Covid-19 (Health): Statements

I welcome this opportunity to update the House on Covid-19 and our response to it. First, and most importantly, I wish to express my sincere condolences to the family and friends of those we have lost to this disease since this House last met. I am conscious that news bulletins every night are full of statistics and reports of new cases and new deaths but we should never forget that behind every number, every death, is a grieving family, friends, colleagues and a grieving community. That grief is compounded even further by our inability to grieve in the normal ways that we usually do in this country. We think of them today; we think of them every day and we offer our sincere condolences to their families.

Against the backdrop of such tragedy, I can often feel uneasy even discussing progress when it comes to Covid-19 but it is important, if not essential, that we reflect and acknowledge the difference people right across this country have made. Members will remember that when I was here last week I updated the House on the modelling work in relation to this virus. The reproductive rate had fallen to between 0.7 and 1.0. I am very pleased to inform the House today that the reproductive rate has now fallen even further to between 0.5 and 1.0. That means for every one person who contracts Covid-19, we now expect that he or she will spread it to no more than one other person and hopefully, to fewer than that. This progress is a huge tribute to the solidarity shown by the Irish people. However, this number is not static. We have achieved this progress by staying apart and we need to continue to keep that distance. If we continue we will suppress this disease even more. That is our national goal. We must not give up when we are starting to see that what we are doing is working and crucially, is saving lives. There are other encouraging signs as well. The model shows that at the beginning of April, around 100 people per day were being admitted to hospital with the virus. I am pleased to inform the House today that the model now shows that this figure has fallen to around 40 people per day which is quite a significant reduction. The number of people in intensive care is also falling and the number of people being discharged from ICUs is rising. I thank each and every one of our citizens and our front-line staff for all their work and for continuing with us on this difficult path. When better days come, these will be among the reasons we can be proud of our country and our people for the way they have acted in trying to defeat this national and global threat.

The significant number of clusters of Covid-19 in our residential facilities is the area of greatest concern and we have put in place significant measures to protect residents and staff. These measures include infection prevention and control teams, active screening of all staff and ensuring PPE supply to long-term residential care settings and home support providers. A total of 18 Covid-19 response teams across the country, each one led by senior nursing supports, are now assisting nursing homes and long-term residential facilities with senior clinical expertise, infection prevention and control and public health input in preventing and crucially, in managing those clusters. We have established a financial assistance scheme for nursing homes which is open for applications. As already mentioned, now that we have additional testing capacity, and I commend the HSE on its excellent work on this, we are now prioritising the testing of staff and residents in these facilities.

By the end of today, 18,000 tests will have been carried out in long-term residential facilities. I thank the National Ambulance Service for the heroic work it has done since this work started last Friday. Tonight, I will meet again with HIQA, the HSE and the Chief Medical Officer to keep a continued focus on this area.

I am aware there has been much speculation and discussion surrounding the potential easing of restrictions from May. I understand why. It is human nature. It is what keeps many of us going, that need for a light at the end of the tunnel - families missed and friends missed, the simple things in life that we took for granted that we now really miss. I promise that we will set out the next steps, but I need people to keep focused on the here and now because the here and now matters. What we do in the next few days matters. For the National Public Health Emergency Team, NPHET, to make these decisions, all of us as a people have a job to do . This involves staying the course, sticking with it, washing one's hands, coughing into one's elbow, social distancing and cocooning and protecting oneself. These are things which, perhaps, we are tired of hearing and saying but they are things that are vital in the next 12 days.

Covid-19 is a highly infectious disease. We are fortunate that the measures we have taken are reducing that infectivity but we are by no means in a safe place. It is important to stress that we are not in a safe place. If we had to decide on lifting measures today for tomorrow the Chief Medical Officer advises me he would not be in a position to recommend any change but we are working on a roadmap, which we will finalise over the next week. This will allow us to have a frank and honest conversation with each other about the weeks and months ahead, one that must acknowledge that increased movement carries increased risk. There is a very thin line between where we could have been, where we are and where we may yet be in regard to this virus.

When I think of the roadmap, I think of it as a new social contract between Government and the people, a way to try to get our country back on track. This will require the involvement of every part of Irish society. It will demand communication and honesty from us on the public health risks and, also, consideration of the mental and physical wellbeing of all of our people. I wish I could tell the people right now what the future holds. We all crave that certainty, but it is too soon. The coming days matter. They will shape our future so please stay the course and please stay at home.

There is ten minutes allowed per group for questions and answers. Would Deputies prefer one minute questions followed by one minute answers or five minutes of questions followed by five minutes of answers from the Minister?

Deputy Browne and I would prefer to split the time and take five minutes each for questions. My first question will probably take a bit longer than one minute but I will lay it out in a way that allows the Minister to respond.

Big efforts have been made to get our hospitals ready for a surge, which have been successful. Efforts were also made to ensure that surge was as small as possible, which have also been successful. The same efforts were not put into getting the nursing homes ready for Covid-19. As we sit here today, seven in every ten Covid-19 fatalities in Ireland are from a nursing home or community care home. Nursing homes are desperately short of staff and personal protective equipment. A nurse told me earlier this week: "Many of our residents have psychological conditions, there is Covid-19 in the air, Covid-19 on the walls and Covid-19 on every door; our senior nurses are all-out with Covid-19 or are self-isolating; we cannot get staff and we cannot get the masks that we need." In this regard, there are two contributory factors. As Covid-19 began to move through the country, nursing homes did not have a voice with the Government or the National Public Health Emergency Team, NPHET. The Government's Covid-19 action plan from mid-March mentions nursing homes only once and only then as facilities to which patients could be discharged from hospitals. There is no mention of supports needed for nursing homes. What of the public health emergency team? According to the minutes available from January to end March, the first time nursing homes were mentioned by NPHET was at its 12th meeting on 10 March. At that meeting it was agreed "that unilateral or widespread restrictions of visiting, which the nursing homes and some hospitals were implementing themselves, is not required at this time." The first time nursing homes were mentioned by NPHET was essentially to advise them to stop their own restrictions. It was a further three weeks before the minutes show that NPHET agreed that action was required on nursing homes. This was at the end of March. The minutes show that NPHET made the decision to close the playgrounds a week before it decided that support was needed for nursing homes.

NPHET has about 45 members and 11 subcommittees. GPs, patients, people with disabilities and the voluntary sector are all represented; nursing homes are not. Nursing homes are represented neither on NPHET nor on any of the subcommittees. The Minister's position is that nursing homes do not need to be represented because they now have good access to him, which is fine, but the Minister also said in his weekend interview with Hugh O'Connell that every single decision he makes on Covid is informed by NPHET, that not a single decision he has made has not been recommended by NPHET. I am not disputing that, but if that is what he is saying then with the greatest of respect, while it is fine that the nursing homes have access to him, surely in terms of effecting policy they must also have access to NPHET.

Will the Minister as a matter of urgency give the nursing homes representation on NPHET? Can he say how many of the NPHET meetings he has attended and at how many of them he has brought up these concerns that the nursing homes have been raising with him?

Deputy Browne has a minute and a half.

We will take our five minutes if we may.

We have five minutes for an answer.

I thought I had five minutes and then Deputy Browne had five minutes. I apologise.

No. The slot is ten minutes in its entirety: five minutes for the question and five minutes for the answer. I call Deputy Browne.

In those circumstances I will ask my questions as quickly as possible but they will probably not have much context. My focus is on mental health and the issues of disability coming out of Covid-19. Covid-19 is now our new reality and will be for the foreseeable future. We are already focused on the immediate Covid-19 curve and flattening it, but there is another curve that is rising, and that is mental ill health. This curve too needs to be flattened. The fallout of this pandemic will be experienced long after Covid-19 has passed. It will bring a secondary crisis in the months and the years to follow. The mental health of the general public is suffering from unprecedented social anxiety due to health, economic and family strains. Even before Covid-19 there was an epidemic of isolation and loneliness in Ireland. Isolation is now Government policy, for understandable reasons, but that does not lessen its impact. I know many people suffering from the impacts of isolation. I think too of our healthcare workers who are having to make some very tough decisions and may suffer moral injury.

Will the Minister establish a mental health task force to flatten the mental health curve and prepare for the inevitable mental health fallout of Covid-19, which will last much longer after the virus itself? Will he put in place very specific mental health supports for our healthcare workers, who may suffer serious mental and moral injury as a result of decisions that now have to be made? Will he put in place specific bereavement supports for those who have lost loved ones during Covid-19 and cannot grieve in the normal traditional Irish way? Will he ensure necessary funding supports to allow people with disabilities who are currently in residential settings, inappropriate settings, who want to live independently but have not been facilitated by the Government to date, to do so?

I do not think it serves us well in our understanding of public health to differentiate between a response in the community and a response in terms of long-term residential care settings as though they are not linked. Had we not managed to flatten the curve as a people in the community, I shudder to think what the situation in our long-term residential care facilities would be like. I shudder to think how many staff would not be able to go to work in those facilities. I shudder to think how much more prevalent the virus would be. In public health policy terms it always makes sense to put in place measures to suppress the virus in the community. I assure Deputy Donnelly that this was not entirely sequential, that a lot of work was ongoing in parallel. I assure the Deputy that nursing homes do have a seat at the table of NPHET. However, it is not for nursing home owners but for the people who regulate nursing homes, the people who set the standards for which this House has legislated, the people who set the standards to ensure that our residential care facilities are safe. HIQA has been a member of the National Public Health Emergency Team since the very start. HIQA knows nursing homes better than any of us - upside down and inside out. It even knows the floor plans. HIQA is therefore on the National Public Health Emergency Team. I note that Deputy Donnelly has not asked for representation for the nurses who work in the nursing homes or other staff members but actually for the nursing home owners. I do not believe that would be an appropriate membership of NPHET, but it is appropriate - I agree with him on this - that we listen to Nursing Homes Ireland. We have a very good relationship with Nursing Homes Ireland and I am now meeting them twice a week. I assure the Deputy that there are people on that call on NPHET. HIQA is on it, the HSE is on it and senior officials in the Department of Health are on it. I am looking at other ways we can further involve them in the decision-making process because they have an important role to play.

Regarding my attendance at NPHET, I do not attend it. I do not believe it would be appropriate for me to do so. NPHET is an opportunity for the Chief Medical Officer to engage on a technical level and often a scientific level. I am briefed before and after NPHET meetings and am in constant contact, as the Deputy can imagine, with the chair of NPHET, namely, the Chief Medical Officer.

With regard to nursing homes, on 19 February, before we had a case of Covid-19 in this country, the head of the HSE held a meeting with the CEO and chair of Nursing Homes Ireland to discuss their Covid-19 preparedness. I also acknowledge on the record of this House that the World Health Organization did not publish its infection prevention and control guidance for long-term care facilities in the context of Covid-19 until 21 March after we had put a number of measures in place so a lot of work has been done with regard to nursing homes. The Deputy is right. This is the front line now. We now need to look at how we can break the chains of transmission in nursing homes and other long-term residential facilities, as we have begun to do in the community. This is why the decision by NPHET now to test residents and staff in those settings who are asymptomatic makes sense. People can ask why we did not it before now. It is a valid question but the truthful answer is that now as we have grown our capacity, we are directing it into that area in terms of a priority.

Deputy Browne is right. I will work with him and this Oireachtas about how a task force could happen. I think it makes sense. We have put in place a number of supports, including gov.ie/together, which is a website that tries to pull everything together in terms of what somebody can do to protect his or her mental and physical health during this crisis. We have also allocated an additional €1 million towards online counselling services for staff and the public. If more funding is needed there, that will certainly be forthcoming. From my conversations with the HSE, I know that a number of supports are in place regarding occupational health around bereavement and mental health but I am sure that this is an area where we can do better so I would be very happy to engage with Deputy Browne, his party and the Oireachtas on this. There are things other than Covid-19 than can make people sick and mental illness and protecting our mental health are areas we really need to watch. There is a lot of tragedy, grief and difficulty in families and communities and the Deputy's suggestion of a task force under the auspices of this Oireachtas at the right time seems sensible.

I will share time with an Teachta Kerrane.

Before I ask my questions, I acknowledge the passing of a care worker in a nursing home in Swords who died of Covid-19. I have been in touch with some of the families in the care home, who are devastated, as are the residents and the people with whom she worked. I do not want to come in here and not acknowledge that because it is a big blow to the community.

The nursing homes sector is reporting a severe difficulty in recruiting and retaining staff. In a survey of 252 nursing homes, we have been advised that there are over 1,000 vacancies, of which 330 involve nurses and 427 are healthcare assistants. Further pressure on recruitment has been caused by the failure to address the childcare needs of healthcare workers. As I am sure the Minister is aware, the proposals he made were not just offensive to lone parents, they were functionally useless for the vast majority of people, as illustrated by the response of the unions. If somebody does not have a spouse working in the public service who is not on the front line, there is literally nothing for him or her.

The Minister said that the CEO of the HSE met with Nursing Homes Ireland on 19 February. Would he not have noticed at that stage that there was going to be a problem? The failure to prepare happened. They clearly were not ready. It is a bit mysterious that the CEO did not realise that. There is an urgent need to address staffing issues and to assist the sector to respond. To that end, has consideration been given to utilising the capacity in private hospitals to assist the nursing home sector? I acknowledge that securing capacity from the private sector was the right thing to do but there was no need for it to be a bonanza for it either. The announcement on 24 March was made but from what we can gather no deal was done for some weeks. That time could and should have been used to negotiate a deal that was good value for money. This open-ended arrangement is far from that. The taxpayer is on the hook for a minimum of €345 million. Has consideration been given to using the capacity that exists within the private hospital sector or redeploying some of the workers, who are telling me that the hospitals have up to 80% vacancies and are so quiet that some of them may be forced to take annual leave?

It was the Minister who raised the potential relaxation of restrictions in his interviews with the media at the weekend. Immediately following those interviews, I was contacted by parents and other people anticipating relaxation. The Taoiseach said this morning that we cannot be complacent.

He is bang on in that regard. In addition, we must not encourage people to be complacent. The Government needs to stop sending out mixed messages. It needs to be consistent and not fly kites because doing so raises expectations. The Minister did so and, in response, people contacted their local representatives and talked among themselves about when and how the restrictions will be lifted and whether it will be on 6 May or at another time. Those questions were not in people's minds until they were put there.

Will the deficit in nursing homes be addressed? Will the capacity in private hospitals be used? I ask the Minister to provide details regarding where nursing homes and home carers can get a steady supply of masks. I am not referring to medical masks but, rather, non-medical masks, as now recommended. In addition to those working in nursing homes, home helps need access to such masks and they wish to know where they can access them. Several of them have, rightly, contacted Sinn Féin.

Is consideration being given to the usage of masks in the community as an element of any relaxation of restrictions? I ask that the Minister provide details of the supply chain for those masks. In certain other countries, masks are being handed out on public transport and in public areas. Is that where we are going? If it is, are we ready for it?

I wish to ask the Minister about current waiting lists for home care packages. All Members know the importance of keeping older people and those with underlying health conditions safe in their homes. Where possible, we must ensure that they receive an appropriate level of care at home to meet their needs. Nobody should ever be left waiting for home care when they have been deemed to need it, but that is especially true at this time. The most recent figures pertaining to my constituency are from last month and relate to the waiting list at the end of February. There were 141 people awaiting new home care packages in County Galway and 69 in County Roscommon, with 27 people across the two counties awaiting additional home care supports. Have those waiting lists been cleared? If they have not, I ask the Minister to provide the up-to-date number of people awaiting home care in each county in the State. These are the very people who need this care provided to them now. They are the very people we need to keep safe at home during this pandemic. I ask the Minister to put the necessary funding in place to ensure that those waiting lists are cleared and that those who require care at home receive it.

I join Deputy O'Reilly in offering my sympathy and condolences to the family of the care worker to whom she referred and indeed to all families who have been bereaved. We think of them all.

On staffing in nursing homes, Deputy O'Reilly made a valid point. All Members know that nursing homes often face staffing challenges and that there is often significant competition between elements of the health services, be they public or private, to obtain staff. One of the best things we can do to help nursing homes on staffing, after engaging with them, is to ensure that there is a quick turnaround time for test results for staff in nursing homes. Last week, a very high number of staff were out of work awaiting tests. I will not quote the exact figure in case I get it wrong. As most of those tests will come back negative, allowing the staff to then return to work, the decision to prioritise that testing will result, it is hoped, in many more people getting a negative result and being able to go back to work. The HSE stated that it has so far directly redeployed 61 people into the private nursing home sector. It is a small number but it must be borne in mind that such redeployment is through voluntary agreement. The HSE is carrying out a census tonight and expects the figure to be higher, but that is the current position.

On childcare, I do not wish for anyone to think anything is offensive or discriminatory. What we are trying to do - and I admit that it is more challenging than we anticipated - is find a way forward that respects the public health advice. What we want to do is twofold. First, we wish to allow public service employees to stay at home on paid leave if their partners are front-line healthcare workers. Second, we wish to look at the possibility of allowing registered childminders into the homes of such care workers. However, we can only do so when the NPHET tells us it is safe to so do. That will be looked at in the context of the roadmap. I engaged with the INMO yesterday and today and will engage with them more formally tomorrow on this issue.

On the Deputy's point about the CEO of the HSE not realising that there was a problem when he met Nursing Homes Ireland, realising there is a problem and challenge is different from being able to keep a virus out of nursing homes. The rate of infection in nursing homes is a problem the world over. There may have been attempts to suggest this problem is specific to Ireland. Of course, it is not. Sadly, the rates of infection and mortality in this country are similar to those in many other countries. We know that many countries, including some very nearby, are not recording data in the way that they are being recorded here.

We are going into nursing homes and trying to identify the virus and not masking it by only announcing deaths in hospitals and not in nursing homes. Dr. Siobhán Kennelly, who is the clinical lead for older persons services, made the point which has been lost in the debate that there are more people recovering from Covid-19 in nursing homes, thank God, than sadly passing away. I say that because I am conscious a lot of people are possibly watching in here who are worried about their mum, their dad or their loved one in a nursing home. The majority of people are recovering from Covid-19.

On private hospitals, the Deputy made some sensible suggestions as she often does. I reject the phrase "bonanza". As I have said to the Deputy before, I know these are phrases she feels she has to say but let me be clear that nobody will make one cent or one euro from the private hospital deal. I published it fully, as the Deputy requested, and all that will be paid is the cost of running those facilities. I want to make them busier. We have seen more than 3,500 patients go through them up to now and we have seen 127 consultants sign up but we need to see more and all costs that we pay over can be scrutinised by the Comptroller and Auditor General. The point the Deputy makes about the spare capacity in private hospitals in the context of nursing homes is a valid one and is something we are actively looking at.

On the relaxation question, when I am asked questions I try to answer them. Sometimes I give the right answer and sometimes I give the wrong answer. I was asked as the Minister and as a citizen what I would like to see coming back at a safe point in time. An awful lot of the commentary has been around the economy and the wishes of certain interest groups in the economy, which are important issues. I get an awful lot of letters and correspondence from kids telling me they are missing school and their friends in the context of their mental health and well-being, and I made the point that I would like to see a way for schools to come back at the appropriate time. I was asked if there is a timeline for that and I said "No". I was asked when that would be and I replied that it would happen when NPHET deems it appropriate. We need to publish this roadmap over the next week so people can see what the different phases look like because I am conscious of not wanting to give out mixed messages. The next 12 days really matter.

NPHET will consider the more broad issues regarding masks and I will come back to the Deputy specifically on the supplies for the nursing homes that she referenced.

I will run out of time but on the issue of home care, I have a note here on the fact that we have been looking at both priority 1 and priority 2 clients for how, in some cases, we could perhaps re-allocate resources from some lower priority cases to help those more in need. We have only done that, however, where there are other supports in place. All cases are reviewed by a public health nurse. If the Deputy has any specific cases, I would be happy to discuss them with her. We are also asking the HSE to closely map the impact of this pandemic on the provision of the home care targets set out in the national service plan.

I call Deputy Feighan.

Do I have ten minutes or am I sharing with Deputy Durkan?

The Deputy should know that. It is not for me to tell him.

I have ten minutes then. I thank the Minister for coming in here today. Most importantly, I want to express my sincere condolences to the families and friends of those we have lost to this awful disease. I also want to pay tribute to the front-line staff of all professions. Their vocation has been incredible. I know they have the support of the entire country in trying to help them out.

It is encouraging that the reproductive rate of Covid-19 has fallen even further to between 0.5 and 1. The one issue is the clusters of Covid-19 in residential facilities. That remains an area of huge concern. I also want to thank the National Ambulance Service and all of the people who carried out the 18,000 tests in the long-term residential facilities. It is an issue we certainly need to deal with.

We have to be very careful that we open up certain businesses and schools at the right time. A lot of people are phoning me about builders providers and garden centres. They genuinely want to do the right thing. I know this is not the Minister's decision but it is an issue that is raising its head. Everyone who has contacted me wants to do the right thing. A lot of people want to make use of the good weather to paint and to work on their gardens. It is one issue we can deal with but I will leave that up to the experts.

I refer to what happened yesterday in light of the restrictions currently in place in our Courts Service.

During the week there have been images in the media of large numbers of people congregating. Does the Minister think these gatherings have put public health in danger? What efforts does he believe should be made in the courts to stop these types of gatherings from occurring again? People who are self-isolating have been greatly frustrated by what happened yesterday. Only down the road from there, the Garda Síochana moved people on. I realise that many of these individuals are looking for attention and that it is up to the Garda to interpret this. Should the people pictured be forced to self-isolate for the next 14 days? Will the Minister join me in condemning their actions?

Yesterday it was announced that the voluntary hospice groups would be provided with an additional €10.5 million until the end of the year. I would like a breakdown of this funding by hospice. How much will the North West Hospice in Sligo receive? For what purpose is this funding to be used?

I refer to the delivery of PPE from China and the problems which arose with one fifth of the original delivery. Was the problem resolved in the context of subsequent deliveries? Will the cost of the incorrect PPE be refunded to the State? I commend the Aer Lingus staff, IDA Ireland, the embassy staff in China and all those involved in securing the PPE.

I support the expressions made by other Deputies about the victims of this pandemic. It is something that happens to individuals and their families. It hits them like it hits no one else. The battle goes on, as it must. I support what others have said that we must be safe. We must continue with the restrictions that are in place in order to achieve the best possible result. Even with all those restrictions in place, there will be casualties, as there have been everywhere. What is confusing is when people can congregate, here or elsewhere, with what seems like impunity. They do not seem to appreciate the damage likely to be done and the message it sends to others who may thing "Why not?" when it comes to gathering and that it is all right to do so. Some of us spoke of these things about international events at the outset, although we will not go into that now. We must go forward cautiously and carefully, and observe the restrictions which have been put in place to the letter.

I join Deputies Feighan and Durkan in thanking our front-line staff, including those in the ambulance service, for the work they are doing. I get the point Deputy Feighan made about builders providers but taking into account the reminder that Deputy O'Reilly gave me about not speculating, which was fair, these issues will be examined by NPHET to ensure that there is clarity for all industries on what is appropriate and safe, and what may not be.

I do not want to comment on a specific indecent which may or may not have happened in a court except to condemn any action by anybody which jeopardises the public health and well-being of anybody and particularly anyone going to work to provide essential services at a time when most of us have been told to stay at home and stay safe and well with our families. Every day there are people who get up and go to work and put themselves in harm's way in order to keep essential parts of our country running. We have a duty of care to those individuals. The law is clear and An Garda Síochána is doing a very good job in the context of enforcing the legislation passed by this Oireachtas and the regulations which I developed.

I am pleased that the Government made an additional allocation of funding to hospices. This was not a direct result of Covid-19-related mortality, rather that some hospices had received less funding from the Exchequer than others and there was a need to equalise that. They had seen a very significant increase in bed occupancy because they had helped us to decongest our hospitals, for want of a better word, to prepare for a potential surge which, thankfully, we have not yet seen.

They have also seen their own funding base dry up. I am very pleased, in regard to the hospice the Deputy mentioned in Sligo and a number of others, that we were able to provide an allocation. The HSE will be in touch to finalise the amount. It has been widely welcomed.

With regard to the issue of personal protective equipment, as raised by the Deputy, our first batch, worth €31 million, has now arrived. It has been quality checked and distributed. Our second batch, worth €67 million, was due to land in May and June but the HSE has managed to expedite it. I thank and commend the HSE, particularly Mr Paul Reid, for this. The first planes arrived from China on Saturday. The HSE has now ensured a continuous supply, or continuous arrival, of more personal protective equipment for ten weeks. This is really good work by the HSE. The third order, costing €130 million, is now in the pipeline. Some 74,000 gowns and protective suits arrived on Monday of this week, with further deliveries of an additional 300,000 gowns expected this week. We now have 275 long-term residential facilities accessing personal protective equipment purchased by the State.

As is well known, there was an issue with some components of the first batch. My understanding from the HSE is that this has been resolved in regard to future batches. There is always a degree of risk when ordering equipment we may not be used to in this country and when we do not have people on the ground. I assure the House, however, that the equipment is all inspected and quality assured before it is distributed to our front-line staff.

I thank Deputy Durkan for his comments. He made the correct point that this country is in a dark place and that there are many families grieving and many people sick. There are many people hurting for a variety of reasons, including reasons of economic well-being. We are thinking of all of them.

The Deputy was also correct to point out that we could have been in an even darker place were it not for the advice of our public health experts and the dedication of the people. It should be remembered that the modelling of Professor Philip Nolan showed that, even with a reproductive rate of 2.7, which is where we were in March, we would have seen 800 people in our intensive care units last week, 2,000 in intensive care units now and 12,000 losing their lives by the first week of May. It is important to outline the context in terms of recognising the difference the people are making.

The Deputy also made a point about people needing to stay the course. Dr. Tony Holohan talks about the risk of anticipatory behaviour. When we shut down elements of our country, in many ways the public were sometimes ahead of us. They thought this was coming so they started cocooning. The risk is that if we arrive at a point where we try over a period to reopen some of our country, the people will start getting ahead of that as well. That would be really dangerous so we need people to stay the course and follow the advice.

I wish to share my time with Deputy O'Gorman. Are we paying our radiography students? I understand that the student nurses are now being paid. Out of fairness, they should have an equal deal. They are dealing directly with Covid-19 patients every day.

I also want to ask about the power to prescribe. I am aware that the Minister has issued an executive order broadening the power to prescribe to pharmacists. That is welcome. Optometrists have asked to have the power to prescribe antibiotic eye drops to take the pressure off general practitioners at such a difficult time.

I want to ask the Minister about contact tracing. I raised this last week in the context of Google and Apple creating an app together. We obviously need effective contact tracing to move on to easing the restrictions. Mobile technology has been central to South Korea's success in tracing the contacts of every person infected with the disease. The European Commission is tracking at least 14 apps that have been developed by member states. The Irish Times reported that a company named NearForm is developing a contact tracing app on behalf of the HSE but we have not seen any specifications or release plans for it. I have a background in software and medical statistics and I am concerned that we have only one chance to deliver a useful app. We should not rush an inadequate solution in front of the public. If the adoption rate is low, the purpose will be undermined.

How many people are currently actively working on contact tracing? How many Covid-19 victims have they identified and notified? What is the daily rate of such identifications? What is the planned release date for the Irish contact tracing app? Who is developing that app? Will the Minister publish the technical, data privacy, cryptographic and API specifications for this app, just as Google and Apple have published theirs? Has a data-protection impact assessment been carried out? If not, will it be?

Will the app comply with the recommendations of the European Commission's e-health network as to how such apps should handle privacy? Recently the French Minister of State for the Digital Sector, Cédric O, said that privacy specifications outlined by Google and Apple should be relaxed in order to give more control over data to national health authorities, which is a controversial position. Does the Minister share that position? Studies indicate that for this kind of app to be effective, we need more than half of the population to voluntarily adopt it. It is similar to herd immunity. What is the Minister's target penetration level of usage for this app? Does he agree that it would be better not to rush out this app and to answer these questions before launch?

When the Taoiseach spoke this morning he warned against complacency in the battle against Covid-19. While the strong national response has been recognised by many, we have all heard of and seen situations where social distancing rules are not being adhered to. Up to now the public information campaign has been very much of a "let's all pull together" nature. Would the Minister consider bringing forward a harder-hitting advertising campaign to highlight the risks of not adhering to social distancing? I remember the advertisements in the 1990s advising people to use condoms as part of the campaign to stop the spread of AIDS. They were very hard-hitting. I think there had to be a parental advisory warning before they were played but they made the point and were effective. Would the Minister consider something similar to highlight the very real dangers and consequences for the most vulnerable from any potential breakdown in adherence to the social distancing rules?

My colleague, Deputy Ossian Smyth, has referred to the importance of contact tracing in the ongoing fight against Covid-19, particularly as we move towards potentially opening the economy again. Can the Minister indicate what sort of technology is being considered at this stage? Is consideration being given to the use of mobile phone information and records to facilitate contact tracing? I understand that this approach has been adopted in Norway. If we do seek to use mobile phone information what are the implications of that for the general data protection regulation, GDPR, particularly for individuals' rights to privacy?

Earlier in the month, a constituent informed me that their elderly relative who was living in a long-term residential setting had become ill and was exhibiting three of the Covid-19 symptoms. This person, who had an underlying condition, died on the third day of their illness. The family was advised that their loved one would be tested by swab for Covid-19 post mortem but the family subsequently discovered that test was never performed and the cause of death was given as aspiration pneumonia. This definition was based on the person's previous medical history. There was no test or post mortem. This happened four weeks ago but it raises a major concern about our ability to identify clusters in locations such as this long-term residence where the State cares for the people who are most vulnerable to this illness. Does the Minister know how common it was not to test people in these long-term residential settings who had Covid-19 symptoms and who died? Is he satisfied that the situation I have described is not being repeated and will not be?

I thank Deputies Smyth and O'Gorman for their questions. I do agree that we need to sort out the problem in respect of radiography students. I need, however, to find a mechanism similar to the one we used to resolve the issue for student nurses. We have not paid student nurses but we have offered them the right to be employed as healthcare assistants and have paid them for that. I have asked the Department to come forward with proposals for other students usefully working in the health service and whom we need. I hope to bottom that out before we meet here again, which I presume will be next week.

Regarding pharmacy regulations, we did that to free up general practitioner slots, reduce physical movements and help pharmacists at a busy time. I will ask officials in the Department to give me a view on optometrists and I will revert to the Deputy directly.

I thank the Deputy for the question on contact tracing. I have a detailed note with me and will try to refer to some of its most important points. NPHET has made a number of changes to contact tracing policy to respond to international advice and enhance our process further. For example, at its meeting on 31 March, it extended contact tracing to suspect cases within prioritised groups and to encompass the period from 48 hours prior to the onset of symptoms, given the risk of asymptomatic transmissions.

The level of resources supporting contact tracing has increased significantly in recent weeks, and an IT system called the Covid case tracker has been built to underpin this work. Significant resources from across the public service have been redeployed to newly-established contact tracing centres. We now have nine centres in operation, with further centres identified to come on stream when required. Some 1,700 people have been trained to date. This includes personnel from our higher education institutions, the Civil Service and agencies, Army cadets and HSE staff. In direct answer to the question, I am told that there have been on average close to 200 people deployed per day in those centres over the past fortnight to meet the current level of cases. This is in addition to staff working in public health, occupational health and infection prevention and control.

The current efforts to develop capacity across all aspects of the testing process, including contact tracing, will continue this month - a paper is due to be delivered to me on the matter by Friday - in order to build the capacity that we will need in order to aggressively identify and isolate cases on a real-time basis, with "real-time" meaning within a day or the following day. This will provide the ability to respond to any planned expansion of the case definition for testing or easing of restrictions at some point. The HSE has appointed a senior manager, reporting directly to the CEO, to lead this work across the full process, end to end, of testing and contact tracing.

As to how many people have been contact traced, the HSE currently advises that calls to confirmed cases and their contacts are being made on close to a real-time basis once laboratory results have been notified to the HSE. It has been acknowledged by the HSE that previously there were delays in the process for notifying results, but it reminds me that it is also important to note that there can sometimes be difficulty in contacting people in terms of having accurate contact information and people answering calls.

The median number of close contacts remains at two per case. Over the two-week period from 6 April, the average number of close contacts per confirmed case was 2.9.

I agree with Deputy O'Gorman that it is better not to rush the app. A great deal of work is being done by the HSE to develop this new mobile phone app. The idea is to complement and enhance the contact tracing process while being fully GDPR compliant. The app is being developed by a coalition of developers and analysts led by the HSE. It is at an advanced stage of development, including work to integrate it into the current manual contact tracing process. When restrictions on public life are lifted, it could provide an enhanced ability to identify potentially exposed close contacts, namely, those not directly identified by direct contacts. It could further support our healthcare system in interrupting the chain. Obviously, it is important that the app be fully developed and carefully tested. I agree with the Deputy that we will only get one chance in this regard. I suggest that, at the Opposition's briefing from the HSE next week, it has a specific discussion on the app and its status. Presuming that the Dáil will debate Covid-19 again next week, I imagine that I will specifically include an update on the mobile app in my opening comments.

I agree with Deputy O'Gorman on complacency. The HSE's public advertising has been good, but the Deputy is right that we must constantly challenge one another as we move into new phases. This is not just a virus that impacts older people, although we know the mortality figures in that regard are concerning. This is a virus that can affect anyone. We have seen children getting very sick from the virus, and the average age of people who have got it is approximately 48 years. Everyone needs to be aware of Covid-19 and there should not be any part of society that believes it is immune from the serious dangers the virus presents. I will consider the Deputy's suggestion on a new public advertising campaign.

Regarding the older resident in the long-term residential care facility, I extend my sympathies to that person's family. I would be happy to take the details of that case as an example and follow up on it, but what I can say now is that we are doing two things. We are trying to identify and report publicly - I am not sure whether other countries are doing this - suspect cases of Covid-19 deaths. We are also undertaking a full mortality census. At a time when most countries are not even publishing confirmed Covid-19 deaths in nursing homes, we want to find as many of them as possible - it might seem like a peculiar thing to say - so that we can have a full understanding of the prevalence of the virus.

Our hearts go out to all those who have lost loved ones and friends throughout this pandemic. It is important that we not become desensitised by the sheer scale of death that we have witnessed in society.

I will focus on long-term residential facilities such as nursing homes. We are very fortunate that we live in a society where care for the elderly is still characterised by compassion and humanity, and so we express our deepest gratitude to front-line workers throughout the country for the work they do hourly, daily and weekly.

Today, I want to speak for those people who live in nursing or care homes. I applaud the Minister's handling of the crisis but there are some questions we feel need to be answered. Today, RTÉ reported that according to NPHET there are 1,944 laboratory-confirmed cases of the virus in nursing homes. According to that report, this is 61% higher than the number of nursing home infections revealed by NPHET on Monday. This represents an increase of 740 cases in two days. The number of nursing home deaths is absolutely frightening and an increase of 740 in two days is astronomical.

What we need is clarity, transparency and a clear communications policy on what is happening in nursing homes. We need to know who exactly is in charge of managing the crisis in nursing homes at present. Is it the Minister, the HSE, NPHET or the Chief Medical Officer? Where exactly does the buck stop? What we need to see is a clearly communicated plan that would give certainty to residents, families and workers in the sector.

Why is the number of cases of Covid-19 in long-term care facilities increasing this far into the crisis? Will the Minister please describe the relationship between stakeholders operating in the State health sector, namely, the aforementioned Chief Medical Officer, NPHET, the HSE and the Minister, and the owners of private nursing homes and their representative bodies? I hope the Minister will disabuse me of this notion or perception I have that at present, there is friction between how the State sector is managing the crisis and how Nursing Homes Ireland is managing its affairs. I perceive some friction in the relationship and I put it to the Minister that now is the time to ensure the safety of older people who are residents of nursing homes. Now is the time to ensure families know who is in charge of managing this element of the crisis. It would be very useful for families of those in nursing homes to have sight of records relating to the day-to-day management of the crisis as it relates to their loved ones. The very notion that in certain circumstances in this society, but for the compassion of individual nursing and care home staff, relatives would not have access to information on how their loved ones died is just not sustainable.

I would like to know exactly what is the status today in real time of the national and regional Covid-19 infection control teams announced on 4 April. How long will they remain in situ? How many clusters exist today in nursing homes? What are the real-time figures? According to the RTÉ report today, 102 people in nursing homes are presumed to have died from the virus. How does the Minister respond to this?

What relatives who do not have access to information about how their loved one died want is clear communication. They want to ensure they know exactly the manner in which their loved ones passed away and, in certain circumstances, that clarity is still not there and they feel they are not being properly communicated with. I know the Minister is doing his best but he might give us some clarity about how he intends to manage that.

In respect of the 18,000 tests that have been carried out in long-term residential facilities, will the Minister tell us how many more have yet to be done? Is there a sunset for that process in terms of completing the testing regime?

I want to deal with two further issues. First, I am hearing from primary care facilities that they are still in need of PPE and they are very concerned about the shortage. In one instance involving a large community primary care facility, I am told they have a week's supply in store. Second, although this is not directly within the Minister's brief, I know he will look through the health prism at the resumption of childcare for working people, not only for those who are front-line workers but across society. I am sure the Minister will appreciate that where two people within a family are working while also trying to manage childcare, it gives rise to domestic challenges. What is the Minister's perspective on whether the Government plans to roll out a childcare scheme that could see more workers outside certain sectors filtering back into the workplace, or at least free up time for people who are working within the home at present by enabling them to send the kids to crèche or a childminder at least to alleviate some of the pressures happening on the domestic front at present?

The Deputy is correct that we are seeing a very significant increase in the number of infections in the nursing home setting. One of the reasons for that, I would imagine, is that we are actively looking for it in that setting. Particularly since Friday, we have seen a concerted effort, starting with nursing homes where there has been a significant outbreak, to test all asymptomatic patients and asymptomatic staff. We are moving then to nursing homes where there is one case and testing everybody - asymptomatic staff and residents - and then looking at nursing homes where there is no Covid-19 and starting by testing all asymptomatic staff there. The ambition was to have this completed within seven to ten days, starting from the weekend, which is the timescale they are working to, and they are doing everything humanly possible to get through that as quickly as possible.

In regard to who is legally in charge, legislation passed by the House defines the person in charge. Every nursing home, private or otherwise, is meant to have a person in charge, generally a clinical person, often a nurse. From my perspective, in terms of how I am managing the crisis, yes, I am engaging with Nursing Homes Ireland twice a week, and it is appropriate I do that as it is a representative body. However, the engagement I am having in terms of overseeing this is with HIQA, which is the regulator and is responsible for the safety of people in facilities and for reporting when it is not safe. By the way, I do not just mean that as a stick to beat the private nursing homes. They also have an obligation, which they take very seriously, to let us know when we are not doing what we should be doing. HIQA has published a new regulatory assessment framework, in line with the Health Act 2007, as passed by this House, and it is going to start visiting public and private nursing homes and inspecting them. As the Deputy knows from his constituency, this will present as many challenges for public facilities as for private facilities. HIQA will also be asked to check with the nursing home owner or the person in charge that the supports we have said should be in place are in place and to report back. There is a meeting on this tonight between HIQA, the HSE, the Department and myself, and that is the way I intend to manage it.

I must conclude as my time is nearly up. With regard to clusters, my understanding is there are 302 clusters in long-term residential centres, 179 of them in nursing homes, which were the figures given out as of last night. In regard to childcare, we will move forward on this as soon as it is safe to do so, but I take the point that it is a very sensitive issue. I assure the Deputy that I do have views on how we need to reform nursing home care and that we need to change after this pandemic.

Now is not the time for it. The time now is for everyone, public, private and voluntary, to muck in and do everything we possibly can to keep people safe.

I call Deputy Róisín Shortall.

I will try to ask five questions in five minutes and hopefully I will get five answers. The first relates to the strategy the national effort is based on, that is, a strategy of test and trace on a large-scale basis - 15,000 a day. We have heard that promise for several weeks now and we are currently at 5,000 a day. Does the Minister accept that the point at which we can start to ease restrictions and get back to some kind of normality is entirely dependent on reaching that figure of 15,000 tests a day and having the capacity to continue that for the foreseeable future? Does he also accept that the level of national debt that will be incurred as a result of this pandemic is entirely dependent on putting in place the strategy which has been promised from the very beginning, which is to test and trace 15,000 a day? We are very far from that at this point. We are doing 5,000 tests a day, and we have no data in respect of the numbers that are traced. The Minister did not provide that figure when he was asked for it earlier. I am asking the Minister again for the second week if he can tell us when that figure of 15,000 tests and trace - end to end - will be achieved. Is he in a position to guarantee that that will be available for the foreseeable future?

With regard to nursing homes, this has been the same problem that we have throughout the health service where our services are hospital-centric and there continues to be an overlooking of social care settings. That is exacerbated by the fact that there has been a move in recent years to privatise large numbers of nursing homes and other care settings and to disconnect them from the main health service and the HSE. Apart from saying mea culpa, does the Minister accept that that was a serious mistake? Can he tell us when we will get to a point where there will be adequate staff, adequate testing and adequate PPE for the vulnerable patients in all of those care settings? There is shared responsibility for that. It is the owners of those facilities and it is also the State but there has to be an acknowledgement that the privatisation of these services is a core problem.

Equally, when it comes to social care, there is the lower level of care and the higher level of neglect of the needs of community services - home help services and home care workers - who again have been left to the four winds when it comes to ensuring their safety and the safety of the clients they visit. Many of them are visiting several clients every day. Again, it is about privatisation of this service. It is about pushing it out and keeping it at arm's length from the State. That has been the critical mistake. When will responsibility be taken for ensuring that all of those very low-paid workers, and their clients, will be given the protection they deserve? Who do these people contact when they need PPE? There seems to be a great deal of ambiguity about that. These are people working at community level on very low pay and left exposed.

My fourth question relates to the issue that arose last week in respect of Keelings and the fact that it seems to be acceptable that large numbers of seasonal workers are coming into this country. We are being told that they are following the guidelines that are set down but can the Minister tell us what, if any, supervision exists in respect of particularly large groups of people who come in from other countries and settle down somewhere in this country? We do not know anything about the conditions in which they are living. Apart from somebody handing them a leaflet at the airport, how can the Minister give us any kind of guarantee that those people are self-isolating properly in proper conditions? Can he tell us if he intends moving to a situation where there will be quarantining of people in those circumstances?

My last question relates to the deal that was done with private hospitals.

When will we get a breakdown of the figure of €1,461 per bed per day to be paid? It is very hard to understand how that figure was reached considering the equivalent figure in the UK is a small fraction of that. Does it include earned income from private patients who are in situ in those hospitals? Will the Minister tell us the actual figure involved and the basis of that figure?

There are a lot of questions.

I will do my best to answer them.

There are a few parts to them. I thank the Deputy for the questions. Regarding testing, tracing and public health surveillance, that will be a major part of the easing of restrictions at whatever point that happens. However, it will not be the sole factor. Restrictions are not in place in Ireland today because we do not have the public health surveillance in place, but because the virus is not where it needs to be. The document published by European Commission President von der Leyen outlines the criteria that must be in place before the easing of restrictions. Public health surveillance, testing and tracing is one of three items. The others are capacity and the behaviour of the virus. However, the Deputy is correct. The HSE tells us it has capacity to undertake approximately 10,000 tests per day. This is in laboratories in hospitals and in the community, including the NVRL, Enfer, smaller laboratories and some international provision. The HSE is due to give an update to NPHET at its meeting tomorrow regarding how it will achieve the roadmap, as it were, to the 100,000 tests per week that NPHET believes is necessary. When the Deputy says we are far from it in terms of the number of tests being done today, it is important to point out that with the case definition as of now, there is not the demand for that today, but there will be a broadening of the case definition in the coming days. We are using the extra supplies now to prioritise the nursing home sector.

The Deputy asked if I can guarantee that this will be available into the future. Only an idiot would do that. The best government and public health service in the world cannot give cast-iron guarantees in respect of all the moving parts, be it reagent, supplies or laboratories. The HSE has said it can do 10,000 tests per day in terms of capacity and it has secured a significant amount of additional reagent. It has built up a very good system. It has put a senior manager in place to deal with end-to-end testing, including the contact tracing. I am confident it is moving into a very good place.

Regarding nursing homes, in the time available I do not want to get into that debate other than to say I am saying a great deal more than mea culpa. I did not bring in the privatisation agenda for nursing homes and I agreed the Sláintecare plan with the Deputy, which moves us in a very different direction. It is important to say mea culpa when one gets things wrong, but some of the tragedy we have seen in loss of life has been in our public health facilities as well and we must acknowledge that. We have seen a significant mortality rate in a number of HSE facilities as well.

As regards PPE, we are providing PPE to more than 200 nursing homes. We are delivering 2,500 to 3,000 cartons and pallets each week to residential units, in excess of 1 million pieces of personal protective equipment, including hand sanitiser gel, gloves, goggles, face shields, gowns, aprons and face masks. On Friday, 17 April alone, 378 deliveries were made to nursing homes, providing 750,000 items. The Deputy is correct that there is a shared responsibility. If one runs a private health facility, one has a responsibility for the safety of one's staff, just as one has in every organisation. We are trying to supplement that, not replace it.

Regarding home care, we made a decision that home care providers have parity of access to PPE with nursing homes. If there is any confusion in terms of who they contact, I will take that up. We are not differentiating in this regard. If there is an issue with PPE, we are not differentiating between public or private. We are trying to protect the citizen. I will follow up on that directly with the Deputy.

The Deputy referred to overseas workers coming into Ireland. I would make the point even more broadly. We must tighten up further with regard to anybody coming into or back to our country. This will become even more important as we arrive at a point where we begin to ease restrictions. The Deputy is correct that currently we ask people to self-isolate, but that is not checked. NPHET has made a number of recommendations to the Cabinet committee and I expect to be able to announce them shortly. We have to consult a few more key stakeholders. What it must involve is a person at the airport being required to fill out a form saying where he or she intends to stay for that period of time and that being checked. We need to put that mechanism in place. While there is not a significant volume of people coming into the country now, we must be sure that we are not in a position where we are all following best practice here and people coming in from abroad are following a different one. I expect an announcement on the further tightening of restrictions at the airports and more than just taking somebody at his or her word that he or she is following the isolation restrictions.

On the question of whether the State must provide accommodation, quite frankly, the answer is "Yes" if a person is not in a position to self-isolate. We believe that many people will be able to self-isolate. However, a person must tell us where he or she is self-isolating and we need to be in a position to check that.

On private hospital costs, I will get the breakdown of figures sought by Deputy Shortall.

Cuirim fáilte roimh na hathruithe ón tseachtain seo caite ó thaobh ár dtithe altranais agus na hoibreacha ann. Dá mbeadh an réimeas seo againn ó thús, d’fhéadfaí a lán saolta a shábháil. All of our sympathy and solidarity goes to those who have lost their lives, those who are ill and the families who are facing the consequences of this.

I have a question on the death rates in nursing homes. I understand that the most up-to-date figure is 450. Not all of those deaths were laboratory confirmed, but most were. Of the 450 people to whom those deaths relate, nine were sent to acute hospital settings. Does the Minister not find that figure incomphrensible and, in the future, will he be able to stand over every single case where a decision is taken not to send a person to an acute hospital setting? I am aware that there can be many complications and that the onset of symptoms can be very quick. However, referring only of nine out of 450 people to an acute hospital setting does not seem right. Will the Minister be checking in every single case that the right decisions were made, in the right setting and with the right advice?

I shall now turn to the next catastrophe we are facing. Direct provision centres are the next possible catastrophe. In a report released yesterday, the Ombudsman, Mr. Peter Tyndall, stated that the highly contagious nature of the virus "brings into sharp relief just how unsuitable and unsustainable it is to have three or more people in the same room". We are told that this is the provision being made for those who live in direct provision. I put it to the Minister that it is an issue of immediate concern and that we need to ensure that everything is done to try to avoid a situation whereby direct provision will become the next serious cluster. There are healthcare workers who live in direct provision and we were told that they would be put into separate accommodation.

My next question is on the protection of other workers. Bus workers are driving up and down the country without being protected. There are no screens on Bus Éireann's fleet. The unions have asked for free public transport in order to stop any interaction with passengers. They have not been given that. We are told that the Health and Safety Authority has no role to play in health and protection during this public pandemic crisis. The Minister for Business, Enterprise and Innovation, Deputy Humphreys, has informed us that those responsible are looking into the HSE playing a role, insofar as the role of environmental health and safety officers will be expanded to check out workplaces. Will the Minister for Health elaborate and tell the House that building workers, bus workers and others who resume work will be protected in their workplaces by means of the necessary protocols and by the provision of personal protective equipment, if necessary, screening and social distancing measures?

With regard to the deal with private hospitals, the Minister and the Taoiseach have said that no one should profit from this crisis. At a cost of nearly €1,500 a night per bed, unoccupied, it beggars belief that vast profits are not being made by some of the wealthiest people in this country who have major shares in the big private hospital chains. I ask the Minister to please explain that anomaly.

My final question relates to masks. How does the Minister feel about encouraging - not forcing - members of the public to wear masks?

Some 20 years ago, 80% of nursing homes in the State were in public ownership and 20% were private. The position now is completely reversed, with 80% in private ownership and 20% public. This has been the result of 20 years of Government policy incentivising the development of the private nursing home sector. I will not go into that now but it means that the majority of nursing home workers do not have access to the HSE's occupational sick pay scheme. It also means that the majority of nursing home workers do not have access to an equivalent sick pay scheme. I would venture a strong guess that the majority of nursing home workers do not have access to any sick pay scheme.

This means that, if they get sick or feel the need to self-isolate, their maximum income is likely to be €350 a week. This is a big cut from their weekly wage. In some cases it would be a cutting in half of their weekly wage. This is very wrong. I will give the Minister two reasons as to why it is wrong. While I am sure that if the majority of nursing home staff woke up in the morning and did not feel 100% they would take the financial hit and self-isolate, this means that there is economic pressure on those workers to take a chance and to go to work. We talk about absenteeism. There is an opposite - presenteeism. This is a push factor as regards presenteeism, which is a danger to health, safety and lives.

It is also very wrong that if such workers get Covid-19 and are off work, those front-line workers will take a cut in pay of possibly half. The other day, SIPTU's Paul Bell said that the private nursing home sector should be taken into public ownership for the duration of the crisis. I believe it should be taken into public ownership full stop. Is the Minister in favour of giving access to the HSE's occupational sick pay scheme to those nursing home workers who do not have it straight away and for the duration of this crisis at least in the interest of health, safety and safeguarding lives? I would appreciate it if the Minister would answer that question.

I thank Deputies Bríd Smith and Barry for their questions. In fairness, Deputy Bríd Smith acknowledged that the cases of those in long-term residential care may be complex because a number of factors quite apart from Covid-19 may be involved in someone deciding to leave his or her home - which is what a nursing home is, his or her home - to seek hospital treatment. That decision is generally made on the advice of a doctor or other clinicians, often in consultation with the individual's family and taking account of his or her wishes. It can also be the case that people have made it clear what they would wish to happen to them with regard to the treatments they wish to get if they get sick. I assure the Deputy that these are clinical decisions. They are not my decisions as Minister - the Deputy is not suggesting they are - or hers or those of the Oireachtas; they are individual clinical decisions made in the same way she or I would expect decisions about our health and welfare to be made by our doctors rather than by the Oireachtas or by the Minister. The clinical guidelines in place in respect of Covid-19 are the same for all of us. Regardless of who we are, what age we are or where we live, there is one clinical guideline governing Covid-19. Of course there are other factors with regard to living in a nursing home, including some of those I have outlined.

Obviously there are many protections in place for anybody who is concerned about any outcome or any conduct of a health professional, although I am not suggesting that issue arises. HIQA also regulates in this area. I am satisfied with the guidelines in place and, having talked to the Irish College of General Practitioners, I am satisfied with the approach being taken by our GPs.

With regard to direct provision, which is an issue the Deputy highlights regularly, the Department of Justice and Equality has undertaken a lot of work to ensure accommodation is available for anyone who has, or is suspected of having, Covid-19 to isolate. I saw a statement from the Department in this regard as recently as today.

On the specific question regarding healthcare workers, there are now 278 people who work in the Irish health service taking up our offer of accommodation. I do not know all of their backgrounds but I know that, so far, 278 people have taken up our offer of alternative accommodation. That is available to anybody working in the health service, regardless of whether they are in direct provision. There are good details on how to apply for that on the HSE's website.

On the issue of bus drivers, or indeed anybody else working in any part of our economy and society, even in environments where it is not possible to fully physically distance, measures must be put in place to safeguard people. These may include guidance on PPE, where necessary. I am thinking of places such as factories and construction sites. I want to be clear that the National Public Health Emergency Team will be monitoring this area very closely as we move towards any decision to reopen any part of the economy. On the specific issue of bus drivers, I will talk to the National Transport Authority through my Department and revert to the Deputy directly.

On the issue of private hospitals, I believe I am going to run out of time to answer. I am happy to stay here and talk as long as Deputy Barry wishes but I am confined by the clock. On the issue of private hospitals, I published the deal last week and laid it before the Oireachtas for all to see.

The issue is that nobody should make a profit. We will be paying the cost of running the facilities and it will be subject to scrutiny by the Comptroller and Auditor General. I am quite sure, and it would be entirely appropriate, if not necessary and essential, that the Committee of Public Accounts will scrutinise this as well. Deputies must bear in mind the conversation we would have been having if we had not secured this agreement. Deputies would be asking me where are the ICU beds, ventilators and isolation facilities. It is some achievement for the HSE and the Department of Health to have secured the use of 19 hospitals for the duration of this crisis. What I want to see now is us making sure we are using those assets and protecting against a surge. By the way, the surge might come. I heard somebody say we should rip up the agreement. It would be an awfully brave politician who would say we should rip up the agreement, give back the ICU beds and give back the ventilators. He or she would be an awful lot more certain about the path of this virus than I would be. We are ripping up no agreement. We are keeping the assets that we have but we are going to make them work. I have heard Deputies in this House, including Deputy O'Reilly, suggest that. We are going to make sure that they are busy.

On the issue of masks, NPHET will guide and inform my view in this regard. The team made a change already in relation to health care professionals and health care workers, and it will look at the issue of the broader public as we ease restrictions. On the issue of the sick pay scheme as raised by Deputy Barry, I do not have any plans to extend that scheme to people working outside of the health service but I will correspond with him further on it.

On a point of information or clarification, it sounded like the Minister was suggesting that I suggested that the agreement be ripped up, but I did no such thing. I think the Minister may have misspoken but that is certainly what it sounded like to me. I did no such thing and nor would I.

The Deputy absolutely did no such thing. I just happened to catch her eye at the time but Deputies in this House did, in recent days, contact me through a variety of fora and suggest that we should rip up the agreement and give back the private hospitals, but I have no intention of doing that.

The point is clarified. We now move on to Deputy Matt Shanahan on behalf of the Regional Group.

I begin by expressing my condolences to all families who have been recently bereaved because of Covid-19. A heavy price continues to be exacted on our population. Also, on behalf of the Regional Group of Independents, I applaud the efforts of our national medical and clinical care staff and wish a full and speedy recovery to those diagnosed in hospital or home care settings at present.

I wish to highlight some areas of innovation and potential in ongoing Covid-19 management which I hope the Department of Health will acknowledge and support. PPE in development in Ireland at present has no expedited access or pathway to gain certification or standards approval so that it can be formally supplied to public, community and national health services. I am aware of two projects in Waterford attempting to navigate the standards approval process. The first is a barrier face mask, the design of which has already been approved for use in France by means of a standards reclassification, but as yet in Ireland we have been unable to accelerate standards consideration. The second is a new clinical full-face mask being developed by the South Eastern Applied Materials, SEAM, research centre at Waterford Institute of Technology, WIT, one of our 15 national technology gateways. Development is in conjunction with University Hospital Waterford's ICU consultants, Boston Scientific, Consort Packaging and Jabil Healthcare. This mask may prove a significant development for clinical care lead protection and I ask for the support of the Minister's office in the coming weeks to assist in the certification of this product. The SEAM technology gateway at WIT is assisting some of the foremost names in medical device design and manufacture in the country. Its 3D printing facility has been manufacturing face visors for local healthcare concerns since the Covid-19 outbreak began. I urge the Department of Health to support the release of approved funding granted in 2018 for the purchase of a CT scanner for industrial X-ray. This apparatus is needed to support the innovation and problem solving that has been second nature to many businesses in Waterford and the south east for many years.

I will now move on to the issues in our nursing and residential care homes. The situation regarding PPE has been well flagged, but there are broader issues which have not been flagged as yet. Some social and political commentary has inferred that we have substandard nursing care prevalent in our community and residential care settings, but I know this to be untrue in my county of Waterford. What is puzzling to me and many others is why the Department of Health and the HSE have not prioritised senior care staff to handle the testing requirements within nursing homes. Testing kits could be made available to nursing staff along with the provision of short training courses to allow for the in-house swabbing of residents and staff as required. These swabs could be sent to local laboratories for analysis. This could deliver a 24-hour test turnaround, the gold standard that we are currently failing to deliver. Beyond this, we have vulnerable patients with dementia, and it is clear that having familiar care attendants conduct swabbing would be far more appropriate to their needs. The Minister has directed HIQA to conduct inspections into Covid-19 activity in residential care settings.

Many nursing homes have already drawn up Covid-19 management strategies in collaboration with HIQA and any further reviews should be minimised to a desktop exercise to prevent individuals accessing care homes and potentially introducing infection.

The Department of Health's announcement of funding to the sector was positive but some of the actions of the NTPF, which the Minister appointed to administer the moneys, have been less positive. Many care homes have expended significant resources in the purchase of PPE, increased staff numbers, creating Covid-19 isolation areas and protocols and bonus staff payments to cover enforced absence of colleagues and the increased workload. The NTPF applications to support funding are onerous in the extreme. The decision by the NTPF that significant preparatory purchases and expenditure in the month of March cannot be supported is unjust. Capitation money is payable for fair deal residents only and not those privately funded. Bonus moneys that have been agreed or paid cannot be supported.

For many care workers the Covid-19 pandemic unemployment payment, PUP, would return more money than their weekly take home pay. The State is prepared to support this cost but is not prepared to support an incentive to allow staff to work extended hours in these most difficult conditions. The Government is not adequately compensating residential care homes for the financial hardship which Covid-19 management has caused and, at this juncture, neither is it providing the extra personnel resources promised that could be switched from hospital settings.

Significant progress has been made in securing additional test kits through the efforts of Dr. Paddy Mallon, Dr. Paul O'Brien and Dr. Oisin O'Connell. I ask the Minister for a status update in this regard. A national training scheme for PPE donning and disrobing would be of immense help in reducing Covid-19 cross contamination in hospital and community settings where the virus exists. Does the Minister or his Department have plans to address this issue? Pulse oximeters have been shown to have significant diagnostic value in identifying the early signs of Covid-19 infection and signalling treatment. I applaud the leadership the Department of Health and the HSE have taken in this area which, as profiled in an article in The New York Times this week, may significantly assist Covid-19 diagnosis and early treatment.

The cath lab at University Hospital Waterford, UHW, was scheduled for refurbishment this year. It has been closed since 14 February to allow for a refurbishment programme scheduled to take 15 weeks. In Waterford, the main cath lab and the temporary contract diagnostic cath lab are closed to service, while a reduced offering is available at UMPC Whitfield private hospital. Will the Minister commit to authorising works on the existing cath lab at UHW to be expedited as an essential service? The UHW cath lab configuration delivered over 4,000 patient procedures last year. Will the Minister also indicate a final recommissioning date and the recommencement of fixed and modular cath lab activity at UHW? In addition, the construction of a second permanent lab at UHW announced by the Department of Health in September 2018 has still not gone to build-tender-approval. There will be companies interested in this Government contract. Will the Minister confirm that moneys are ring-fenced to support this capital project and that his Department is committed to advancing it as soon as possible to construction-tender-award? I ask that the Minister deal first in his response with the issues of the cardiac service.

I acknowledge that the Deputy has done a huge amount of campaigning and work in regard to cardiac services in the south-east. I also congratulate him on his election. On the second cath lab in Waterford, money is ring-fenced for it. I will get a status update for the Deputy. It is not for me to police what is essential or non-essential in regard to construction works, but there is an exemption for essential works to continue. I would have thought that the refurbishment of the existing lab was an essential work. I will raise that issue directly with my Department and the HSE and I will revert to the Deputy in that regard. I know how important and sensitive that issue is for the people of the south east.

On the projects which the Deputy highlighted, it is clear the south east is a very innovative place because the Deputy has highlighted a number of projects under way where Irish companies and Irish industry are eager to help and support our national effort. I would appreciate a note on those projects, which I will then ensure is given to the Office of Government Procurement and that any assistance that can be provided by our State agencies will be provided.

On the issue of testing, the point made by the Deputy regarding in-house swabbing is a valid one and one I know the National Public Health Emergency Team is looking at. Currently, we are largely using the National Ambulance Service, mainly for reasons of speed. What we want to do very quickly is try to find as much of this virus as we can in our residential care settings so that we can quickly move to try to break the chains of transmission, as we seem to have largely done so far in the community.

However, the Deputy's point about the fact that many nursing homes have the clinical ability through experienced nurses to carry out in-house swabbing is valid.

Regarding the issue of HIQA and its visits to nursing homes, I assure the Deputy, as I have assured nursing homes and as I have spoken to HIQA, that the purpose of these visits is to be supportive, not to catch anybody out. The purpose is to visit both public and private residential care facilities, voluntary and otherwise, nursing homes and the like, to engage and to see whether what is meant to be happening there is happening and whether the supports and the connectivity for supports that are meant to be in place are in place in order that we can have more than anecdotes of what is going on and see very clearly from the regulator areas that are doing well. I hope to be able to report that many nursing homes are doing well because I believe that people are working really hard in them. We must remember that the majority of our nursing homes are still, thankfully, Covid-free, which is some achievement for them. This is a highly infectious virus, and people are doing an awful lot of work. The visits are therefore a supportive tool to provide us with accurate information from the regulator that I think people in this country expect.

The NTPF is the administrator of that scheme. I do not expect or wish the scheme to be bureaucratic. Obviously, certain checks and safeguards need to be in place. I know that meetings were due to take place today and perhaps yesterday in that regard, certainly in recent days. There has been ongoing engagement between officials, the HSE, the NTPF and nursing home representatives, and I am due to meet Nursing Homes Ireland again tomorrow on this issue.

To respond to the Deputy's final two questions, I thank him for his comments on the leadership being shown by Ireland on research and diagnostics and so on. I want us to remain in that space. We have appointed Professor Colm Bergin to head up a research group on Covid-19 in our country. We have also carried out one of the first health technology assessments by HIQA on new testing that may become available in order that Ireland can be ready to avail of any of these in the future.

Finally, regarding the issue of extra staff for our nursing home sector, I know this is a very important and very sensitive matter. All the unions were brilliant in agreeing a voluntary redeployment scheme, but I must concede that it is tough to match appropriate staff to appropriate settings. We have already seen, I think, 61 directly-employed staff moved to the private nursing home sector. I expect that number to increase, and the HSE is due to give a census update on that this evening.

I also ask the Minister to put pressure on for the development of our second cath lab in order that we advance it to a construction tender. It has been lying around for quite a number of months.

Obviously, the current restrictions on work and the likes have an impact, but I am very eager for that second cath lab in Waterford to proceed.

We move to the Rural Independent Group. Again we will hear from Deputies Michael Collins and Richard O'Donoghue.

Three minutes for my questions and three minutes for Deputy O'Donoghue.

I like the way the Deputies are alternating.

It is very smooth.

We are trying to keep ourselves fully alert.

I got a letter some time back from the husband of a worker in the private nursing home sector and another a few days ago. I will refer to an extract from it. It just shows the worry and upset that are out there and the concerns that need to be addressed. The nursing home in question is without masks. It had been promised a supply from the HSE weeks ago but as of yet has received nothing. This was on 4 April. The first letter states that the men and women, mothers and fathers, working in the nursing home are nervous and scared, not only for themselves but also for their patients and families. The staff are resigned to the fact that it is only a matter of time before they are infected. They are still working away and looking after their patients without face masks. This was just a couple of days ago.

Three weeks later, the care centre has three Covid-positive staff members and 19 Covid-positive patients and one dead, with another five staff out sick and at least 18 patients suspected to have Covid-19 and awaiting testing. The staff have still to date received no PPE from the HSE. The home has been in touch with the HSE and we are told it has no PPE for the nursing home. Three other nursing homes where this man's wife used to work and where she still has friends have said they have got no PPE from the HSE. Their children have not left the house in 37 days. It is not that they were afraid they would catch Covid-19 in their community but, rather, that they may have already caught it from their mother and may spread it. The staff in her nursing home are now under tremendous pressure, working in tremendous fear and understaffed. They must hand back used single-use face masks at the end of their shift for them to be cleaned and reused.

I ask the House to remember the scenes we saw from Italy, France and Spain of doctors and nurses struggling each and every day. Those scenes are happening here in Ireland right now, not in our hospitals but in our nursing homes, and it is the same for home help workers. I am getting texts - I presume other Members are - and mobile phone calls from people working as home helps who have not got any protective gear, and it is very upsetting for them. Right up until last night I got texts, and I received another this morning, to the effect that in areas of west Cork they were promised something and nothing arrived.

Nursing home workloads are immense at the moment and we must look at ways where application packs for the NTPF for extra assistance could be simplified. It is much better for directors and nurses to be dealing with residents and implementing advanced infection control procedures rather than projecting figures and spending time on paperwork. The scheme only covers fair deal residents and not private residents. These private residents should not be excluded.

Older people need to be supported to live independently in their own homes as long as they wish to do so. We have been fighting for this for many years. Previous Governments turned their backs on elderly people. The cuts to home care packages and home helps were unforgivable and the embargo on new home help hours has forced many people into nursing homes prematurely. This mistake cannot be repeated by future Governments. Sadly, as a result of Covid-19, we have seen the danger of dormitory-style accommodation for residents in some of our community hospitals in particular. Are HIQA standards being investigated in all community hospitals? Has there been investment to address the issue? What is the Government doing to incentivise Irish healthcare professionals who return from overseas? These are truly tremendous people, some of whom have come from very lucrative jobs, who have given up their whole lives to save lives here and help in the current crisis. What incentives at least exist to persuade them to remain in Ireland for the next five years?

I commend the Minister on his work on this. My question, which I asked of the Minister for Finance, concerns farming. What is considered essential work depends on the contact in the Department of Agriculture, Food and the Marine. Many farmers are under severe pressure with harvesting due to the growth rate. They are looking to get construction work done on their farms, and if they do not get it done in the next fortnight, there will be a backlog and they will have nowhere to put their silage and round bales to keep things like effluent at bay. There is a knock-on effect. If they do not have their farm buildings finished by the end of the summer, they will have the same problem in the winter when they need to put their cattle indoors. At the moment, contractors will not go on site because they say they are waiting for a directive to say it is essential work. All farming is essential work. All farm buildings constitute essential work. Social distancing can be maintained 100% but all farming work involving the food chain must be considered essential work. Our dairy industry is essential. Farming is essential when it comes to everything on our tables, but it is not just for now. Contractors are willing and will maintain social distancing but it is not happening.

Some home help workers have been reduced to one hour while others have been reduced to half an hour, but while they are on contract to the agencies, they do not qualify for a Covid-19 payment. I am receiving calls telling me that the agencies will not release these workers because they are under contract. Can we address this with the agencies so that if somebody's hours are reduced below a certain number, the top-up can be up to €350 to make sure healthcare workers are protected?

I thank Deputy Michael Collins for bringing the issue of PPE to my attention. If he wants to give me the details of the individuals or institutions involved, I will certainly liaise directly with the HSE on his behalf. In respect of the letter dated 4 April, I would hope that we have seen an improvement since then based on the decision taken by NPHET to have parity of access regarding PPE for residential settings and hospital settings, but I will certainly follow up those cases for the Deputy. I must make the point that there is also parity of access with regard to home care, so if the Deputy has come across a blockage, he should email me or write to me about it and I will address it.

The Deputy raises the valid point that we have seen a number of Irish people come back home to work in the health service. We have seen the GP from Toronto who contacted me to say that she had come back, and Irish doctors who had been working in Perth and nurses coming back, all of them coming back to be on call for Ireland and to put their shoulder to the wheel. The Deputy is right. We want to keep them here, which will be the challenge. My Department and the HSE need to do a bit of work on how we ensure that it remains an attractive place for people to work in.

I hope that their being back and our being able to sign them up to jobs will help in that regard. The Deputy raises an important and timely point and I will engage with my Department on it.

I am glad the Deputy raised the issue of community nursing units because much of the conversation in the media, the House and elsewhere in recent days has involved a suggestion that all of the challenges are in our private nursing units, which is not the case. We have a blended mix of community nursing units, as well as private and voluntary nursing homes. There have been significant challenges relating to our community hospitals. The HIQA framework published on Tuesday will apply to all residential settings, including those owned by the HSE or the State. As part of that framework, there will be HIQA visits to community nursing units. As Members are aware, there is a significant programme of capital investment to upgrade the facilities. Although excellent care is provided in the facilities, many of them are old buildings in need of refurbishment. The HSE is in the process of implementing its capital programme in respect of residential services for older people. The programme commenced in 2016 to rebuild or refurbish approximately 90 centres requiring upgrading of infrastructure. There has been significant progression of refurbishment across the country, but there is certainly more work to do in that regard.

Deputy O'Donoghue asked me two questions, both of which merit my getting more information and reverting to him with proper responses. The issues in question are somewhat wider than my remit in the Department of Health. On the issue of farmers, I accept that the farming sector is essential and matters relating to food supply are very important. If there is confusion as to what is appropriate, safe or essential, I will engage with the public health officials in my Department and correspond with the Deputy to provide clarity in that regard.

He raised an issue regarding agency home help workers whose hours have been reduced for a variety of reasons as a result of the pandemic and stated his wish that they would qualify for the differential between what they are earning and the Covid-19 payment. That payment is not administered by my Department but I will discuss the matter with the Minister for Employment Affairs and Social Protection and ask her to revert to the Deputy.

Incidentally, next week there will be an engagement with the Minister for Agriculture, Food and the Marine, Deputy Creed, and the Minister for Business, Enterprise and Innovation, Deputy Humphreys, which will provide an opportunity for Deputies to ask questions of them.

My colleagues, Deputies Joan Collins and Pringle, and I have tabled seven questions. I will not reach all of them in the limited time I have. I ask the Minister to confirm that written answers to those questions will be provided. That will ease matters. I will hone in on questions Nos. 3 to 7, three of which are in my name and relate to residential facilities. The Minister may have heard my contribution this morning when I stated that I have no idea why residential facilities were not top of the list from day one. I still do not understand why that was not so. I have tried to come at the matter in a different way. There is a clear obligation on HIQA, the Mental Health Commission and other bodies, including regional medical officers, to report infectious diseases. Question No. 4 that I tabled asks how many Covid-19 outbreaks in residential care facilities were reported to regional medical officers. I ask the Minister to address that question.

On community healthcare organisations, CHOs, Members received a briefing document from the Department of Justice and Equality on 3 April which stated that those organisations were going to look at congregated settings and do a full assessment. Has that been done? If not, why not? When will it be done?

Deputy Joan Collins tabled a question on the reliance on PPE from abroad. What progress has been made in sourcing such equipment in Ireland? There is a significant amount of goodwill and people have come forward from all sectors, from individual women to the arts sector, to say they can and are making such equipment. What progress has been made in that regard?

Deputy Joan Collins also tabled a question regarding Keelings. The Minister partly answered her question while replying to Deputy Shortall. Is it correct that there was no contact between Keelings and NPHET? Is the answer to the long question that Deputy Collins took great time to table "No, there was no contact"? If so, what monitoring, if any, is being carried out by the Government of Keelings or any other company that is behaving in that manner?

We need workers. I have no problem with that but what measures are being taken to ensure the law is being adhered to?

The issue of nursing homes is really upsetting me and upsetting people on the ground. Why were all of the residential facilities, including direct provision centres, not the number one priority? Peter Tyndall's report has been mentioned already and I will quote from it again. The report said that this virus has brought into sharp focus "just how unsuitable and unsustainable it is to have three or more people in the same room" and so on. My time is up but I would like to get answers.

The Minister signed off on the regulations that determine what limitations there are on people's liberty. Essentially, we are all subject to house imprisonment, except for being allowed to avail of essential services or to visit essential retail outlets. The essential retail outlets are listed clearly to be fair to the Minister. The list says that hardware stores are essential retail outlets, as are outlets that provide equipment for gardening. Given that, why are other Ministers going on the airwaves saying that garden centres and hardware stores should only open in emergency situations and should not be open? When this Chamber delegates the power to the Minister to make law, and he clearly makes law, surely that should be adhered to and other Ministers should not be giving information that is contrary to that law. I would like the Minister to confirm whether the regulations he has signed off on say in black and white that hardware stores and garden centres are essential retail outlets or whether they do not.

Ursula von der Leyen's criteria for opening up have been mentioned quite a bit. She also spoke about moving away from blanket measures and more towards regional measures. The law which this House passed, which gives the Minister the power to make the orders, talks about areas and regions and the Minister chose to make an order in respect of the whole country. The transmission rates are different across the country and there are particular pockets of infection. Has the Minister given consideration to having different regimes in place for different areas? What is required for a city such as London, where there are 2 million people on the Underground every day is different to what is required for a city such as Dublin and is different again to what is required for rural Clare. However, it seems to me that regardless of that, there is the same infringement on liberty, on people going about their lives, on people seeing their family members and on people earning some money - because ultimately the health service has to be paid for, whether it is paid for through a planned economy or a capitalist economy but either way, we need a functioning economy to provide for the health service. Has the Minister given consideration to that?

One of the tracing measures which will probably be looked at is an app. I heard the Minister answer questions on this point already. Will there be open sourcing in advance? Will the coding be published in advance? If not, why not? If the coding is not published in advance and if there is no open source coding, how will the app get buy-in from the public? People will obviously be distrustful of the app if they are carrying it around while it is collating essential information about where they are at any time and who they meet. People will understandably want to know who that information is being collated for, where it is going and who it is being given to. Will that be open source coding and if not, why not?

I thank the Deputies. There were quite a few questions there and as I have a limited amount of time, I will respond to each of the seven questions that have been tabled in writing. I want to reassure Deputy Connolly because at the heart of her questions is this idea of why long-term residential facilities were not the first priority, presumably because of the vulnerability of the residents living there. I assure her that from day one, work has been done on this. HIQA, the regulator of nursing homes, has sat on NPHET and has done a good job. Guidance was published in February and meetings took place in February before we even had a case of Covid-19 in Ireland. We know that every year, whether it is with the flu or the vomiting bug, it is very difficult to keep infections and viruses out of residential settings. We know it is difficult to keep infections and viruses out of our homes and we have homes with large numbers of people but that is not to say efforts were not made. However, it is right and proper, from a public health point of view, that when the virus is suppressed within the community, and it is thankfully looking like we are beginning to do that in Ireland at least at this moment in time, that sectors that need more supports are then further honed in on.

I said this earlier and I mean it: I would not like to think how much more difficult things would be in our long-term residential facilities today had the virus not been suppressed in the community. Residents are not going out of the facilities, the virus is being brought in. The more that the virus is prevalent in the community, the more it can come into a long-term residential care facility, including by essential staff who are doing a very good job.

I have a detailed note, which might be best to send to the Deputy in the interests of time, on what we can do to work with Irish companies. We are not reliant on anyone else to provide us with PPE - work is ongoing on that - but the short answer is that it is about speed and the time it takes to ramp up production here when we need the PPE yesterday. That is the challenge that we are trying to work our way through.

On Keelings or any other firm, it is not the job of NPHET to consider individual applications. The airports are open and people can come into the country. The issue is for them to give advice on what should happen when any of us comes back to or into our country. The answer I gave to Deputy Shortall earlier indicates the direction of travel in that regard, perhaps tightening the monitoring process so one does not ask people if they would mind self-isolating for 14 days but would ask them where they will self-isolate and that there will also be an ability to check that. That is important as we begin to open up the country more in due course.

On Deputy McNamara's question on hardware shops, it has been much debated. The view of the National Public Health Emergency Team is that they should only be open for emergencies as of now.

The law is a mess. The Minister signed the law.

We have cancelled and closed many things including pubs, rugby matches and so on, on the basis of people doing what is good for them, their staff, the public -----

What does the law that the Minister signed say?

The law, I believe, says that they can open but the clear public health advice -----

The Minister signed the law.

I know that. I am aware of that and if Deputy Byrne wants to ask me a question about that in a moment, I ask that he please do so.

The clear advice from Dr. Tony Holohan, our Chief Medical Officer, is that hardware shops should only be open for emergencies. That will be reviewed as will all other things. We have operated a compliance structure based on buy-in and support from the public, not based on the law. The law has been there as a safeguard. The Deputy makes good points on infringement on life but the biggest infringement on life is death. We are trying to save lives here. The Deputy is correct - the Oireachtas has given me the power to look at regional areas. It is something we keep under consideration. The current view is that the size of the country means that would not be practical in terms of the transmission of the virus but it is always kept under review.

I agree with the Deputy that there would need to be significant public buy-in in a voluntary capacity for an app to work. The more information that can be published, the better and I have committed to the House already to provide a detailed update on the mobile app in my opening statement next week.

Is the Minister happy that he has covered everything or does he want five minutes to wrap up?

I am happy if Members are.

Then we will take a five minute suspension before we move on to education.

Sitting suspended at 5.58 p.m. and resumed at 6.05 p.m.