemented as a priority. We hear all the time that supply is patchy, and all Deputies have raised this issue today. If a nursing home does have an outbreak of Covid-19 cases, more supplies can be provided to it.
My next question is also on nursing homes. I asked the nursing homes whether they had sufficient staff to deal with the pandemic. A total of 50% said they had while 50% said they had not. All were hugely complimentary about their staff but said they were not without challenges.
I know much work has been done on insurance indemnity. We know there is an agreement with the HSE to allow nurses, physiotherapists, occupational therapists and other healthcare staff to be redeployed to private nursing homes. Private companies are being asked to redeploy staff. A lot of work had been done up to Tuesday of this week, but as of today, the indemnity scheme to allow private home care providers to redeploy their staff to community nursing homes has not gone through. Within the past half hour I was speaking to a manager at one of the biggest providers in the State.
I thank Deputy Butler for her questions and the work she has done on this. The HSE informs me there are approximately 1,250 PPE deliveries to nursing homes and residential units every week and that the deliveries consist of 2,500 to 3,000 cartons and pallets, providing in excess of 1 million pieces of PPE per week to nursing homes and residential units. The Deputy is right to highlight an issue in relation to gowns. This is an area in which the HSE has highlighted a particular shortage. I am told by the CEO of the HSE that 2,000 more gowns are due to arrive in Ireland over the next few days and 1 million more gowns are due to start arriving from 18 April, which is this week.
On the issue of indemnity, I will check where that is at and revert directly to the Deputy. I welcome the redeployment agreement reached, which will be a very big help.
As we increase our testing capacity for next week, and I have discussed this with the Chief Medical Officer, one of the areas where I really want to see an increase in testing is asymptomatic residents of our nursing homes. We need to be able to identify very quickly if anybody in a nursing home could have Covid-19 before they show symptoms. This could really help the sector.
I have more to say on nursing homes but I will wait until the next round of questions when I have more time.
We move on to Sinn Féin. I call Deputy O'Reilly. Is the Deputy sharing time?
I am sharing time with an Teachta Darren O'Rourke. I want to ask the Minister about the advice given by the Chief Medical Officer that the restrictions on nursing home visits were premature. Will the Minister acknowledge that vital time was lost and that this is contributing to the fact there are more than 200 clusters of this virus in congregated settings throughout the State? This is an issue I have raised repeatedly with the HSE. Two weeks ago I was advised that teams of infection control personnel would be going into nursing homes. Yesterday, I asked what should have been a fairly simple question on the exact number of personnel involved but I could not get an answer. If this is a priority, and the Minister will need to convince us that it is, he should be able to tell me how many staff are actively working in the nursing home sector. Of the nursing homes surveyed by Nursing Homes Ireland, 29% have not received contact from the HSE. If we are going to be proactive about managing this pandemic in the nursing home sector, the Minister should be able to tell me how many people are actively involved in it.
I have a number of questions and I will ask them all together. Will the Minister publish in full the deal between the State and the private hospitals? We understand the Taoiseach has confirmed it is worth approximately €115 million per month. My understanding is that this is the absolute minimum that will be paid. Will the Minister confirm whether a minimum figure has been set? What is his estimation of what the maximum figure will be? Is there a minimum amount of time for which this deal is in place? Have we purchased a certain number of weeks, months or days from the private sector? Are we obliged to pay for these regardless of whether they are used? Will the Minister also tell us how many people are in the private hospitals and how the hospitals are being utilised?
I have a question on swabs taken before the case definition was changed.
I have seen on social media medical personnel tweeting that in their opinion some of those swabs may have been discarded. We know there are people waiting, in some instances, more than three weeks for the results of tests. They do not have very much confidence that they will ever get a result but can the Minister confirm that every swab that was taken will be tested and a result advised or that the people will be advised that although they had a swab the result will not be notified to them?
I raise with the Minister the case of a woman by the name of Paula. She works as an SNA in a school for children with special needs. She finished work on 12 March. She became ill on 15 March. She was tested on 23 March and she is still awaiting confirmation of her result. This morning, she contacted the National Virus Reference Laboratory and was advised that a positive test had been sent back to public health after four days. Fair play. There was a quick turnaround time but nobody told her. In the intervening time, her daughter has had a test cancelled because she did not fulfil the criteria. Her daughter has subsequently become ill. This family did everything they were supposed to do. They isolated, but she was left chasing that result for herself. I ask the Minister to indicate the number of people currently working per day on contact tracing. How many contacts have been traced for the past fortnight? If he can provide that information either here or in written form I would be very grateful.
The Minister has three and a half minutes to respond.
I thank the Deputy. I dealt with the question of the Chief Medical Officer's comments on restrictions from Deputy McNamara earlier but it is important to say that, when putting widespread national restrictions in place, it comes from the National Public Health Emergency Team, NPHET, and from our clinicians. I stand by the judgment of the Chief Medical Officer. To be clear, he never said that individual nursing homes or individual hospitals could not put in restrictions but the idea that blanket restrictions are put in place, or restrictions on any of our movements, by anyone other than the NPHET is not a place I will go. The NPHET is the right structure to do that.
In regard to the priority, let us be clear. Nursing homes are our priority. I do not think anyone will doubt that we are all unified in regard to that. We need to take some serious actions in this regard. The answer to the Deputy's question is that there are 61 direct staff - that is the last figure I saw - working in our nursing homes as of today. It may have gone up since then but that is the figure I have. There are 18 Covid-19 response teams in place. It does take time to put those in place. Progress is being made. Incredible leadership was shown by the union movement yesterday in terms of everybody agreeing to the redeployment agreement. There was very good progress that will make a difference. I want to thank people for that. We are seeing substantial PPE deliveries. We have seen training in PPE usage rolled out across the nursing home sector, with more than 1,000 participants. We have a situation now where 183 nursing homes have access to telephone advice and support; 180 have access to infection prevention and control support; 162 have access to public health support; and, 171 have access to PPE support also.
The Deputy had a couple of specific questions. In regard to the private deal, I have sent that to the Oireachtas today to lay it before these Houses. I fully agree with the Deputy. It should be out there. It should be transparent. People should see it.
In that regard, I will say briefly that under the terms of the agreement the HSE will secure 100% of the capacity of the private hospitals. The hospitals will work in co-operation with the hospital groups. The heads of terms have been signed by the 19 acute private hospitals and it is expected that final contracts with individual private hospitals or groups of private hospitals will be agreed shortly. The arrangement is in response to the Covid-19 pandemic. It is for a three-month period with an option for the HSE to extend it for a further month and by mutual agreement thereafter. It is not possible to indicate a precise cost estimate for the use of the private hospital facilities as the rationale for the arrangement relates to the Covid-19 epidemic for which no one can provide a definitive time horizon but there are significant safeguards, including eligible costs, third party verification and termination built in against a necessarily uncertain disease background.
Under the arrangement, the private hospitals' recent management accounts will be examined by a firm of accountants acting on behalf of the HSE. Payments will be determined on actual costs incurred and will be subject to verification and, as part of an agreement, a process is being put in place to resolve any disputes. Under the arrangement, a participating private hospital is due 80% of its estimated monthly costs in advance from the HSE. Costs incurred are subject to verification, as I have just set out, and any difference is subject to a claw-back in the subsequent month. The HSE has made advanced payments for April totalling €90.2 million. This is based on estimates provided by participating hospitals and, importantly - I want to say this before people say that is the final figure - will be adjusted based on verified actual costs. Can I continue?
The Minister has about 20 seconds, yes.
I have three minutes for my-----
I am sorry. On the issue of swabs, to be clear, I have asked the HSE and it is my understanding from the HSE that swabs do not expire and were not discarded. The backlog, as the Deputy knows, has been processed with the assistance of a German laboratory and additional laboratory capacity here. We are now seeing, on average, 1,200 swab requests per day from our GPs. That does not include our hospitals.
Finally, in terms of contact tracing, I do not know the individual details. I am happy to take them from the Deputy.
We now have nine contact tracing centres, with 1,700 people trained to date and an average of just over 200 people per day deployed to these centres during the last week.
I wish to ask about the Be On Call For Ireland initiative. This is a great initiative. It has really tapped into the national mood and the number of respondents was fantastic. It has been reported as 72,000. It has also been reported today that out of 14,000 candidates deemed satisfactory, that is, 14,000 qualified and registered nurses, doctors, staff who can work in medical laboratories, ambulance staff and healthcare assistants who are immediately available to work, just 1,300 are being made available for a role or have started a role. Speaking on my own behalf, I was one of the 72,000 who signed up on 17 March. As a qualified medical scientist I am one of the 14,000 but I am not one of the 1,300. Instead of waiting for a third holding email from the Be On Call For Ireland initiative in one month, I made my own arrangements through the Academy of Clinical Science and Laboratory Medicine. I am on standby to return to the laboratory bench in the case of a surge. Like so many others I am of course happy to do that, though I hope we do not see that surge.
That experience raises a question. We are in a crisis situation. Why is more not being done to maximise the potential of this initiative? What are we doing to ensure that applications will be processed more quickly? These staff are seriously needed on the front line in our nursing homes, our residential care facilities and elsewhere.
I thank the Deputy for his question and for his public service in agreeing to go back to the front line, though we hope there is no surge. Before I address the Be On Call For Ireland initiative, I should point out that we are hiring people in other ways. More than 4,000 student nurses have now been given offers of paid employment as healthcare assistants, which will be a huge help to those on the front line. The Deputy rightly notes that around 70,000 people filled out forms as part of the Be On Call For Ireland initiative. When we worked our way through them, approximately 27,000 were identified as having relevant work experience. Further online screening significantly reduced that number. We are currently focusing on doctors, nurses, healthcare assistants, domestic staff, cleaners, porters, dentists, dental nurses and dental hygienists, and we are adding new categories as directed. As interviews do not give a reliable indication of hire potential, we are instead reporting on those who are in the clearance process. These are the candidates who have engaged with the selection process, who are interested in work and, subject to Garda vetting and a reference check, will be employed. I will provide the Deputy with a table showing the breakdown of those grades.
I wish to ask about nursing homes. What measures are being contemplated to maximise the impact of efforts to curtail and contain the disease?
There is absolutely no doubt that this virus does not discriminate in terms of age, gender or where someone lives in our country. However, we know that it has a significant impact on people of a certain age. Very sadly, nine out of ten deaths in our country, some 91%, have been people over the age of 65. Roughly two thirds of deaths have been people with underlying health conditions. This is a cruel, dangerous and disgusting virus that is having a particularly devastating impact on older people, particularly older people with underlying health conditions. In fairness to nursing home staff, the Health Information and Quality Authority, HIQA, the HSE, the Department, GPs and public health doctors, a huge amount of work is under way to try to protect residents in nursing homes. We are seeing real challenges in this regard, not just in our own country but across the European Union. I have already outlined to the House a number of measures that are being taken to provide parity of access to personal protective equipment, to provide training in the use of personal protective equipment and to establish 18 Covid-19 response teams so that people can provide support to supplement the work of our nursing homes. We are providing staffing support, including 61 members of our own staff who are now directly working in nursing homes. I expect that number to grow significantly as a result of the redeployment agreement reached with the unions and representatives bodies, for which I really thank them. The financial scheme, which is worth €72 million, will open tomorrow. We may be able to get it open even earlier than that. I hope that the funding from that will start flowing to the nursing home sector next week. I now want to see a particular focus on an enhanced role for HIQA.
When we hear commentary on the nursing home sector we need to be very careful to take our cue from the regulator.
The Health Information and Quality Authority, HIQA, knows the nursing home sector better than any of us. It knows the sector inside out because it inspects the nursing homes. HIQA is already helping and doing a good job. Deputies will have heard the statements it has made. We need HIQA to shine a spotlight on the matter. I will be having another teleconference with representatives of HIQA tonight. I do not wish to be overly prescriptive but I would like to see a set of standards drawn up quickly by HIQA to address Covid-19 preparedness, in addition to the work that is already going on. I want our staffing beefed up in line with the redeployment. I want testing expanded to include testing for asymptomatic residents of nursing homes and staff. The Chief Medical Officer believes that to be key and I am guided by him.
We also have a lot of isolation capacity in the country at the moment and I have discussed that with representatives of the HSE. That is something we need to move ahead with if institutions cannot safely accommodate staff or, in some cases, residents, although I understand that can be difficult, sensitive and would have to be clinically-led. Those are the next areas on which we will focus.
Nobody can prevent every fatality from this disgusting virus that is causing such devastation but we can make sure that when we look back on this time, we did everything possible. That is what our focus is going to be on in the coming days.
More than ever before, people around the country are suffering from mental health problems. Has guidance been provided to mental health services on how to deliver standard mental health services to people by video call, both to protect the patients and the healthcare workers? I understand that has already happened in the UK.
The Taoiseach told us there is no roadmap for how to exit this crisis. We need one because we need to know how to reopen the economy and get back to normal. A roadmap has been published by Dr. Scott Gottlieb, a former commissioner of the federal Food and Drug Administration in America. He has provided four steps, starting from lockdown which is the phase in which we are. Lockdown seems to be working but we cannot stay in that phase forever. The second phase is when we start to relax restrictions and we can do that only when testing is rapid, contact tracing is comprehensive and isolation is effective.
Our testing has been far too slow and I know the Government is working on this. The knock-on effect of that is that contact tracing is completely ineffective. It is too late to approach somebody three or four weeks after they have shown symptoms. Contact tracing simply has not been working and the Minister knows and accepts that.
There are thousands of unemployed people who would like to take part in the contact tracing effort, have registered to do so and heard nothing in return. I would like the Minister to comment on that.
Technology can help us. Will the Minister support Google and Apple in their announcement that they want to co-operate to produce an application that can help with contact tracing on the basis that it respects privacy?
The third phase of Dr. Gottlieb's roadmap is drug therapies or a vaccine. It is only at that stage we can get away from social distancing and that could take a year. People need to know that and the Minister needs to say that. It is at that point that people will be able to return to normal life.
The final phase, after doing all these things, is that we are prepared for the next pandemic. We have seen outbreaks of severe acute respiratory syndrome, SARS, Middle East respiratory syndrome, MERS, human immunodeficiency viruses, HIV, ebola, human papillomavirus, HPV, Zika virus, Lassa virus, yellow fever and smallpox in recent memory. It would not make sense for us to see Covid-19 as a strange outlier. We need to prepare our health system, personal protective equipment, medicines and so on for the next microbial pandemic after Covid-19. I ask the Minister to create a pandemic preparedness unit or pandemic readiness unit within the Department of Health.
I thank the Minister for his recent statement in support of the World Health Organization, WHO, as it comes under fire from the President of America. That took some courage. As a gesture of solidarity, and to show that we believe in science and medicine, I call on the Minister to immediately increase Ireland's contribution to the WHO to help, in even a small way, and fill the moral and financial vacuum created by President Trump's terrible action.
Are those all of Deputy Ossian Smyth's questions?
We support the WHO and I hope and believe there is a political consensus in this House in that regard. The Tánaiste, Deputy Coveney, today announced that we are quadrupling our normal annual financial contribution to the WHO this year to €9.5 million.
That is right and proper. It is the very least we can do. It is a global pandemic. The WHO is doing incredible work. Our own countryman, Dr. Mike Ryan, has been to the fore in this work. I will not waste time in my response on what I think of the comments of President Trump on the WHO.
On online counselling, I am aware the Deputy has a major interest in the issue of mental health. We allocated last week an extra €1 million in funding to beef up online counselling, including counselling for staff. I will get the Deputy a note on that. The counselling is online counselling for people working in the health service during this pandemic.
On the issue of the roadmap, the Deputy is right. I assure him there is work under way in this regard and that the work will be led by NPHET. The way to deal with the public health emergency, whether it involves going into lockdown, for want of a better phrase, or reopening, is to remember it is a public health emergency. Everything else flows from that. If one deviates from that path and looks at the matter from an economic perspective rather than a public health perspective, one makes a complete mess of it and must start all over again.
I had a very good call with European health Ministers yesterday and the European health Commissioner on the roadmap published by the European Union on how to reopen countries. I was heartened by the fact that the criteria it is setting are very much in line with the criteria being set by our Chief Medical Officer. The first step is to suppress the virus and examine factors such as ICU admissions, hospital admissions and the rate of growth. The second is to make sure there is capacity in the health service. In other words, it is a matter of determining whether there are enough ICU beds if the virus flares up again. The third step, in respect of which the Deputy is entirely correct, concerns how to have very robust public health surveillance. That includes testing and contact tracing, but there is more.
I absolutely accept we have had challenges in this country regarding testing but I do so knowing that every country has had them. I am pleased to be the Minister for Health in a country that did not throw in the towel and just decide not to bother testing in nursing homes or in the community, and to record deaths only in certain settings. That is not the way we address the public health pandemic in our country.
I will certainly follow up on the issue of people volunteering for contact tracing. I am very supportive of the app. We really need an app. The HSE is at a very advanced stage, with my Department, in respect of launching one. We have been discussing with mobile phone operators whether they would host it as a platform. Other companies are also thinking about it. It would involve people opting in. I believe the Irish people would opt in. They would do so in overwhelming numbers once they knew the parameters regarding the protection of their own data and once they knew it could save their lives and those of their families.
On the issue of research, we have established a research sub-group, chaired by Professor Colm Bergin. On 9 April, I wrote to the WHO confirming Ireland's participation in a solidarity trial for therapeutics for patients in critical care, and designated co-ordinated research trials are now in final planning in respect of opening recruitment for hospitals. I want Irish hospitals to be a part of this. We want them to be to the fore in trying to find therapeutics.
On preparing for future public health pandemics, the Deputy is right. Public health has been the poor relation of health in this country for a really long time. The Department of Health has often been a Department of illness. We ask what we do when somebody gets sick and we realise the real value of public health only at a time like this. On whether we go down the road as in the United Kingdom with the establishment of the standalone organisation, Public Health England, or whether we have a unit in the HSE, as the Deputy suggested, my view is that we should establish an integrated unit that is part of the health service rather than set up other bodies. I am open to having this discussed in this House. Whoever forms the next Government may be able to help us with that challenge.
We shall move to the Labour Party, beginning with Deputy Ó Ríordáin.
I thank the Minister for Health and other members of the Government for their efforts. I thank all Members of the Oireachtas for the leadership they have shown in their communities and constituencies in coming together to fight this invisible menace. I witnessed a funeral in my community this morning. It was very poignant to see people standing silently within a few metres of each other knowing the reason the person had passed away. It will stay with me for a long time.
We cannot repeat often enough that the reason for these measures is so we will not have empty chairs around the table at Christmas. In his endeavours, the Minister will have the support of the Labour Party but that does not mean we cannot ask questions and move to a better system of tackling the issues we face.
We have put down a number of questions for the Minister, particularly regarding the testing kits the HSE had in its possession from 23 February to 5 April. The issue of personal protective equipment for healthcare professionals arises time and again, as does the funding of such equipment.
One of the issues which has come to our attention is the guidance the HSE has given to organisations in the homeless sector. Obviously, there are a number of vulnerable communities which will be more affected by this issue than others. It is quite right to say that viruses do not recognise borders but they sometimes recognise that some groupings and workers are more vulnerable than others. These include those working with very vulnerable people in homelessness services, who sometimes have underlying health issues or addictions. The HSE has issued guidelines for such workers but has not provided PPE for them. Will the Minister comment on that?
I note his comments on the Be On Call for Ireland initiative. Will he provide statistics regarding who has been hired and a breakdown by location as to where they have been assigned? I know he has committed to doing so in response to an earlier question.
I want to ask a question with regard to a previous suggestion in respect of the redeployment of special needs assistants. I believe the Minister's Department engaged with the trade union Fórsa yesterday, an accommodation was reached and a clarification sent out. There was, however, a great deal of disquiet among special needs assistants, SNAs, who were concerned they might be redeployed from the educational setting, with which they are familiar, to a setting with which they are not familiar. It would be appreciated if the Minister would clarify that no special needs assistant will be taken out of the education sphere, with which they are familiar and for which they are trained, and put into a different setting, for which they are not trained and about which they are concerned.
We also want to ask about the childcare needs of healthcare workers. That is coming up again and again. I also wish to raise other issues, although I appreciate that the Minister may not be able to respond to them immediately. He may be able to respond in time. There seems to be an issue within the Department with regard to the renewal of medical cards. There seems to be confusion in that regard. Our own public representative, Senator Mark Wall, is getting different answers from the HSE and the Department with regard to his queries on the renewal of medical cards. Will the Minister speak to that?
I referred earlier to those in homelessness services. Is the Minister's Department, or any other Department, analysing whether individuals facing economic disadvantage or the results of the high housing density, poor housing and higher levels of lower paid work in our society are experiencing higher levels of infection and hospitalisation? Is that analysis being done? If it is not, could it be done? Could we have a conversation in that regard? It is probably not accurate to suggest that we are all as susceptible to this virus as anybody else. This pandemic is ripping a plaster off some of our assumptions about our society and about how it works and is run. If the Minister cannot comment on that now, perhaps he could forward that information to me in good time.
We will have to ask a lot of questions of our society after this pandemic has passed. On one level, it may always be with us. None of us in this House asks these questions to trip the Minister up or to be difficult. We are absolutely beside him as we fight this menace. What I witnessed this morning, however, certainly makes me more resolute, and should make all of us more resolute, to make sure we see the end of this crisis.
I will start with the Deputy's last question. I believe this has exposed a great inequality that exists in society. While I do not yet have data, I do not need them to tell me that it is harder to isolate in crowded accommodation. I do not need the data to tell me that vulnerable people living in congregated settings are more at risk or that it is more difficult to ask those who are managing to keep well to stay in the family home when it is cramped or crowded than it is to ask those of us who do not live in such circumstances. I would absolutely ask for such analysis to be done, although at the right time so as not to interrupt the work against the pandemic.
I share the Deputy's gut instinct in respect of the matter. It also raises the issue of universal access to healthcare and how we try to deal with that during a pandemic. Hopefully, we will take forward some of those learnings beyond this pandemic.
On the issue of swab tests, I will ask the HSE to reply in writing as to how many it had in each of those weeks.
On the issue of PPE, batch 1 was an order worth €31 million and its delivery was completed on 10 April. It consisted of 60 flights into our country and 33 million items. Batch 2 is on its way and is due to commence delivery on 17 April. It has a value of €67 million and will contain 11 million gowns or coveralls, 7.5 million gloves, 2.5 million face shields, 6 million respiratory masks, 10.6 million surgical masks and 3 million pairs of goggles. We are also working to see if we can get batch 3 advanced further. I accept there are challenges in this country in respect of PPE, as there are in every country, but the HSE, working with a number of State agencies and industry, has done a very good job in securing a supply line. I would rather be in our position than in that of some other countries. Nevertheless, we are not in any way complacent in this regard and are continuing to look at how we can ramp up supplies in our own country. That cannot be beyond the ability of our country. A company in Limerick that produces face masks has agreed to treble its supply, while we have set up a dedicated website - gov.ie/covidsupplies - for anybody in Ireland or abroad who thinks they can help us in that regard.
On the issue of the homeless, I will revert to the Deputy on the issue of PPE but, of course, it should be provided where clinically appropriate.
On the issue of Be On Call For Ireland, I have outlined the figures the Deputy referred to. The initiative is not the only route into recruitment. We usually start approximately 745 intern doctors each year, whereas this year we have decided to offer all 1,100 graduates an intern place. We have brought forward graduation ceremonies and are hiring more than 4,000 student nurses as healthcare assistants.
On the issue of SNAs, in order that I do not misspeak I will have to engage with my officials. I will issue an official clarification to the Deputy in writing by tomorrow.
We again discussed the issue of childcare at the Cabinet sub-committee earlier and some more proposals will go to the national public health emergency team tomorrow. It is proving trickier than we had expected, to be honest. We all want to introduce the measure but do not want to have an unintended public health consequence in that regard. Any of us who leaves our home and enters someone else's home is at risk of transmission. The Chief Medical Officer is working hard on the matter. Personally, I think there is more the public service could do. If someone is not an essential public service worker, he or she should be able to stay at home and not work. The State's contribution should be to enable someone to mind his or her child if that person's partner works in the health service. The State should show leadership in that regard and let some of our public servants not just work from home but stay at home if that assists the other person in the short term in going to work on the front line of our health service.
On the issue of medical card renewals, I do not want to see this become a burden for people during this time. I have made this clear to the Department and the HSE and will write to Senator Wall to clarify that further.
I thank the Deputy for his constructive engagement.
There is a question about transparency, although I am not pointing the finger at anybody. A number of aspects of the response to Covid-19 do not add up for people. One such matter is the fact that the test numbers are so low. People have heard for many weeks that we should be doing 15,000 tests a day, but that is not happening. In fact, the numbers are very low, which calls into question the whole strategy and which questions some of the data being used. Clearly, we are operating off theoretical models rather than real-time data. When people listen to the information every evening, they cannot figure it out because it does not seem to make a lot of sense. I appeal to the authorities to level with the public. The public has kept with the Government, the health authorities and so on. They have stuck with the measures and been remarkably co-operative but it is important there is absolute transparency and clarity in respect of the data. Where serious problems arise, they should be explained. There are worldwide shortages of different products that are required, and that needs to be explained to people rather than being glossed over. The more data the public get, the better, and the more upfront everyone is in telling people frankly what the situation is, the better. As for the figure of 15,000 tests, the strategy is not working unless we are doing that level of testing.
We cannot get to a point where we can consider lifting the restrictions until we have that level of testing. I know what some of the difficulties are and I raised with the Taoiseach earlier the issue of intervening with regard to the reagent. At this point, what is the Minister's estimate of how soon we will get to the point where end-to-end testing will be done at the level of about 15,000 per day?
The other point on data relates to the situation in nursing homes. It is a matter of regret that it took until last Friday night to get a figure for the number of deaths in nursing homes. That should not have been the case. We now know that more than half of the total number of deaths - approximately 54% - took place in nursing homes and other residential settings but those figures were not being provided. As I said, last Friday night for the first time we got the figure for the number of deaths in nursing homes. What we need to be getting on a regular basis is data on the number of deaths in nursing homes and the number of deaths in hospital of residents of nursing homes. We also need data on the number of deaths in disability centres and there is some very concerning news coming out today in that regard. It should not be the case that we are depending on individual reporters for information on deaths in disability centres and mental health settings. I have given the Minister notice of seeking such figures now and I hope he can provide them but I also appeal to him to arrange for such figures to be provided on a regular basis so that we get a full picture of what is happening, the scale of the challenge and what the response needs to be.
There is also an issue with the figures we get on clusters. To say that there are 206 clusters, or whatever, is not very helpful. We need to know if these are small clusters of just two people, or clusters of between five and ten people, ten and 20 people and so on. It would be very helpful if we had a breakdown of those figures which would inform the response that needs to happen. There is another data-related issue which I have written to the HPSC about but I have not received a reply yet. The data deals with different age cohorts in terms of prevalence and death rates but once we reach 65, the remaining cohort is 65 plus. I do not know what the rationale for that is but we should be getting data for those aged 65 to 74, 75 to 84 and 85 plus. I ask the Minister to pursue that to see if such data can be provided.
My final question is on nursing homes. I have written to the Minister and to HIQA about this. What protocols are being followed when a nursing home resident contracts Covid-19? Who decides, and on what basis, whether that person is sent for treatment in an acute hospital or remains in the nursing home? These are legitimate decisions but who takes them? Are they taken by clinicians? If a decision is taken for the person to remain in the nursing home, are we in a position to provide palliative care? Is palliative care being provided in those circumstances? The issue in nursing homes is exposing the weaknesses in how we provide services, as it has done in a number of different areas. There has been a tendency in recent years to privatise a lot of services and disconnect them from the public health service. Sometimes these nursing homes are regarded as investment opportunities rather than care centres and things are cut to the bone in terms of staffing levels. In that context, I have a real concern that there is not adequate palliative care available for those patients who sadly will remain in nursing homes and see out their days as victims of Covid-19 in those settings. I would appreciate answers to those questions.
At the outset I just want to say that we will need to have a very serious conversation about the way we care for older people at the end of this pandemic. The Deputy is 100% correct that the current model is not fit for purpose. I would love to talk about that for longer; we do not have the time now but it is not fit for purpose.
On the issue of transparency, Deputy Shortall has been constructive throughout this. She is right in that we need to continue to put out as much information as possible. I am making the point that we are striving to do that. We have carried out 19,646 tests so far in Ireland. We are testing more per head of population than most countries and I believe people recognise that. We are consistently testing in the top five in Europe and in the highest quartile in the world. The demand at the moment is approximately 2,700 tests per day. The Deputy is right to point out that the figure represents suppressed demand because of the case definition. It is made up of approximately 1,200 from general practitioners per day and approximately 1,500 from hospitals, but it varies from day to day. I am saying this without making political commitments but the HSE chief executive told me as of today that the HSE expects to have laboratory capacity for 10,000 tests from next week. That is on foot of bringing on the German laboratory.
That represents progress but I want to - we all want to - focus on the turnaround time rather than the actual number. This is because some days we will need to do 10,000, some days it might be less while other days it might be far more. The turnaround is crucial. The question is whether we can test everyone that Dr. Tony Holohan would like to see tested. Can we test them quickly? Can we get the results quickly? Between now and the end of the week the HSE is doing a body of work - I welcome the fact that the HSE has appointed one person to co-ordinate end-to-end testing - to set turnaround targets for each of the three stages. The three stages are swabbing, laboratory testing and contact tracing. We need to re-engineer all three stages to enable a turnaround target to be set from end to end. We need to list any of the constraints that exist in the processes and remove them. Then those responsible will model the various volumes of testing and run through the process to assess robustness. Then, from next week, the national public health emergency team will alter the case definition. However, we need to line up capacity with the case definition so that we do not end up in the situation we ended up in on 18 March.
Deputy Shortall's first question related to nursing homes and the breakdown of figures. The categories that I have been given are nursing homes, community hospitals and residential settings. The details include 245 deaths in nursing homes, 28 in community hospitals and 17 in residential institutions. That comes to 290 tragic deaths. Our hearts and prayers are with all of them.
I am glad Deputy Shortall brought up the issue of clusters. I have been making this point for a long time but people are getting the wrong impression. If two people, for example, the Deputy and her husband or someone else, live at home and they both get Covid-19 and are doing well, they are still a cluster. However, that does not tell us much. That is very different from a situation involving an uncontrolled outbreak. The phrase "cluster" can be misleading. Up to 80% of us will get this virus in a mild manner, so the term can be misleading. I agree with the Deputy's point on the Health Protection Surveillance Centre data and the question of why we stop at 65 years and use 65+ from there upwards. I will follow that up with the HPSC.
The Deputy asked who makes the decisions, and this is an important point. The question related to who makes the decisions on what should happen in terms of the clinical care of a person. The decision is made by what is classified as the person in charge. The person in charge is meant to be a healthcare professional. The definition is outlined in the Health Act 2007 and the associated care and welfare of residents in designated centres regulations. I will send the details to the Deputy in writing in the interests of saving time. Following the terrible tragedy in Portlaoise, one thing I was pleased to hear was the confirmation this morning from Dr. Ní Bhriain that consultants from the local hospital were involved in the decision-making on whether people should move to hospital and that palliative care consultants were also provided. That has to be our obligation during this pandemic. It cannot be based on what setting a person is in. It is a question of how we care for the person whatever setting that person lives in. That is the approach we have to take.
I was struck this morning while listening to the eloquence of the Taoiseach when he talked about the 445 people who, unfortunately, have lost their lives. He said they were not only statistics but that they were loved and cared for. I totally agree and our sympathy goes out to them, their families, their loved ones and friends. However, I think there is a gap between the words and the reality.
On 12 March I attended a HSE briefing with the Minister. I asked the Chief Medical Officer if we were testing people who care for the elderly in our community. Does the Minister remember the answer? He said, "We do not do that." No reason was given. He simply said, "We do not do that." I was shocked by the answer. I am still shocked by it but I also think that now we have reached the stage where the head of HIQA, Mary Dunnion, is saying that speedier testing will be of benefit. She said we are all learning as well. I put it to the Minister that we were slow learners not to have recognised at that point that the most vulnerable cohort in society, as experienced globally, are the elderly and remain the elderly. Yet, we were not testing those who care for them. I want to ask the Minister about the testing of care workers for the elderly. Are they now being tested?
Are those elderly people who are moving from a hospital situation into a care home situation being tested? I believe this was not happening, which has led to the spread of clusters in care homes which we are now seeing developing as a national emergency.
The impression is given that the 25,000 plus citizens who are in private nursing homes are somehow not responsibility of the State or the HSE. That is an impression that comes from a disjointed and fragmented system which the Minister has just admitted he wants to see ended and that the care of the elderly has to change. This did not happen by accident, however. This was the result of political decisions taken by Fianna Fáil and Fine Gael in previous regimes. Indeed, when Deputy Micheál Martin was Minister for Health, his regime showered developers with massive tax breaks in order to get them to invest in private care homes. It was done under Charlie McCreevy's rule as Minister for Finance at the time. The Minister should look it up. Since then, the number of care homes in private hands has mushroomed. One lesson we must learn is to move away from that system.
To hear the testimony of those working in this system on RTÉ this morning, on Facebook and other social media is heartbreaking. It is shocking that in this country, a First World country in the 21st century, we are still living in the Dark Ages when it comes to the care we give to the elderly. There is a fear out there. I am not expressing it just for myself because many people contact me about it. There is a fear that somehow there is an unwritten or deliberate policy to keep the elderly out of the hospitals. When the Taoiseach said earlier that by now we would have expected our ICU system to be full to capacity but that it is not - in fact it is far from it - perhaps it is because we are not sending those who may need ICU care from nursing homes into hospital settings. I would like the Minister to address that question because it is serious. We need assurance that there is no guidance or hidden rule that we do not take people from care homes and put them into hospitals.
In the case of the Maryborough centre, the Minister was reassured that two consultants were involved. However, he did not say how they were involved. Did they actually see the patients? Were they there physically or was the decision not to move them into more acute care taken by teleconference or some discussion over the Internet through Zoom or some other means? Those questions need to be answered.
Professor Jack Lambert of the Mater Hospital said today that the situation in nursing homes is a catastrophe in the making and is a national emergency. Will the Minister for Health respond to that statement? Will he explain how the State, or the emergency team, will respond to that statement and if they agree with it?
I understand staff are being shifted and particularly agency staff have been asked to go to these care homes. A list of 50 in the Leinster region, which urgently need staff, was published last night by certain agencies which employ nurses. The problem is that many of those staff move from nursing home to nursing home but we are still not testing them. We are still in danger of creating more clusters and more problems.
Dr. Myra Cullinane, the Dublin coroner, has said she is concerned that not all Covid-19 deaths, whether proven or suspected, are being reported according to the law. Will the Minister comment on that and tell us if he shares her concerns? Are there proposals to change regulations for those who are allowed to fill in death certificates when a death occurs?
I am all in favour of hazard payments for all health and front-line workers. However, can we start testing and protecting them, whether they are bus workers, shop workers or health workers? We are not doing that. The Taoiseach said at the highest level that he is doing his best to convince the companies which produce reagent. He is imploring and encouraging them in this regard but he is failing. The Government has emergency legislation. Will it instruct those companies to make the supply reach the need for the demand, because it is not happening fast enough?
Is the Minister now paying student nurses in placements as against those who are volunteering?
First, I will not make any partisan political comments. I used to be an awfully partisan politician and, really, this pandemic teaches one that everybody in this House in all parties and none is working their very best to save lives. That has been my experience of engagement with people here.
I think we are very lucky to have Dr. Tony Holohan, a public health specialist, as the Chief Medical Officer in our country. When he answered the Deputy's question on 12 March, of course he answered it entirely correctly, as a clinical expert, and I would rather he made the decisions than politicians. I think the public would too. He pointed out that the case definition provided by the World Health Organization that is being applied here is that we test people when they have two or more symptoms. I think it is fever and a respiratory condition. Given the definition, if a person working with an older person has the symptoms, of course he or she would get tested, but the definition at the moment does not allow for asymptomatic testing.
In fairness, the point Deputy Smith raises is a legitimate one, that is, as we broaden the testing whether we should be trying to test more people, in particular those coming into contact with vulnerable people and particularly vulnerable people. The short answer to that is "Yes" but that broadening of the case definition will be decided by clinicians at the national public health emergency team rather than by me or, respectfully, on the floor of this House. I expect the case definition to be broadened next week in line with the comments I made to Deputy Shortall. I agree 100% with the Deputy on the idea that we cannot allow a viewpoint to fester in any way that somebody who is in a private nursing home is not our responsibility. They are a citizen of this country. They are at particular risk to this virus. This is a virus that we cannot beat and stop in every circumstance but we can do everything humanly possible to protect as many lives as possible and we will not be found wanting in that regard. I know people working in HIQA and the HSE, public healthcare staff and nursing home staff will not be found wanting either.
For reassurance, I need to make the point that while 70% or thereabouts of nursing homes, according to HIQA are still Covid-19 free today or do not have significant outbreaks, 30% do. We deploy different strategies for those ones. For the 30% that do, we try to mitigate, help and support, and for the 70% that do not, we try to keep them Covid-19 free. Some of the comments I made recently about trying to test asymptomatic people, providing isolation facilities where appropriate for staff or for patients, and beefing up staffing through the redeployment agreement with the unions, who have been super, are some of the ways that is achieved.
I am pleased the Deputy brought up the hospitalisation of older people because it gives me a chance, which I think is what Deputy Smith wants, to put on the record of this House some clarity in that regard. These are clinical decisions. We have loads of empty beds. We have never had so many empty beds in the health service. We have ICU capacity. The health service is open for patients and there is no bar in terms of age or disability, as I have heard in recent days. Clinical decisions are made in nursing homes. The principle of the right care in the right place at the right time applies. I will not go into an individual case but it is about individual clinical reviews deciding if a hospital transfer is appropriate, talking to the resident about his or her wishes, and talking to the family and deciding if they want palliative care. People may have advance care planning in place too. These are clinical decisions and they should not be made by anybody who is not a clinician. Person-in-charge regulations for nursing homes make it clear that it should be a person with clinical training. People should not be worried or fearful in that regard, but I accept they are. If an older person needs to go to hospital he or she should be brought to hospital. I am conscious that many families and individuals are having these discussions too.
I very much welcome the fact that the coroner wrote that letter because we want to find as many cases as possible. The intention is not to suppress numbers. The more cases of the virus we can find and, sadly, the more fatalities we can find, the more we will know about it and the more we can deal with it. I am satisfied that we are reporting an awful lot more in this country than in other jurisdictions but we need to continue to strive to do as best we can. From memory, I note that the coroner did also say that she detected a very high level of reporting, but she is right and proper to be vigilant in the discharge of her duties.
As one of only two medical doctors elected to the Thirty-third Dáil, it is appropriate and fitting that I am here today to ask questions on this very important topic. I do not say this to establish my credentials in any shape or form but to explain the burden of responsibility I feel to contribute to this debate in a very meaningful and constructive way. As always, my questions will be designed to help rather than hinder the national response.
I have only four questions, three of which relate to nursing homes and residential care settings, which I may group together if that is okay. The fourth question relates to the air bridge to China, which I will deal with separately.
The first one is to do with the €72 million that the Minister quite rightly allocated 12 days ago in a financial support package. I very much welcome that announcement. The Minister may or may not be aware that not a single red cent of that funding has been paid out yet. The nursing homes are screaming for supports, the funding has been allocated, but it is not available. Not only has it not been drawn down but I understand that a mechanism does not even exist for it to be allocated and distributed. I also understand the National Treatment Purchase Fund has been tasked with setting up this mechanism. If this is the case, I would appreciate it if the Minister could indicate the likely date for a mechanism to allow this funding to flow to where it is needed most.
Second, I have just come from St. Fintan's Hospital, Portlaoise, where there were unspeakable tragedies over the weekend. I understand that in this care setting and in nursing homes all across the country, one of the main reasons they cannot source PPE is that suppliers are openly telling them that they are prioritising the HSE facilities. It would be useful if the Minister takes this opportunity to clarify that the nursing home and residential care settings in the community are now ground zero, that they are the main effort of the national health response and that they are the epicentre of the problem. That would solve many issues of access to priority testing, priority staffing and priority equipment.
My third question on the nursing homes is more of a general point. I totally understand the Minister is currently fighting the acute phase of an emergency, and rightly so, but the seeds of the problems in the nursing homes sector were sown long before Covid-19 arrived on these shores. It has to do with the fair deal scheme. It is early days, but will the Minister at least give consideration to a review of the fair deal scheme as soon as the acute phase of this crisis has passed? My information is that the funding provided to private nursing homes through the fair deal scheme is nowhere near the cost of care for an individual patient.
Those are my first three questions all together. I would like to hear the Minister's response if possible and I will follow up with a fourth question about the air bridge thereafter.
I thank Dr. Berry. It is good to have his expert opinion as well.
In relation to that scheme, it will open tomorrow. The CEO of the National Treatment Purchase Fund, NTPF, had a conversation with the head of Nursing Homes Ireland this week anyway in that regard but it will open tomorrow. I thank Deputy Berry for bringing that up.
In relation to St. Fintan's, Portlaoise, I can only begin to imagine the horrific tragedy and upset that people, including staff, are experiencing there. When one is dealing with long-term facilities, a bond builds up with the residents in one's care. Our hearts and prayers go out to all of them.
I wish, on the record of this House, to take the opportunity Deputy Berry is providing me with to clarify that there is parity of access to personal protective equipment for all parts of the health and social care settings, regardless of whether it is a HSE setting. To be clear on that, there was a decision made by the national public health emergency team. In the interests of time, I will not repeat it. However, I read onto the record of this House a while ago the volume of equipment now being provided to the nursing homes and that more is due to arrive in the country, in terms of gowns, starting now, and another big order, starting from 18 April, of 1 million more gowns. We will continue to do everything we possibly can. I will have another teleconference with Nursing Homes Ireland tomorrow. I chair that teleconference now at least twice weekly with them to make sure that they are satisfied that there is progress at least being made in that regard.
On the issue of the fair deal scheme, obviously a pricing review has been done in respect of it. A number of proposals have been made by this House and by the current Government in respect of tweaking the fair deal scheme as well. Whether it is me or somebody else, I would expect an incoming Government to get on with that fairly quickly. I will not use up the Deputy's time by getting into this in too much detail but we will need a more fundamental conversation as well. I have huge respect for the work being done by nursing home owners and the staff but there is a piece missing in terms providing clinical care and making sure that the nursing homes are plugged into the integrated care system. As we move towards implementing Sláintecare, we have to get that right as well. I await the Deputy's next question.
As for the excellent service provided by Aer Lingus that has provided an air bridge between Ireland and China, I believe there have been in excess of 30 flights already with plenty more in the pipeline. Is there an indication of how much that service will cost the State, has any money been handed over to date and what will be the total cost of that air bridge? That is the first part of the question.
Second, and slightly connected, there has been an issue in the past regarding the quality of PPE provided on the international market. Does the HSE have a small qualified team on the ground in China working with the Irish Embassy to assess the quality of the PPE before it is put on a flight and flown halfway across the world to Ireland?
If that is not the case, would the Minister consider putting such a small team of qualified people in place on the ground?
I do not know what the cost has been in relation to Aer Lingus, but I will check it out and revert to the Deputy. As he rightly said, its staff have done heroic work. I thank the crews, pilots and everyone else who have left their families and flown out there to do this. They have done the country a great service. I do not know the answer - I am being honest - but I will come back to Deputy Berry on it.
On the issue of quality assurance, we do not have anyone on the ground in China. I am told it is very difficult to get anyone on the ground. What we are doing is having the equipment quality assured by Professor Martin Cormican and his team when it arrives, before it is dispensed to staff. While I accept that is not ideal, nothing about this pandemic is ideal. As the equipment is coming in batches, we are also able to tweak and feed back what we would or would not like in the next batch, based on what came in the previous one. It is not ideal - nothing about the pandemic is - but I am told it is not logistically possible to get somebody on the ground as well.
I wish to record my gratitude to the Chinese authorities and the Chinese ambassador here in Ireland for their assistance. Many countries are crying out for PPE. We have challenges here but we have a supply line. Of course, we would all love the equipment to be provided here in Ireland. If we can do more, we should, and we are trying and working with our agencies, but in the midst of a pandemic we need to get our hands on as much stuff as possible. As Paul Reid said, it is better to be looking at it than looking for it. I think that is a good philosophy. While not everything we have received has been absolutely perfect, the overwhelming majority of it has. We will continue to keep that under review. If it is possible to get someone on the ground, we would be delighted to, but I am told it is not realistic at the moment.
Can the Minister confirm his Department's position on how people with long-term disabilities and the elderly will be dealt with should intensive care unit resources have to be rationed? The Minister has referred to this already. Will the Department amend the ethical framework for decision-making in a pandemic to specifically refer to people with disabilities and the elderly? I am sure the Minister is concerned, as we all are, about the number of fatalities in nursing homes.
I also want to ask the Minister about a separate issue, which is very important as regards health and safety and community response. The Irish Community Rapid Response air ambulance has been grounded. It is a wonderful initiative which, although it got some support from the Department, was fundraised for to get up and running, and has expert pilots and response times. It is called in to help with serious incidents by first responders in the south west, south east and my area. However, it has been grounded due to its inability to fundraise this last while because of the pandemic. It is a shameful situation. It is only in its infancy but is proven to work. I have the figures and statistics, as I am sure the Minister has as well. We and many other TDs have written to him about the costs and the fact that it cannot fundraise and has been grounded. It is a very valuable service and the pilots, the doctors and medics who are giving their time are now unable to help on the front line.
I refer to the weekly testing capacity. Can the Minister give us a definite answer on that? We need clarity on the numbers and whether tracing is being affected by the fact that we do not have county-by-county numbers. Up to 50 test centres have been rolled out and I salute the likes of Croke Park, the GAA, GAA clubs and others who have given their facilities for that purpose. I do not know whether they are being paid, but they have given them nonetheless. They are drive-through centres. They are there but they are not at full capacity or even half capacity. I know we have had difficulties in getting the reagents and commodities for testing, but we have to expedite testing and get the results much sooner.
I also refer to nursing homes. I am told that if two people in a nursing home are diagnosed with Covid-19, that is all that will be tested and we will not know if there are more. There is also a worry, to which Deputy Bríd Smith referred and about which I have also been contacted, that nurses are now being asked to certify the cause of death for patients. That is wholly unacceptable. The nursing home sector cannot be treated as the poor relation.
However, it has been and we have left it behind. We are only playing catch-up now. We must treat nursing homes with the respect they deserve and give them facilities, tools and clarity. Yesterday morning, they were told that they could not get any staff. On the news last night, however, they were told they could. Things are not adding up. We need total clarity. Nursing homes must be supported in every way, including with PPE and, above all else, staff, especially where staff have had to self-isolate or to stay at home because of childcare issues. In nursing homes, nurses could be asked to certify deaths.
Unfortunately, we have heard of the deaths of two healthcare workers. We did not want there to be any, but there could be others. We do not want to see the numbers we saw in the care home in Laois. Families are entitled to know what illnesses are involved.
I thank the Deputy for his questions. We are operating in a time when we are trying to do a great deal simultaneously and at speed. Normally, many of the matters we are discussing - redeploying staff from one place to the other, for example - would take months of negotiation. We are now doing them day in, day out with the WHO's mantra in mind, that is, speed trumps perfection. It has to. This means that we will not get everything perfectly right and that we will have to retrofit, tweak and improve things as we go, but I am determined that we will do that.
My heart, and that of the Deputy, go out to the family of every single person who has died. Sadly, more will die. We are all heartbroken by that painful reality. However, I will say to the people who are tuning in as well as the Deputy's constituents that, thanks to the efforts they are making, they are saving lives. That should not be lost in this discussion. The modelling by our experts predicts that there would have been more than 1,700 deaths in our country by this day next week if the R rate - the reproductive number - was at 2.7 and we could have seen 12,300 people die in Ireland by 7 May. People's efforts are working, but that does not take away from the devastating tragedy to which the Deputy rightly alluded.
I am pleased that the Deputy raised the important issue of people with disabilities. I thank him for that. He was right about it causing many people concern. NPHET, which comprises doctors and not politicians, approved the publication of what it called "Ethical Considerations Relating to Critical Care in the context of COVID-19". It published this on 3 April. This document deals with issues relating to the provision of critical care interventions in a situation where ICU is exhausted and not all patients who require intensive care can be admitted. Thankfully, that is not where we are at, and we are all working to ensure that we do not arrive at that point. We have 127 vacant critical care beds in the health service today.
The guidance sets out the criteria for ICU admissions and stresses that the allocation procedure must be fair, justified and transparent. The document recognises that each patient is unique and that all clinical judgments will be made on a case-by-case basis. It emphasises the requirement for clinical decisions to be based on an objective assessment of the severity of the patient's current illness in conjunction with several other interconnected clinical factors such as the likelihood of benefitting from critical care interventions and the potential for good clinical outcomes.
The document also emphasises that no single factor should be taken in isolation when it comes to accessing intensive care. Age is given as an example. However, as I have discussed with members of NPHET, this statement equally extends to other factors, including disability. To be very clear and provide the reassurance that people are looking for, the guidance makes it clear that everyone is morally equal, every life matters, everyone will receive care and no one factor should be taken in isolation, be that age or disability.
Regarding the air ambulance, Irish Community Rapid Response, ICRR, has been working closely with the National Ambulance Service, NAS, to examine workable solutions, including process efficiencies, to ensure continued provision. I was pleased, therefore, to hear that the ICRR was in a position to continue with the provision of its service in the short term. The Munster helicopter emergency medical service is provided by the ICRR under a service-level agreement with the HSE. Under the terms of that agreement, the ICRR commits to funding all maintenance, repair, fuel and other expenses incurred in the provision of the transportation element of the service. In return, the NAS commits to providing the clinical staff and consumables. It was never envisaged that Exchequer funding would be required to subvent the service and the decision to proceed with the service was contingent on that ongoing contribution to the cost of its running. The Deputy is right to be grateful, as I am, for the work carried out by the ICRR to date. I welcome the ongoing engagement with the NAS to try to find solutions to the current funding difficulties.
On the issue of testing, like every country in the world, we have been challenged in this regard.
We have gone from the National Ambulance Service visiting people's homes, maybe only if they had come back from holidays in Italy or China, to a situation now where we are testing a broader group of people, and we need to expand that definition again. I am pleased the number of tests is more than 91,000, and today I saw that 93,715 tests have been carried out in our country. We are among the top countries in the world per head of population for the numbers we are testing. We are consistently in the top five and often in the top three in the European Union, including the UK. We want to do more and we want to do better and we need to keep doing more and doing better. However, I have to be honest that there are a number of pinch points. Countries throughout the world are competing for reagent, supplies and swab tests. We are continuing to do this. Mr. Paul Reid, the head of the HSE, has said he believes he has secured laboratory capacity for 10,000 tests. This does not mean there will be 10,000 tests done every day. On an average day at present, only 3,500 to 4,000 tests are ordered, but it is important that we continue to grow this capacity, particularly when we move to a point post restrictions, or after some of the restrictions have been lifted, so that we can survey the virus very closely.
I will share time with Deputy Harkin. I will use my five minutes as efficiently as I can and I will keep my questions short. It would be remiss of me not to put this into perspective. This morning, I pointed out that nursing homes did not appear in eight briefing documents produced in April, apart from two sentences. This tells me that no priority was placed on them as a concern. One mention, on 1 April, was to state that screening would be introduced twice a day for staff. Was screening introduced? How many staff have been screened? How many tests have been carried out? Tests for staff were to be prioritised. Will the Minister clarify whether, in the case of a cluster of two cases in a nursing home, no more tests are carried out? Will the Minister put this to bed and tell me it is not correct?
The Minister has mentioned he will publish the information regarding private hospitals and I welcome this. In the meantime, will the Minister clarify the following matter for me? I have received urgent representations regarding surgery from a person with cancer of the uterus. There is a delay in treatment although a diagnosis has been given. Perhaps the Minster will give me a written reply on how long people are waiting.
Deputies Joan Collins and Pringle have submitted questions on personal protection equipment, PPE. People are coming forward to state they want to work with the Government on PPE. The Minister referred to a website. Will he clarify the situation because people very much want to come forward?
I am glad that it has been clarified that those aged over 70 have not been ordered to stay at home and that it is a strong recommendation. That was not clear to them. It is time to reflect on this policy. I understand the background to it but at this point can we not reflect on it and see whether we can ease up, in the sense of telling people aged over 70, who have worked all their lives for this country, that we treasure them and want to thank them for what they have done for us and that we will share it with the younger people so that at a particular time those aged over 70 can leave their homes while the rest of us will stay inside? I really think serious consideration should be given to this.
I read the ethics document published by the Department of Health on 3 April. It is quite general and gives background. After I submitted questions to the Minister, it came to my attention in a tabloid newspaper that a points system is in operation in the Saolta hospital group in the west. Has this been brought to the Minister's attention? Is a points system in operation whereby somebody aged over 80 gets an automatic seven points? I do not want to waste time on this. Is the Minister aware of it? Has he seen the document? Is it actually happening?
Earlier, I spoke about the good work undertaken by front-line healthcare staff in our acute hospitals, the HSE and the Department, by the Minister, and by all of the other front-line workers. I recognise this work. Nonetheless, as many Deputies have said, there is a sector that is experiencing a major crisis, which is our nursing homes and congregated settings. I emphasise that I am very concerned that none of us in the House wants to raise the fears of those in nursing homes or their families, but if there is a place for questions to be asked it is surely here.
First, I ask the Minister to give a response to the comments by Dr. Jack Lambert, which many Members quoted, who spoke of the situation in the nursing homes as an emergency and a catastrophe in the making. He stated, and I thought this was a shocking statement to which I would like the Minister's response, that there is not a joined-up plan and that the nursing home patients are suffering, many of them dying and probably unnecessarily.
Second, while I recognise that many people in care homes are quite frail and vulnerable, some are not. Equally, in congregated settings throughout the country, while many residents have underlying conditions they are not essentially that different from the rest of the community at large. Members stated earlier that many families and individuals have real concerns about those in nursing homes receiving appropriate care. We have seen many examples of people in the community who are older surviving Covid-19. We had an 82 year old man walk out of Sligo University Hospital. In that context, and in terms of my second question, the HSE has told us that approximately 20% of those in the community who contract Covid-19 access hospital care. Can the Minister confirm, and I gave this question to the Minister a few days ago, the percentage of hospital admissions for those in nursing homes or congregated settings who have contracted Covid-19? I want to hear those figures because if we could get them they would back up the Minister's assurance that those in nursing homes have the same chances on a clinical basis of accessing healthcare as those in the community.
I thank Deputies Connolly and Harkin. In response to Deputy Connolly, I have to put on the record of this House that whether they appeared in a briefing document or not, nursing homes certainly were a constant source of attention. I say that because HIQA, which regulates our nursing homes, is on the National Public Health Emergency Team so the nursing homes regulator has been sitting at the table and doing a good job. Many of the decisions we have made have rightly focused on older people, a proportion of whom reside in nursing homes. The chief executive officer of the HSE specifically sat down with the representatives of nursing homes on 19 February to discuss Covid-19 preparedness. I am told by local HSE staff that there was an unprecedented level of engagement by individual HSE officials with nursing homes. That is not to say in any manner or means that enough has been done. We need to do more. This is a pandemic in which we take actions every single day. We then take another set of actions and then another set. That is what we are doing. We will have to continue to do more because not just in Ireland but across the European Union and the world we are seeing particular challenges in regard to breaking the transmission. We are trying to break the transmission of this virus and it is harder to do that in congregated settings. That is not a reason for not doing it. That is why I spoke earlier about wanting to test asymptomatic patients so that we do not have to wait for a symptom as we can test and see if a person has it, and looking for an enhanced role for HIQA, not in terms of HIQA being difficult for nursing homes but HIQA saying, "These are the standards. Let us make sure everybody can adhere to them". It is about wanting to look at isolation facilities. If staff are living among each other and bringing the virus from one nursing home to the other inadvertently, it is about providing them with alternative accommodation in a voluntary sense.
On the issue of clusters, I will come back to the Deputy if I answer the question wrongly but a cluster is two or more cases within 72 hours in one setting. That setting could be a family home or it could be anywhere.
I am sorry. I heard the Deputy ask about clusters. I could not hear her properly.
That is not my understanding. I will confirm that in writing but it is not my understanding.
In regard to private hospitals, I issued a letter through my Department to the HSE about the importance of continuity of care. One cannot just wash one's hands of one's patient. Whether it is a public or a private hospital, there is a continuity of care duty. Our doctors take that very seriously and we have issued that clarification. I am happy to take the details of that individual case but I would not like to see that arise.
On the issue of PPE, I welcome the question on how Irish companies can do more. The purpose of the website is not to say to people, "Go off to the website and be done with you". The idea is that an application form goes directly to the Office of Government Procurement under the Department of the Minister, Deputy Donohoe, which can quickly assess the offers of help. Is this something that we could quickly turn around with a business? If there is feedback, I would like to hear that as well.
We will of course reflect on the over-70s in these measures.
We are always reflecting on all of the measures. I will not reflect on them, but I will be guided by Dr. Tony Holohan's committee which will reflect on them and is constantly reflecting on them. I am conscious that 70 is not old. A lot of people over 70 have said as much to me. Many people over the age of 70 are perfectly fit and healthy and are asking why we are keeping them at home. We are doing that on the basis of medical advice, but I understand the very real challenge it poses to people's mental and physical health.
Regarding the Saolta hospital group, I have not seen that points system. I think I read it, but I have not seen it. The ethical and clinical guidelines are clear. We also have spare ICU capacity.
I do not know Dr. Lambert, but he is an expert. Nobody should ever try to silence an expert or dismiss what he or she has to say. I intend to reach out to him. I think he has written to me today, though I have not seen the letter yet. I would like to hear what he has to say. He is an expert on infectious diseases and we should be listening to him. I do not agree that there is no plan in place. I have outlined some of the measures that are already being taken. Can we do more? Yes.
I think the doctor said a joined-up plan.
If we can join up plans better, we should, so I would like to hear from Dr. Lambert and I would welcome his input in that regard. Did I miss the Deputy's last question?
I asked about the percentage.
I do not have that information, but I would very much like to see it as well. I will try to get that figure for the Deputy this week.
That concludes questions to the Minister for Health. We thank him for his engagement with us. We will now move quickly along to our question and answer session with the Minister for Finance. I call Deputy Michael McGrath.
I wish to share my time with Deputies Devlin and Troy. We will be brief to allow time for the Minister to respond. I wish to quickly raise three issues. Will the Minister confirm that a stability programme update, SPU, will be published in the next two weeks, that is, by the end of April? We have had several economic assessments so far looking at different scenarios. They have included a deficit of up to €20 billion, according to the Central Bank; unemployment estimated at between 10% and 12% at year end; and contraction of the economy by between 7% and 8%. We know that we have about 1 million people on income supports at this time. It goes without saying that protecting public health is the priority. There will be economic fallout. I am trying to get a handle on the Department's assessment of it at this time. I am also seeking confirmation that an SPU will be published in the next few weeks.
Will the Minister give us an overview of the expenditure commitments that have been made so far? My understanding is that commitments run to more than €8 billion at this stage. We had the initial €3 billion announcement, then some €3.7 billion, then the extra funding going to health by way of an Estimate went from about €430 million to €2 billion. That brings the total to more than €8 billion if I am correct. Will the Minister give us the current assessment?
I am sure the issue of businesses trading in severe financial distress and the implications for directors of potentially trading while insolvent has been raised with the Minister. Changes are being made in that regard in the UK. Obviously we want as many of these businesses as possible to survive the economic storm. Are any changes to the Companies Acts being considered by the Minister or by the Minister for Business, Enterprise and Innovation, Deputy Humphreys, in that regard?
My question concerns the Covid-19 emergency unemployment payment. I have been contacted, as I am sure other Deputies have, by people who are over the age of 66 and are either employed or self-employed. Many of these people have faced financial hardship and they are not entitled to that payment. I am wondering if the Minister has costed that payment.
Who will ensure that the forbearance measures concerning insurance that were announced last week will be implemented and the commitment will be honoured by the insurance companies? Regarding the business interruption aspect of insurance policies, it is disgraceful that certain insurance companies have written to their policyholders stating that they will not entertain their claims, despite the direction coming from the Central Bank of Ireland and indeed from the Minister's Department. Will the Minister consider establishing an independent process, perhaps through the Financial Services and Pensions Ombudsman, that could adjudicate on legitimate claims in a timely fashion and would have legal standing?
I refer to legitimate, tax-compliant companies which wish to avail of the temporary wage subsidy but have inadvertently been late in filing their returns.
They are not eligible for this scheme, which is forcing companies to put people into the social welfare system. Can an appeals process be established to ensure that legitimate companies can avail of this scheme?
I will answer each question in turn. It is my intention to bring an update on the stability programme to the Cabinet and the House in the next two weeks. It merits discussion in the Dáil Chamber and the Government can give an indication as to where we are from an Exchequer and employment point of view.
Deputy Michael McGrath asked about expenditure and that could amount to as much as €8 billion. The reason I use that figure is because there are some trade-offs within the figures that we have announced. In particular, while we have made a significant additional amount of funding available to the Department of Health, it will be up to the Department to decide how much of that needs to be drawn down and where it needs to be deployed, and much of that will depend on the spread of the disease throughout the country in the coming days, weeks and months. In the update on the stability programme, I aim to give the best possible indication of where we believe expenditure will be at the end of the year. I will also note, in particular, the trade-offs between the pandemic unemployment benefit, the higher level of sickness benefit that was announced and the wage subsidy scheme which means that we can have individuals moving across some of those payments. That may mean that the overall cost to the Exchequer is not as simple as adding two different figures that were announced at different points.
To date, no proposals for solvency legislation have been put to me by other Departments but that could change. The Government has to consider what additional measures will be needed to allow our economy to build itself again when we move past this phase of the public health crisis.
I have spoken to the Minister for Employment Affairs and Social Protection, Deputy Regina Doherty, about those over the age of 66. I have been informed that the reason payments are not available to people over the age of 66 is because that is the point at which jobseeker's payments come to an end. The pandemic payment is anchored to jobseeker's payments. I am informed that there are other State payments available to those over the age of 66 and, if a person of that age was to lose his or her job, there may well be an opportunity for the value of those payments to be increased. Those who find themselves in a position of hardship should contact their local social welfare office and ask for a reassessment to be made because they may be entitled to more than they are being paid at the moment.
I will turn to the two questions asked by Deputy Troy. It is a requirement of the wage subsidy scheme that those companies accessing the payment have been compliant with their tax requirements. That is a fair expectation. As with all these issues, I would encourage companies to engage directly with the Revenue Commissioners on these matters because the Revenue Commissioners understand that this scheme is in place for particular reasons and it would not be happening without them.
I may have an opportunity to deal with the business interruption issue when responding to other Deputies.
I welcome the decision on the wage subsidy scheme. I will make the point that I have made to the Minister privately, namely, that it still does not go far enough. Those on the minimum wage are better off on the pandemic unemployment payment and it is crucial that people are connected with their employers. I ask the Minister to keep this under review when considering the new round of figures when nearly twice as many people are receiving the pandemic unemployment payment as are availing of the wage subsidy scheme.
The three-month mortgage break is not, in fact, a break but a deferral. The Minister will be aware at this stage that, unlike in some other jurisdictions, interest will accrue on those which means that somebody with a €300,000 mortgage over a 30-year term with Bank of Ireland will pay back an additional €2,700. A similar person with a mortgage with AIB will pay back an additional €1,650. The people bailed out those banks. Those banks are only surviving because of what the people did and the hardship they went through. Given that the State is a shareholder in both of those banks, does the Minister not think it is now the time to call on them to give people proper breaks and that interest would not accrue on those deferrals?
I have raised insurance for business interruption on numerous occasions, including nearly a month ago in the Chamber. What is happening regarding a number of insurance companies is absolutely scandalous. FBD, in respect of which I have seen the policy documents, letters and side letters, has made it clear to businesses, including pubs, that they are covered for Covid-19 but it is refusing to pay out. It is not acceptable and people should not be forced to go through the courts to vindicate what is their right. I ask the Minister to step in. Allianz insures in the community and childcare sector. Schools are insured through IPB. We have been engaging with Allianz. It is possibly about to move on this but I ask the Minister to join me and others to try to ensure such companies make the business interruption insurance payment. The policyholders have paid out a pretty hefty fee over recent years to make sure they were covered.
While more than 500,000 applications for the Covid-19 unemployment payment have been processed, discrimination is at the core of the policy. There is discrimination against certain cohorts of society, one being the over-66s. Many who have been forced to work longer to continue to pay their bills, rent and mortgages now find themselves out of work and are being discriminated against because they cannot apply for the Covid-19 pandemic payment. They pay their taxes and have done so throughout their working lives. The criteria need to be changed. Many of those affected are self-employed and do not qualify for the wage subsidy scheme. The eligibility criteria need to be changed to ensure anyone over 66 should be able to apply for the Covid-19 payment.
The other cohort of people is cross-Border workers. Many of them have lost their jobs. They work in this State and pay their taxes to it. Solicitors have checked out legally the position on people who work in the fields in question. The excuse given by the Government is, that under EU rules, it cannot apply the payment to the cross-Border workers. We have information that contradicts that. Has the Minister talked to the European Commissioner about this? Has he got advice from the Attorney General on it? What is happening is unfair and the discrimination affecting the two cohorts needs to end.
I thank Deputies Doherty and Brady. Deputy Doherty referred to the wage subsidy scheme. I apologise to him because I should have notified him of the detail on what we were doing in advance. I want to put that on the record. I was under some urgent pressure to try to get the changes in place so payrolls could be affected quickly. Notwithstanding the urgency, I should have notified the Deputy of the change that was coming. On the question he put to me, I appreciate that he welcomed the changes we have made. I have made those changes because I am aware of the pressures workers on lower incomes and their employers were facing in comparison to the scale of the pandemic payment and other benefits that could have been available to them. My genuine judgment is that by moving the subsidy up to 85% for incomes just over €24,000, we have made a very significant contribution to bridging the gap. If an employer is in a position to top it up at all, a level of payment will be reached that is comparable to what will be available elsewhere. As the Deputy is aware, we have made the decision not to taper off the payment if an employer decides to top up a bit more in order to get to a level of income that is comparable to other forms of income that could be available.
With regard to the mortgage break, I reiterate that nobody should in any way be profiting from the public health crisis we are facing due to Covid-19. I am informed that more than 40,000 people have now availed of the mortgage break. I am aware of some of the issues that have now been identified by a number of Deputies. I plan to engage with the banking sector and its representatives again because I want to underscore that nobody should be profiting from what we face as a country.
Let me turn to business interruption insurance.
Insurance Ireland has come back to me - Deputy Troy made this point to me - and has said that it now accepts that there is no difference at all between advice issued by Government and a direction issued by Government as to whether a business should close down. I plan to engage further with the insurance sector on this matter in the coming days now that this principle is clear.
To respond to Deputy Brady, I dealt with one matter relating to those over 66 a moment ago. I am not underestimating for a moment the contribution they have made to our country, to themselves and to their families, but I make the point again that the pandemic payment is based on how we make jobseekers' payments available and such payments are given up to the age of 66.
I have engaged with the Department of Employment Affairs and Social Protection with regard to the matter of frontier workers. The Department and I are clear that what we are doing is absolutely compliant with EU law. If the Deputy has a view to the contrary, and opinion to back up that view, I would be very interested to see it.
Did Deputy Durkan want to come in?
Not at this moment.
This is my first time speaking in the Dáil. I take the opportunity to thank the voters of Wicklow for supporting me and for trusting me to be their representative in Dáil Éireann. I will endeavour to uphold their trust. I look forward to working with Members across this House towards a fair, equitable and sustainable future for all throughout our country.
None of us could have imagined the scale and gravity of the challenges that would face us within weeks of being elected. The Covid-19 global health crisis has created a huge threat to our country's health, jobs, communities and economy. We have worked together quickly and collegially to put measures in place to protect and maintain the fabric of our society through these difficult times. We have all witnessed the heroic efforts of our front-line workers in healthcare and the emergency services and of community volunteers, retail staff and the staff of our public service and Civil Service. These efforts and the community response to social distancing, cocooning and other restrictions have helped to manage this emergency. For these actions we owe a collective debt of gratitude.
As we emerge from this pandemic, bowed but not broken, we will seek to repair the damage that has been done both financially and societally, yet we must still address the existing crises. These are the crises in climate change, housing, health and other areas. While we seek to rebuild our fractured society with a sense of urgency, we must not overlook the opportunity to forge a new social contract built on principles of equity and sustainability.
Climate change is a slower and longer-term threat to our health, communities, economy and planet. The global impact of this virus and the united responses required to battle it have demonstrated how we can react and work together to defeat a common threat. The battle to reduce our climate-changing emissions, environmental degradation and biodiversity loss requires that same level of thinking, commitment and action. We can no longer abdicate our responsibility to deal with this global challenge head-on. The State must take a leadership role in addressing climate change. The decarbonisation of our economy, meeting our carbon reduction targets and uniting behind the science must be at the core of all future Government policies and objectives to ensure our health and an equitable society.
I wish to return to more immediate matters and to ask the Minister a number of questions regarding finance, business and social protection. Will the Minister consider creating and financing an arbitration process for commercial tenants and landlords? As he will know, many will face cash flow and liquidity issues as businesses are closed by Covid-19. Many of these businesses are unable to meet rent demands at this time. An arbitration process would benefit both parties and create the breathing space for businesses to return to work and deal with outstanding rent costs in a manageable way.
Will the Minister examine the implementation of a six-month commercial rates write-off for businesses that are adversely affected by this emergency and make up that shortfall for our local authorities? As businesses re-emerge, they will be faced with many challenges. Many will be unable to pay three months of deferred rates bills. This will have an impact on our local authorities' finances and their ability to fund vital public services. In general, the inadequate funding of local authorities is a matter to which we must return at another time but, in the short term, any loss of rates will adversely affect their functioning.
With regard to the re-opening of businesses, which must be done in a manner which complies with best health and scientific advice, have specific plans been made to assist those enterprises with social distancing and other workplace modifications that may be required over a longer period?
Will the Government increase the value of the business continuity voucher and expand its remit to include the implementation of physical distancing or other structural measures that may be required to allow trading to recommence?
What measures can be put in place to assist the arts, festivals, musicians and the film sector, given that artists and workers with casual contracts or who are dependent on the seasonal nature of such work will have little or no employment this year? Are they eligible for pandemic unemployment benefit if contracts for upcoming or seasonally recurring work have been cancelled due to Covid-19 restrictions?
The Minister will no doubt be aware of the circumstances at Debenhams, where the company has served formal notice of redundancy to its Irish workforce, totalling approximately 2,000 people. Normally, this would start a 30-day process within which negotiations between the employer and the union take place before a liquidator is appointed. Due to Covid-19, however, it is virtually impossible for negotiations to take place. Will the Minister investigate whether the 30-day statutory period can be extended? This would allow for a longer period over which negotiations could take place and increase the possibility that workers could achieve a redundancy agreement beyond the statutory minimum payment.
I thank the Deputy and congratulate him on his inaugural address. The Minister may not be able to cover the five questions but he might correspond with the Deputy in writing.
I will do my best. I too congratulate the Deputy on his opening address and wish him the best of luck in his tenure in this Dáil representing the people of Wicklow.
On arbitration, the Government does not have a role to play between commercial tenants and their landlords. Nevertheless, I would say to any commercial landlord that it should appreciate the value of keeping a tenant, particularly a commercial one, when we move into a much-changed economy as we exit where we are with Covid-19.
As for a rates write-off, I have put in place, through the Department of Housing, Planning and Local Government, a deferral of rates for a number of months. I accept we will have to look at further ideas, not least in respect of how we can get smaller businesses up and running in the coming period. Part of that relates to the Deputy's subsequent question on social distancing and concerns how we can support smaller businesses, in particular, to open in a way that is social-distancing compliant. The Government is considering that and will look at ways in which we can do it. It is all contingent, however, on public health guidance. As the Taoiseach indicated earlier, it means it may be some time before many businesses can become operational.
The Minister for Culture, Heritage and the Gaeltacht, Deputy Madigan, announced a set of measures a number of days ago to support the arts sector further. It is the case, unfortunately, that the pandemic unemployment payment is dependent on the applicant having lost work at a particular time, which in turn relates to issues for seasonal workers, for example.
On Debenhams, I understand that the 1977 Act does not indicate that the consultation has to be completed within a period of 30 days. Therefore, the Act may give some of the flexibility the Deputy is looking for. The Workplace Relations Commission is available to deal with matters of this nature.
I thank the Minister. A lot of ground was covered there. I call Deputy Nash.
A lot of ground indeed, and here is more. I put on record my appreciation of the Minister's efforts to address one of the key anomalies identified in the operation of the temporary wage subsidy scheme and the speed at which he acted under what were difficult circumstances. It was inevitable that there would be anomalies in the scheme, and a number of other Deputies have identified some of those on which they may correspond with the Minister and his Department.
Does the Minister intend to oblige companies of a certain scale that are availing of the wage subsidy scheme to top up their employees' salaries? Will he request that large companies, as defined under the Companies (Accounting) Act 2017, desist from availing of the scheme in the first instance? We are all aware of circumstances where enormous corporations such as Ryanair, having cut the hours of their workforce, have subsequently applied to use, and are using, the scheme to resource their payroll and provide their staff with some of their salary.
To the best of my knowledge, they are not seeking to top that up. That does not sit well with me and should not sit well with anyone in this House. This scheme was designed to assist our SME sector, the real heroes of our economy, that is, those who employ up to 70% of our entire workforce. Will the Minister join his French counterpart in asking that larger companies would desist from using this scheme? I speak here of large companies with enormous turnovers which have posted enormous profits. I ask the Minister to speak to the rationale used by the Revenue Commissioners in terms of the application of force majeure for the purpose of establishing an individual's tax residency. I ask him to elaborate on the thinking behind that. Again, this is a measure that does not sit well with right thinking people. I do not think it is fair that these individuals could potentially see their net wealth surge over the next period of time when front-line workers are forced to exist on low wages. I hope the Minister will consider using his good offices to seek a reversal of this decision because it seems that while most of us think that we are all in this together, there are some people who think they are exceptions and should be treated differently. It seems that the Revenue Commissioners take that view as well.
I ask the Minister to elaborate on the efforts, if any, he has made in recent weeks to implore the banks to pass on interest rate reductions to mortgage holders and those with business loans. We know that we have some of the highest interest rates in the eurozone but we are borrowing money very cheaply. Banks are borrowing money on the markets very cheaply indeed and even a small reduction in mortgage and business loan interest rates would greatly support the business sector and our economy at this very difficult time.
I ask the Minister to comment on the switch to PRSI class J for workers who are under the wage subsidy scheme at this point in time. This is causing a little bit of anxiety at the moment. People want to be sure that the PRSI contributions they are making will not be interrupted and that there is no knock-on effect, ultimately, on the benefits to which they would be entitled.
I thank the Deputy for his recognition of the work that was done on the wage subsidy scheme. I want to recognise the Irish Congress of Trade Unions, ICTU, and IBEC for the role they played in terms of putting forward ideas for how we can support our economy and, crucially, for explaining these schemes to their members. The role they have played in explaining these schemes has been critical for keeping people in work and I want to acknowledge that. They have raised particular issues, as have Members of this House, including Deputy Nash, and I am doing my best to respond to them.
I will now deal with each of the questions that Deputy Nash has put to me. First, he asked if I can compel companies to top up the wage subsidy. I cannot compel them to do so and would be wary of doing that because it is very possible that we could get to a point, with the consequences of Covid-19, where many companies are in no position to top up but I still want them in the scheme. I still want them operational in the future and putting in place a requirement for them to top-up might undermine their ability to be viable again, to return to growth and to return to employment quickly, which is what the Deputy and I want.
In terms of larger companies participating in the scheme, I read the interview that my French colleague gave regarding this issue. I take a different view on the role of this scheme and larger companies because such companies tend to employ a lot of people. There are many large employers who are now participating in this scheme. If they were not participating in this scheme, the live register could be in an even more difficult situation than it is now. It is my belief that if this scheme was not brought in, we would now have over 1 million citizens on the live register. That is why we need this scheme. I want to use this scheme as a bridge for getting those people who went onto the live register when the first round of public health guidance issued off the live register, back into a relationship with their employer and back working again as soon as our public health guidance permits it.
The force majeure decision was made completely by the Revenue Commissioners. The context of the decision was not that they made a decision about designating Covid-19 force majeure to impact on any decision relating to the treatment of non-resident taxpayers. They made the decision to designate Covid-19 a force majeure event. This had a whole set of tax consequences, one of which was the issue the Deputy is raising with me. I know that the Revenue Commissioners will ensure that this decision is fairly implemented and ensure that all pay their tax liabilities fairly.
Deputy Nash also asked about PRSI class J. It is the intention of the Government to ensure that anyone who is participating in the wage subsidy scheme does not have social insurance contributions adversely affected as a result of this. We are aware of the issue the Deputy is raising. We do not want to see such social insurance contributions interrupted. The Minister for Employment Affairs and Social Protection is looking at some legislative proposals relating to this particular point.
Deputy Durkan is next. My apologies, Deputy, I should have called you earlier. I misheard you.
I have two quick points relating to banking and the application of rules under the present circumstances. Some lending institutions are applying a system whereby arrears occurring and accruing will be capitalised. This will result in an increase in the monthly mortgage repayment. That will be no great help to the unfortunate mortgage holder. Could it be appended onto the end of the mortgage repayment period? That would be far more realistic. The same lending institutions were bailed out by the State, the people and the country. They seem to have forgotten that.
Other points have been raised generally relating to the processing of hardship cases accruing from the banking collapse. If I see another financial statement in front of me, I will beat my head off the wall. They keep repeating the same procedure. We see another financial statement and another and another. The Minister will know this himself. It is crazy. Some people are ill or under pressure or in danger of losing their homes. They find themselves in a situation where they get another mortgage statement. I said to someone in a lending institution today that there should be no more mortgage statements. The local authority has already decided to convert from mortgage to rent. It is now the Minister's job to approve that. Perhaps it might be a good time to apply some pressure there.
Deputy Durkan's first question related to whether the mortgage could be extended for a number of months. My understanding is that some banks have an issue since this could require the issue of a new mortgage contract. That is why this is something not all banks have been able to do. However, as I said in an exchange earlier, I am aware of issues that have developed since the initial statement was made. My officials have been working on this and we will see if there are new ways in which the issue that Deputy Durkan is raising could be addressed. However, I am keen to emphasise that over 40,000 citizens are now availing of the mortgage break. That shows the value of it. I know that staff in our banks are working hard to respond to applications quickly and to give people clarity on where they stand.
Deputy Durkan's second question was on whether financial statements should issue across this period. I reckon there is a case for why they should issue. Citizens should always be aware of where their financial affairs are, especially at a time in which their income might be reducing or when they could be in financial difficulty. However, I will take on board the point Deputy Durkan has made. I will be engaging with the banks further. I am sure the Deputy's idea has merit and I will see if there is a way in which it can be usefully used.
I will get straight into my questions. I have five questions and if there is time at the end after the answers you might come back to me again, a Cheann Comhairle.
What is the process for reassessment of social welfare rates in one-parent families in scenarios where one parent has stopped paying maintenance? I am asking the question given that the family courts are not hearing maintenance cases during the pandemic.
Will the Department launch a public awareness campaign informing the public of the changes which have been made to the rent supplement scheme? Many people remain unsure as to their eligibility for the scheme. Will the Minister consider raising the rent supplement to stop people falling further into debt?
I want to revisit the closure of Debenhams and give the Minister a greater opportunity to respond to that issue. Will he comment on the decision to put the company into voluntary liquidation? This decision has been viewed as a cynical and opportunistic decision affecting almost 2,000 employees of the firm throughout Ireland. Many of them, particularly in my area in central Dublin who contacted me, were with the firm when it was Roches Stores. There was a call yesterday from the workers' trade union, Mandate, for the Government to intervene and suspend the liquidation process. Today, a liquidator was announced with some degree of haste. It is unfair that during this crisis that the 2,000 Debenhams workers in the 11 stores across Ireland do not have access to the appropriate industrial relations mechanisms. The State must intervene. This process simply cannot be allowed to continue.
Will the Minister include all workers of working age in the Covid-19 payment who have been laid off from their employment? The issue of the over-66s has been raised to some degree in the Chamber today. I also want to highlight 16 and 17-year olds who are not included in the pandemic payment. Many of them were contributing to their families. The fact they were earning money meant their parents, often from low-income backgrounds, did not have to. It has created a burden on families and a degree of unfairness in the system.
Will the Minister consider developing an opt-out scheme for those in receipt of fortnightly social welfare payments? For many, these payments are really welcome. However, some people have been in touch with me who simply cannot manage the excess cost of dealing with larger shopping trips and digital costs. This in turn is putting them into debt. If we can have an opt-out scheme, it might alleviate some of the burdens placed upon them.
Where one-parent family recipients contact the local Intreo centre to state they are no longer receiving maintenance due to the liable relatives losing their jobs, they need to provide a declaration to that effect. The result of this declaration means their means will be reassessed on that basis and a review marked for 12 weeks. Liable relatives who are resident in this jurisdiction and are not working because of the Covid-19 pandemic should be entitled to either the Covid-19 pandemic unemployment payment or, if their employer is availing of it, the wage subsidy scheme. The one-parent family recipients will be contacted in 12 weeks to see if there have been any changes to their circumstances and to establish if there has been any change in the situation. The means will be reassessed, if necessary, following this review.
On the need for a press statement to further highlight changes made to the flexibility of the rent supplement scheme, the Department believes there is a high level of public awareness of the changes made. One of the benefits of the changes that have been made is that there is a high level of flexibility for individual community welfare officers to support citizens who find themselves in difficulty at this point of a public health crisis. We can see this flexibility is now being broadly used. We do not see any evidence of an increase in people losing accommodation due to rent supplement restrictions. If Deputy Gannon has any concerns about this or is aware of an individual matter, if he lets me know, I will raise it with the Department of Employment Affairs and Social Protection to see if we can make progress on it.
As to whether an increase is needed for the payment level, rather than there being a need for the level of payment to be increased, the higher level of flexibility that has been granted on that payment is sufficient to deal with issues generated.
As to whether the eligibility age for the working payment should be revised, I believe it is fair.
I believe that the level of age that we have on the payment at the moment is fair. I accept what Deputy Gannon said about younger workers but he will have heard some of the challenges that we have concerning workers who are over the age of 66. What we have looked to do is structure this payment on the age criteria of the jobseeker's payment because that is a very well established principle regarding how we make payments available to citizens who are no longer in work. As the Deputy knows, there are now hundreds of thousands of citizens availing of the pandemic payment, which shows that it is a payment that is needed and also that the decision that was made to increase the level of payment was the right one to make. If Deputy Gannon is aware of any individual cases of citizens who are experiencing hardship because of the age decisions that have been made, he should let me know and we will examine those cases.
On whether an opt-out is needed, the Department informs me that it is not possible to opt out of the decision that has been made on the timing of when social welfare payments are made and that we have to treat everybody the same. If Deputy Gannon is aware of particular individuals who are encountering financial difficulty or concerns about when they access their payment, they should let their local community welfare officer know.
On the question put to me about Debenhams, I received a lengthy response as to why we cannot intervene with such insolvency arrangements. I will write to Deputy Gannon and provide him with the detail of the answer.
I have a number of questions and if it is okay I propose to get the answer to each one before moving on to the next question.
I suggest the Deputy asks all his questions and then we will get the responses.
What was agreed originally at the Business Committee was a minute for the question and a minute for the reply.
It was, but that is not what is being done here. Perhaps Deputy Paul Murphy would put all his questions together.
I would find it more effective if I could get the answers to each one separately.
The Deputy can suit himself. We will roll the clock back to the start of the seven minutes.
Thank you very much, a Cheann Comhairle. The first question is about the deal with the private hospitals. The Taoiseach confirmed to me earlier that the estimated cost is €115 million per month for 2,601 beds, which works out at an average of €44,000 per bed. It has been reported in the UK that the NHS deal with private hospitals there is worth £72 million per month for 8,000 beds. That works out at an average of €10,000 per bed. My question is what is the breakdown of the costs. There are 8,000 staff in the private hospitals so that would be €14,000 per person, which means the money is not all going on staff costs. Where is the money going? Is there profiteering? Fundamentally, why does it look as if we are paying four times as much per bed as the British NHS to private companies that are owned by people like Denis O'Brien, Larry Goodman etc.?
I will double-check the figures that were given to Deputy Paul Murphy and I will check what the Taoiseach said earlier about the level of payment that is being made to private hospitals. The fundamental reason we have accessed this bed capacity is, in particular if Covid-19 intensifies in the way it could, the beds that are available in the private hospitals and in particular their intensive care facilities could play a critical role in keeping the country safe, avoiding loss of life and keeping more citizens healthy. That is the reason the Government made the decision to lease those facilities from the private health sector. Those payments will only be made available up to a maximum level and they depend on the usage of those facilities across the period.
The Minister knows he did not answer the question. He is the Minister for Finance. Does he know the details of the agreement? He might answer that question.
The second question has been touched on. Is Ryanair abusing the scheme? Aer Lingus has done something similar. Ryanair has reduced its workers to 50% of their wages and is availing of the wage subsidy scheme. A press statement from Michael O'Leary says openly that Ryanair is putting people on a monthly income of 50%. The rules of the wage subsidy scheme say employers should apply for 70% of average net weekly pay for January and February of 2020 based on payroll submissions made to Revenue by the employer.
That does not seem to be in line with the rules. The rules state one can get 70% of the net weekly pay for January and February. However, what has happened is that workers' wages have been cut to 50% and they are only get 70% of that.
I answered the Deputy's question earlier. I know who I am and I know what job I am doing. The Deputy asked me why have we entered into an agreement with private hospitals and I explained-----
I asked for a breakdown of costs.
-----why we are entering into an arrangement with them. I gave an answer to the Deputy. I do not have available to me a breakdown of the individual costs. I will get information in that regard and notwithstanding any commercial confidentiality agreement involved, what is available to me and that which can be publicly shared, I will share with the Deputy.
On whether any individual company is participating on the scheme, I am not in a position to comment on any company in the scheme. However, I will say that it is my expectation that the full value of subsidy the taxpayer is making available to any particular company should be passed on-----
I thank the Minister and call Deputy Paul Murphy.
I am sorry, a Cheann Comhairle. I want to conclude on this point; I think it is six minutes. The full value of that subsidy should be passed on to an employee.
The record will show my question - it is fair enough if the Minister heard it that way - was not: "Why have we done it?" My question was whether we can see a breakdown and are paying four times as much per bed.
The Minister has answered.
The Minister did not answer but he spoke in the answer section, which is fine. He may not have the information.
My third question relates to the conditions of workers who are in what are deemed essential workplaces and are currently going to work. I have been inundated by communication from workers stating that they do not feel safe at work. For example, Bausch & Lomb employees state a factory is working with hundreds of employees without the required distancing and machines being shared with four or five people, and workers scared to speak out. In another case, a fast-food shop, a worker states they are too busy for social distancing.
The Deputy's time is up.
Let us take the seven minutes.
You wanted one minute per question.
I am willing to take the-----
You wanted one minute per question. You wanted to differ with everyone else. We have done that for you. Your minute is up.
I wanted it in line with the way it was agreed at the Business Committee it would be done.
Please resume your seat.
Will you let me get up again then or not?
If there is time, if you stop interrupting.
Can I use the time now to finish the question? Then I will be happy. This is my last question.
There might not be time for an answer. Go on then.
I will make sure there is a minute for an answer.
The point is another worker went to the Health and Safety Authority, HSA, and was told, because it is a pandemic, it is not under the authority's remit and it will not be inspecting. That is the issue. The Health and Safety Authority has publicly stated it is not its job to enforce the HSE guidelines on Covid-19 and it cannot do workplace inspections. That is a significant problem and it can easily be resolved. It can be resolved by the Minister signing a ministerial order under section 35 of the Safety, Health and Welfare at Work Act to expand the powers of the HSA to cover the Covid-19 guidelines. Will the Minister do that?
I understand that is a matter for the environmental health section of the HSE. That is my information. All employers by this point should be fully aware of their responsibilities. If any employees feel any concerns about their physical safety, they should absolutely be in a position where they can speak up, where their employer should respond and where workplaces be made safe. The public health guidance from the Government on this issue is clear. The National Public Health Emergency Team has issued guidance on this and I also understand that the NSAI has provided Covid-19 workplace protection and an improvement guide to assist workplaces in this area. Only essential sites are allowed to remain open.
I repeat that this is a matter for the environmental health section of the HSE.
In recent days I have noticed a shift in people's focus. While people remain overwhelmed and afraid of all aspects of the coronavirus, there is an acceptance that life as we knew it has temporarily disappeared. There does remain a strong sense of gratitude for the supports that the Government has put in place. However, overriding fears for our financial future are intensifying.
The reality is that people know we are facing another period of great uncertainty, and there is rampant speculation about just how bad it will be. People are worried that the assistance being handed out by this Government will be clawed back by any new Government. Will the income protection schemes that are currently in place be extended if necessary beyond the current three-month deadline?
I acknowledge the Minister's prudent and careful management of the economy, which had put us in line for a budget surplus in 2020 and 2021. The disastrous health and financial consequences of Covid-19 are going to transform that projection to an estimated €20 billion deficit. We obviously have to borrow in order to fund the national economic programme. In doing that, we have to be mindful that as a country we are already heavily borrowed. The National Treasury Management Agency confirmed that as of the end of March this year, our net national debt stands at €191 billion. That is the equivalent of €39,000 owed by every man, woman and child in this country. The yearly cost of servicing that debt is €4.6 billion. Does Ireland, as a country, have the capacity and the creditworthiness to secure further enormous borrowings at favourable rates? Am I correct in assuming that the Minister would be reluctant to borrow under the European stabilisation mechanism? It is inevitable that this fund would attach strict conditions including adherence to a national fiscal programme similar to that enforced by the Troika. Is the Minister in favour of the establishment of the proposed corona bond scheme, which in effect means that euro members' national debt would be consolidated across the eurozone? Would the other option, of borrowing through markets with the European Central Bank's support and guarantees, be the preferred route for Ireland to borrow through? Finally, could the Minister envisage an opportunity under any of the European Union funding mechanisms to refinance our existing loans with the intention of reducing our existing annual interest bill?
First, extending the income subsidy scheme at the end of the 12-week period is a decision for the Dáil to make. The average cost of the income support schemes we have in place at the moment is between €300 million and €400 million per week. The future of that particular scheme is, and will be, a very significant decision, but my very strong view is that while we can fund that scheme to respond to this phase of Covid-19, it and the pandemic unemployment payment are not schemes the State can fund indefinitely. A decision will have to be made regarding how they are removed or tapered when our public health guidance allows such decisions to be made.
Regarding how we would borrow in the future, my strong preference is that the State will be in a position where we will be able to fund ourselves independently on the financial markets, as we have been able to do for the last number of years. Only this morning, the National Treasury Management Agency was successful in selling some short-term debt on behalf of our country at a negative interest rate. Other investors were willing to pay to hold Irish debt. For that reason, it is absolutely in our interest to continue to fund ourselves freely on the financial markets, as we respond to the challenge of Covid-19. We will be able to borrow more if we need to, in order to respond to the economic consequences of this disease, but we do not have an openended ability to borrow. There will come a point at which a decision will have to be made about the maximum amount of money we need, whether we can fund it and how we are able to borrow that money.
Regarding the challenges facing us as well as future decisions that the Dáil and the Government may need to make, I believe that we will be able to pay for them as long as they are sensible and affordable and do not add in an unsustainable way to our current level of debt.
The way in which issues like corona bonds will be addressed is through the recovery fund that was agreed by finance ministers of the EU last week. There was also a meeting of finance ministers this afternoon and in which I participated. Normally I would not support ideas such as debt mutualisation, but the circumstances are so exceptional that we have to be willing to look at new ways in which we can support countries that find themselves in grave difficulty because of this disease.
As to our ability to refinance, we will consider any opportunity to refinance. However, it is my expectation that the way in which we will refinance our national debt will be through our engagement with the financial markets, with the European Central Bank and its commitment to allow the continued functioning of those debt markets in the background. We will do that through engaging directly with investors as opposed to using the institutions of the EU or elsewhere.
Yesterday, the Minister announced changes to the temporary wage subsidy which was introduced on 26 March to provide income support to eligible employees where their employer's business activities had been negatively impacted by Covid-19. Section 28 of the relevant legislation, the Emergency Measures in the Public Interest (Covid-19) Act 2020, makes provision for the Minister for Finance to determine the amount of the temporary wage subsidy, including in respect of those earning in excess of €586 per week. It has been acknowledged that since the scheme was developed at speed, imperfections and anomalies have arisen, including for lower paid employees.
A similar assessment now needs to be made in respect of carers' payments and entitlements, which are not captured in the recent revision of the legislation. In addition to the engagement with Family Carers Ireland, will the Minister ensure that this assessment takes place so that anomalies that are unfair and inequalities around accessing financial supports for carers are addressed? I have already written to the Minister for Employment Affairs and Social Protection on the issue.
What financial stimulus package is the Minister for Finance planning for the economy following the Covid-19 pandemic? In particular, what supports will be introduced to help the SME and tourism sectors to reopen following the lifting of restrictions? There is considerable unease in the tourism sector, including among hoteliers. We have all received emails, and I would like to be able to revert to those people with something definitive.
The question of mortgage breaks from banks has already been mentioned. I have received a number of calls from frustrated constituents. Not only is there profiteering, but the mortgage holders are being punished simply for looking for a mortgage break. I welcome the Minister's statement that he will engage with the banks, since that is the way to proceed, but is it possible that Deputies could receive a briefing document following that meeting so that we could then inform the constituents who phone with queries and concerns of what has happened and set them straight?
I thank the Deputy for her questions. I understand that the matter raised in her first question relates more to the operation of the pandemic payment as opposed to the wage subsidy scheme. If the Deputy has any correspondence in respect of that issue from carers or other groups, she might pass it on to me and I will respond on her behalf. The pandemic payment has been structured to help those who were working on a particular date, lost that work and are no longer working. It is therefore the case that some people are not benefiting from that payment because, for example, they were not working on the date at which the payment was introduced or they may still be in some form of work. If the Deputy provides me the correspondence on the matter, I will respond to her on the issue.
The first step in helping sectors such as the SME and tourism sectors to recover is the income subsidy scheme. It is designed to help employers who have seen a huge decline in their revenue. I know this is the case for anybody working in hospitality or tourism. They have not just seen a decline in their income, they have seen the loss of virtually all of it. Any employer in that sector should either be examining the wage subsidy scheme or should be on it. The very reason the scheme is in place is to support employers at the point at which their income is next to nil. I am absolutely aware of the challenges the sector is facing. It was the first sector to experience massive job losses. When we put together a plan to look at how we can rebuild our economy it is the sector that will be very much at the centre. Our ability to reopen our hotels and restaurants depends on where we are from a public health point of view, whether provisions for social distancing can be implemented and whether it is the right thing for the health of all of us for the sector to reopen, which it will at a point in time but first and foremost it will be influenced by what is right from a public health point of view.
With regard to mortgage breaks, when I have had further engagement with the sector I will provide briefing material to Deputy Nolan and others to ensure they are aware of where the issue stands.
To go back to a point on which I have touched previously, I want to emphasise again that measures such as the pandemic payment and the wage subsidy scheme are exceptional measures for an emergency period. They are schemes through which the Exchequer is making available many billions of euro. It is the right decision to support so many people when they have lost their income so suddenly and in the absence of these schemes would be facing either a huge decline in their income or would find it even more difficult to go back to work. I want to emphasise that their cost will require significant decisions on how they are used in future and how their use coincides with changes in public health guidance.
I will share time with Deputy McNamara. I have submitted a number of questions, of which I will ask two now, and perhaps the Minister will answer the others separately.
Seasonal workers in the tourism industry in County Donegal and elsewhere include employees and self-employed people who were not working on 13 March, which is the reference date for the pandemic payment. They are suffering a loss of income because there is no tourism. What measures can they avail of? Can they avail of the pandemic payment?
In recent weeks, I have spoken to a number of employers who have some cash on hand and are afraid to engage with the payments because they are afraid the Revenue Commissioners would insist that they run down the cash before they could avail of the payments. I do not believe this is the case but I ask the Minister to put it on the record. It is a good and positive scheme that can help an awful lot of workers but it seems employers have a fear of the Revenue Commissioners and do not want them to know what they might have available, which I think is crazy. It is a real fear that they have.
The Minister mentioned restaurants opening up again. Where is the recovery plan? When will we have a recovery plan? What are the benchmarks? I understood when the lockdown happened that we would speak about a recovery when the transmission rate went below one. We have been told today that it has gone below one but there is no concrete talk of either a recovery plan or a date when we might start to talk about opening up again. It is important that some certainty be brought to bear on this. Neither the Minister nor I are doctors but my understanding is that when an emergency plan is being prepared a recovery plan is put in place beside it. We know what the emergency plan is. Where is the recovery plan?
I return to an issue I have raised twice with the Minister in the House and also privately, that is, seasonal workers, particularly in the tourism industry, who because they were not working on 29 February are not entitled to the payment. Likewise, employers cannot avail of the payment if they take them on now because they were not in employment on 29 February. A date last year in the middle of the tourism season might be considered, especially for tourism, if we are to have a tourism industry in Ireland.
I will ask two questions on behalf of Deputy Harkin, the first of which is regarding the microfinance rates. They have dropped from 8% to 4%, which is welcome, but in The Netherlands the interest rate is 2%. Why was our rate at one stage four times that of The Netherlands and why is it now twice that of The Netherlands? Second, will the Government look at small grants to SMEs? I know there is forbearance on loans etc. but nevertheless debts are clocking up and there will be a number of businesses, and in particular small businesses, that will not reopen unless there is some degree of either debt forgiveness or grants from the Government.
In regard to Deputy Pringle's two questions, I want to deal with the matter of reserves and make very clear that because a company has cash-in-hand is not a reason for it either to apply for this scheme or be on it. I have spoken directly to the chairman of the Revenue Commissioners on this point and he made the point to me that a company having reserves or cash-in-hand is exactly what it needs to be able to recover, honour commitments it may have to suppliers and pay debts. To be absolutely clear about it, a company having reserves is not a reason it should be on this scheme. As always, companies should talk directly to the Revenue Commissioners who will help with this matter.
While I am talking about the scheme I want to place on the record of the House my appreciation for the Payroll Software Developers Association, which has been instrumental in setting up the scheme and having it operational as quickly as we have been able to do so.
On the issue of frontier workers raised by Deputy Pringle, I dealt with that matter earlier in the session but I will briefly say again, and I think he is aware, that the access to payments like this are determined by one's point of residency. The Department of Employment Affairs and Social Protection informs me that this is a well-established principle in regard to how we make these payments available and that this is consistent with the way the European Union treats these kinds of matters.
Regarding the recovery plan and where it stands at the moment, we are beginning to give consideration now to what the next phase of the recovery plan will look like. I say "next phase" because the first phase of it was the wage subsidy scheme currently in place but as we become clearer on the parts of our economy that can be reopened as the public health guidance allows it, the Government will have to put in place measures to help with those parts of our economy reopening. We are not at the stage yet of changing that public health guidance.
I did not mean a financial vehicle recovery plan. I understand that any medical emergency plan has to be accompanied by a medical recovery plan. There is no sign of a medical recovery plan in this State as of now. That is worrying.
That is because our health experts are still of the very strong view that the level of transmission of Covid-19 in our country is such that the measures we have in place will be in place for some while.
Regarding seasonal workers, the Deputy has raised that issue with me on a number of occasions. The reason they are not able to access the pandemic payment is because they were not working on 13 March. The Minister, Deputy Ross, and the Minister of State, Deputy Griffin, have asked to meet me on this matter because it is being raised with them, as it is being raised with the Deputy. I will meet them but if we were to open up the principle that anybody can access the pandemic payment, even if they were not working on 13 March, many more workers would be available to access this payment. Currently, 500,000 people are drawing down this payment, which they are entitled to and deserve.
That is the reason that particular group of workers is not able to access that payment at the moment.
On the interest rate, I have an answer and I will write to the Deputy on it.
That concludes the questions. Should the Minister wish to wrap up the debate, there are five minutes available.
I thank the Ceann Comhairle. I have covered a number of different matters with Deputies in responding to their questions. When I take the stability programme update to the Government and have it agreed I would like to be in a position to update Dáil Éireann on it. I believe it is appropriate that I am able to inform the House regarding where we are with the total level of support that is being made available to the economy and also with the Government's view regarding the impact of this disease on our economy in 2020 and beyond. I believe it is very important that the House is aware of that to influence discussions that may happen in the future regarding this House, to colour contributions Deputies may wish to make regarding what a recovery plan could look like and also to inform demands that are being placed upon them regarding additional resources and the additional spending of taxpayers' money. Before that happens, it is very important that everybody is clear regarding where the economy stands now and where it might be able to move to in the second half of this year and in 2021.
I conclude by offering my condolences, as many others have done, to those who have lost their lives so far as a result of this dreadful disease. I also want to thank all those who are on the front line in trying to keep all of us safe and combating the spread of this disease to families and across communities.
I emphasise that I will look at what kind of measures are needed to move the economy into a better place in which it gets people back to work again and which will see incomes rebuilt again. The measures in place now are exceptional. We can afford them now because of the quality of our public finances entering the crisis, but we would not be able to afford them indefinitely. We want to be in a position where we can ensure we can get our economy back to work and ensure the public health guidance being offered is implemented. The first step towards economic recovery is the recovery of our public health. Because of how we entered into this crisis, we are in a position that we can now afford the kind of measures being put in place. I look forward to working with the Dáil to see what kind of measures we need to put in place in future to see our economy recover and to see the many sectors of our economy get to a far better place than they are currently, and most of all to see the 500,000 now claiming income support and without work, who never thought they would be in this position and never thought they would have to access a pandemic payment, back to work, to get small companies open again and to get employers of all sizes back to employing people and contributing to the recovery of our economy.
Sin deireadh leis na ráitis, na ceisteanna agus na freagraí maidir le Covid-19.