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Dáil Éireann debate -
Thursday, 30 Apr 2020

Vol. 992 No. 8

Covid-19 (Health): Statements

I welcome this opportunity to update the House once again on the Covid-19 disease and our national response to it.

I will begin by providing an update on our modelling work. I am pleased to say that the R number, which we have been talking about for several weeks, has remained stable at 0.5 to 0.8. That is quite an achievement by the people of this country. By now, Deputies know what this means but it is important to reflect on its impact on people and their lives. When the Taoiseach announced a series of restrictions on 27 March, our modelling at that point showed the R rate stood at 2.4 - 100 people were being hospitalised every day, 70 people were in intensive care units and 22 people had lost their lives. If the epidemic had continued at that rate, our modelling suggests that today there would be 2,200 people seriously ill in critical care units. Our modelling also shows that if that trend had continued, by today, 30 April, 4,800 people would have lost their lives from Covid-19. Sadly, 1,190 lives have been lost to this virus. We think of all those families grieving at such a difficult time. However, thanks to the incredible efforts of the people, our modelling suggests that over 3,500 lives have been saved. That is 3,500 reasons to stay at home, stay the course and keep with us on this journey. We have made significant progress but we cannot let that mask the current reality. Up to 40 people are still being hospitalised with Covid-19 each day. Between three and four people are being admitted to intensive care units each day. They are the sickest patients in our country. We must finish the job.

If we want to give this country the very best chance of success, we must continue with the work. If we want to continue to save lives, we must stay united and stick together. I understand the fatigue that people are feeling at this stage. We all feel it. It is human nature. We are all human and denying ourselves many of the things most intrinsic to our very humanity.

We all now know a lot more about the virus and the ways in which we can protect ourselves from it. We must guard against any sense of invincibility, however. It is true that some people are more vulnerable to this virus. In truth, everyone is vulnerable to this highly infectious disease. In the past few days, we have heard a growing commentary that it is only people of a certain age or with certain conditions who are susceptible to this virus. That is not the case. We are all vulnerable to it. We must, as individuals and as a country, remain cautious and vigilant.

I know people want us to map out what the next phase will look like for Ireland. We will do so tomorrow. The Taoiseach has set out the criteria which will guide our decisions. We have every chance of success but we have to get the timing right. Moving too quickly will set us up for failure. That failure would have real and devastating human consequences of which we are all too aware. There will also be social consequences of this going on longer or of us going backwards, which is also a possibility if we get it wrong.

We will provide a clear sense of direction, but in the meantime our collective objective remains to suppress this virus. We must do everything we can to stay safe and to protect each other. Despite some positive signs, it is too soon to say that we are safe from this disease, but it is in our power to keep ourselves safe and to keep others safe if we continue to stay at home, to wash our hands, to practise good respiratory hygiene and to continue physical distancing. We have come this far. Let us not risk undoing it and let us not risk going backwards.

For our part, we continue to build capacity across a number of areas to respond to Covid-19. I will now provide some updates on key areas. Our target for overall testing, as determined by the National Public Health Emergency Team, chaired by the Chief Medical Officer, Dr. Tony Holohan, is 100,000 tests per week operating on a seven-day a week basis for a minimum of six months from mid-May. The HSE has developed a roadmap as to how we can rapidly reach that capacity. It has the full and unequivocal support of my Department. Significant progress has been made in a very short space of time to develop our testing capacity. The scale of this effort and the pace at which capacity is being developed cannot be understated. I know there have been bumps in the road; there has been in every country in the world.

I thank the people who have worked so hard to get us to this point and to build these systems, because huge progress has now been made. The establishment of 48 community testing centres across the country and a steady supply chain of swabbing kits is in place. Significant laboratory capacity has been sourced nationally and internationally and a range of supply chains for reagents and other materials has been sourced. A robust testing referral pathway for GPs has been put in place. New IT systems have been developed and existing ones modified to ensure tracking of testing across the full process. Nine new contact tracing centres are in operation and 1,700 people have been trained to date to support specialist teams in public health, occupational health and infection prevention and control. A major programme of testing is under way in long-term residential care facilities. Some 28,000 samples have been taken since 18 April. This is a significant, complex and large-scale operation spanning a number of sectors and hundreds of providers.

As we continue to build the capacity of the health services to deal with Covid-19, we will also need to further plan how we will provide services for non-Covid-19 care over a protracted period. We know now this is going to be a protracted period and people are going to get sick with things that are not Covid-19. How do we care for them? This is a challenge with which all health services around the world are now grappling. At the end of March the HSE entered into an arrangement with the private hospitals to use their capacity, including their ICU beds and their isolation facilities, in our response to Covid-19. The deal was on a cost-only basis and all patients are to be treated as public for the duration of the crisis. It is important to remember that the requirement for this additional capacity will remain with us. I have heard some people suggest that perhaps because we did not see a peak that we do not need the capacity now. That is nonsense. Thankfully, and thanks to the sacrifices people have made, so far we have avoided the expected surge so that currently there is a level of spare capacity in the entire system, both the public health service and the private health service. We will use that capacity, particularly that of our private hospitals, to deal with the ongoing urgent work and the backlog of elective care need which has grown further in the past month. We will also use it to guard against the potential need for a Covid-19 surge in the future, a risk that should not be dismissed. As of today, we are using about 33% of their capacity, with some hospitals at 50%, and this is increasing and will increase further when we restart elective work when deemed safe to do so. Over 150 consultants have now signed up to the contract offer and I understand more intend to do so, once the recent agreement that the HSE can fund private rooms, if required, to provide public services, is concluded this week. The arrangements provide for continuity of care for existing patients on an equal basis to public patients. The more consultants that sign up, the more services we will be able to provide to all members of the public.

I thank all consultants currently providing excellent care in these challenging circumstances and everybody in all professions and all workers right across the health service. I know doctors would also want me to take this opportunity to remind everyone to contact their local health service if they are unwell. People should not feel they are a burden on the health service at this challenging time. If people feel ill they should please still come forward because the risk of secondary deaths and secondary illnesses arising from this Covid-19 pandemic is very real. People should please not wait if they need treatment.

The number of clusters of Covid-19 in residential facilities remains our area of greatest concern. We are continuing with the significant measures already in place to protect both the residents and staff. These measures include 18 response teams across the country, led by senior nursing support and infection prevention and control in public health input into preventing and managing clusters. We are prioritising the testing of staff and residents as I have outlined.

The regulator, HIQA, has published and is now assessing a new quality assurance regulatory framework for long-term residential healthcare settings so that we have ongoing oversight, not anecdote, into the response of each of these facilities - public, private and voluntary.

We are currently looking, as the House will be aware, at the public health measures that are in place until 5 May. Our primary focus in that analysis will be to ensure that any access taken will not endanger the progress that we have made in suppressing this disease. Extreme vigilance will be needed so that we do not put our country at risk from future waves of this disease. Our society has already paid a significant price for the ground we have gained against this disease. As we move into the future, we must not lose that ground. The National Public Health Emergency Team is taking into account the expert advice of the World Health Organization, the European Centre for Disease Control and Prevention, and the European Commission in developing public health criteria to guide our decisions. In order to move forward, we must have the capacity to measure the effects on the disease of any changes we might make and to be able to do so very quickly. We can do this if our actions are underpinned by an efficient sampling, testing and contact-tracing strategy and access to real-time epidemiological and clinical data. At every stage, we must watch the transmission of this disease. We must be confident that we have sufficient capacity. We are also fortunate that as some countries are at a more advanced stage of this pandemic, we can monitor that also. The truth is that we cannot act unless we see that the disease remains suppressed and achieving that, as I have said, is in the hands of each and every one of us. If we continue to make good progress we can begin to restart our economy and, most important, our society, and we can look forward to a time where there are no new cases and no new tragic deaths. We will have a roadmap for the next phase but we must continue to unite around a common purpose to stay safe and to protect each other.

I thank the Minister. We go first to Fianna Fáil's Deputy Stephen Donnelly.

I will share time. I will take the first five minutes. Maybe the Minister and I could go back and forth, with the Ceann Comhairle's permission.

I would like to start by expressing my sympathies as well with the friends and families of the many women and men who have now died. This has come at an extraordinary cost so far. It is a very difficult time for anyone who is trying to mourn a loved one or a lost friend. I would also like to acknowledge that without the extraordinary work of our healthcare professionals and, indeed, of every individual and family in this country, that tragic number would be an awful lot higher. Much good work has happened.

I would like to talk to the Minister about getting the non-Covid healthcare going as quickly as possible. I cite the following case with the permission of the family involved. Callum is a five year old boy from Wicklow. He lives close to where the Minister and I live. He has Down's syndrome and he has unfortunately many medical conditions associated with that. Here is what his Mum, Gillian, told me earlier this week:

Callum is my lovely boy. He started walking in 2019 after so much hard work. A year and a half ago, it was felt he had juvenile arthritis and he was referred to rheumatology in Crumlin. Callum needs an MRI scan under sedation for this treatment. His scan is scheduled for next year, two years from when his doctor said he needed it.

Callum is in pain. He is pre-verbal so he cannot tell us when he is in pain or where the pain is. His doctors need the MRI done so that they can limit the damage to his body.

Callum's arthritis recently flared up so he cannot walk much anymore. He seems to have a lot of pain in his hips and his hands and he is now on very strong painkillers. This week, his doctors in Crumlin thankfully decided to start the treatment but to do so without the MRI, and to try and provide what care they can.

Callum needs physiotherapy twice a week. He has not had any for six weeks now.

That is Callum's situation.

My question is why is the urgent therapeutic care in the community, including physiotherapy, not happening now? We have people going into work in supermarkets and other places without personal protection equipment, PPE, who are public facing. It would seem the trained clinicians, such as physiotherapists, with PPE should now be able to re-engage in urgent cases, such as Callum's. I would like to hear the Minister's thoughts on that.

On the Minister's point on the private hospitals, they are largely empty. We have diagnostic suites empty. We have operating theatres empty. We have entire clinical teams still not treating patients. Does the Minister envisage that children such as Callum will be able to get these scans and treatments through the private hospitals? If so, when can Callum and his Mum, Gillian, expect to start seeing that kind of treatment?

I thank the Deputy for raising these two important matters, which are both linked to the provision of non-Covid-19 healthcare. He has hit the nail on the head on a very important issue. In this country as in many others we have all been preparing for the pandemic to take a certain course of action: to come, to reach a very high peak with huge human consequences in terms of deaths and very serious illness and then hopefully to begin a downward trajectory. Thanks to the efforts of the Irish people we have not seen that awful surge. However, we now know it is highly likely that this virus will stay with us for a protracted period. That means we really need to ask and act on the questions the Deputy is asking about how to provide for non-Covid-19 care alongside Covid-19 care. I do not want to use up the time of the Deputy and his colleagues, but several examples of that have started. Community assessment hubs have been set up to try to keep Covid-19 care there and non-Covid-19 care in regular GP practices. Many of our physiotherapists, speech and language therapists and occupational therapists have already volunteered to be redeployed to help out with other areas of the health service, both in the constituency the Deputy and I share and nationally. People are helping with contact tracing or in community assessment hubs and testing centres. We are now going to have to make a call on the appropriate allocation to each of them to make sure their services can continue to operate. The HSE will finalise plans in that regard. One specific discussion at our medical leaders' forum last week, which was chaired by the Chief Medical Officer and the chief clinical officer of the HSE, concerned what a non-Covid-19 care work stream will look like.

While I cannot comment on a specific case, as the Deputy will be aware, I absolutely want to see private hospitals fully utilised for the benefit of public patients. The taxpayer is now paying for the use of these facilities. There are 19 of them around the country. We have diagnostic equipment in them. I made clear in my opening statement that we will need to keep some capacity free because a surge or a second wave could come, but we can do more than we are doing now. We have seen a quite significant increase in the number of cases being treated. We will need to see it increase further. I will look at Callum's case and others like it.

As the Minister will be aware, 90% of deaths due to Covid-19 are among those aged over 65. All my questions today will be Covid-19-related. The Health Protection Surveillance Centre issued guidance for immediate implementation saying that surgical masks should be worn by healthcare workers when providing care within two metres of a patient, irrespective of Covid-19 status. Does the Minister agree that this should also be the case for home care workers, who see as many as six different people each day? Most people receiving home care are older or more likely to have an underlying health condition. I have been contacted by many home care workers who are concerned. That is my first question.

My second question is not exactly the Minister's remit, but he will certainly have influence in this regard as it affects the care of those cocooning during the Covid-19 pandemic. While I appreciate that we are coming into the summer months and the fuel allowance would not normally be needed at this time of year, we are in exceptional times. Older people are being asked to cocoon and are, therefore, unable to leave their homes, which is having a knock-on effect on their fuel usage. They cannot walk outside their homes or visit libraries or day care centres. I appreciate that the scheme has already been extended for four weeks, but it is due to expire on 8 May. Could the Minister use his influence to extend this again? When someone is cocooning and is not mobile, he or she can feel very cold.

My next question concerns nursing homes. The situation in nursing homes and care homes is still in need of urgent attention. According to HIQA, almost a third of nursing homes in Ireland have the Covid-19 virus. The agreement between the HSE and unions allowing for health staff to be diverted to private nursing homes, where needed, must be implemented urgently. I raised this two weeks ago. There are still issues around insurance indemnity. I acknowledge there has been movement on the issue, but it is dragging on and is causing a major issue where staffing is concerned.

I appreciate that testing in nursing homes has ramped up since last week and, as the Minister stated, 28,000 samples have been taken to date. There were two issues in nursing homes, namely, personal protective equipment, PPE, and staffing. I acknowledge that the position concerning PPE has improved significantly in many nursing homes whose representatives I have spoken to, but there are still huge staffing issues. The Government has tested 28,000 samples. It is imperative that the test results are accelerated, because staff members having to isolate for 14 days while waiting or a test result places significant pressure on staff numbers.

My final question relates to asylum seekers located in Cahirsiveen. I raise the question on public health grounds. According to RTÉ news last night, there were 22 confirmed cases.

The fear and anxiety expressed by the residents, pleading to be removed from fear of catching the virus, was intense. The locked gate was a terrible image. There is also the worry and anxiety that it has caused for residents and businesses. I ask the Minister for an update.

The Minister has a minute and a half. If he cannot answer all the questions, he might correspond.

I will send a written note on the last one. I imagine it might come up in conversations here anyway.

It will come up anyway.

On the issue of home care workers' PPE and nursing home workers' PPE, over the past seven days, from 23 April to 29 April, 6.63 million items of PPE have been delivered across the health service. Some 54% of this volume was delivered to community residential facilities in 1,767 individual deliveries. As for the full distribution, 54%, as I said, went there and 8% went to home care. I had a very good meeting yesterday with Home and Community Care Ireland, HCCI, which represents many home care providers across the country. We have put in place a direct contact point for them with a national director in the HSE. They have also brought forward some other suggestions, which I am working through, regarding their own provisions. Home care workers are now being provided with 8% of our entire PPE. Some 497,380 items of PPE over the course of the last week went to home care. We want to continue to do better and to do more on this. It is a fair point. Regarding the fuel allowance, I will resist speculating about Departments that are beyond my remit. I certainly will pass on the Deputy's comments to the Minister for Employment Affairs and Social Protection.

The Deputy is right about nursing homes. A voluntary redeployment scheme is in place. I have seen figures of more than 200 HSE staff who have been redeployed on various occasions to private nursing homes. The number is significantly increased from when I was last in this House, when it was about 61. We have now reached an agreement with home care providers to redeploy too. The indemnity issue has been ironed out. An agreement was reached about 48 hours ago. I expect to see a benefit from that shortly. There was a bit of back and forth between Nursing Homes Ireland and my Department about the funding scheme. Clarifications have been issued. The deadline is 30 April, that is, now. A surge of applications is coming in. We are turning them around quite quickly, within 24 to 48 hours. That will also help our nursing homes. The Deputy is right about the testing. There was an occasion when more than 900 nursing home staff were out awaiting various tests or with symptoms. We are testing people and getting their results back quickly. Most of them will be negative and they will be able to go back to work. We can help nursing homes through quick testing, direct redeployment, the home care working scheme and the funding scheme.

The protocols that we adopted stipulate that there should be only two Members from any party or group in the House at any one time. Please have regard to that. I call Deputy Niamh Smyth.

I pay my deepest sympathies to the families who have lost loved ones in this global pandemic. The efforts of our health workers have been truly inspirational, yet we heard this morning on "Today with Sean O'Rourke" that the Labour Court deal for nurses is behind schedule. I hope the Minister is dealing with that because as we know, these have the inspirational men and women at the forefront of this pandemic. I thank our doctors, nurses, paramedics and home support workers, as well as everyone on the front line, who have been to the forefront of this. We have been blessed in Cavan-Monaghan to have Cavan General Hospital and Monaghan General Hospital as the backbone during this pandemic. Unfortunately we have seen week-on-week increases and Cavan, as of Wednesday of this week, had 634 cases with 388 cases in Monaghan. Cavan has one of the highest rates in the country.

I want to raise two particular issues today. I am conscious that I have little time. One is home testing. There are incidents where referrals from home testing are being lost in translation. There is an elderly couple in my area. The husband was taken to hospital and subsequently died. He tested positive for Covid-19. His wife was at home, living alone for three weeks, waiting for a test. A referral for a home test had been made. Her daughter was living in the Minister's constituency and her son is somewhere else in the country. Eventually her daughter had to come and put herself, her mother and her family at risk, taking her to her own home in Kildare. She was tested within three hours of that transfer to a different community healthcare organisation, CHO, being made. I think that home referrals are a problem in CHO 1.

There is an issue with cancer patients. I am thinking of one particular gentleman, a young man with a wife and four small kids, who is waiting for an operation on a tumour in St. James's Hospital. He has been given no clarity as to when that operation might happen. Are operations that were scheduled before this pandemic happened still scheduled? What are the implications?

Since this is an unorthodox time of social restrictions, my speaking opportunities in this Chamber are rather limited these days. I take the opportunity to express my immense gratitude to our heroic staff, especially our nurses and doctors. When this pandemic is over, we must remember them. That will have to come up in the autumn when we are into the budget process.

As health staff risk life and limb to treat Covid-19 patients, Ms Gemma O'Doherty and her band of followers are flouting all laws on the street, giving cheek to our gardaí, making a farce and being treasonous towards our front-line health staff. I hope the Minister for Justice and Equality will ensure that the laws passed by this House will apply to all individuals and that those who continue to flout them to court notoriety and attention on social media will be taken to task fully.

A constituent in Clare sent me a letter earlier in the week. It relates to her elderly husband who is suffering from advanced cancer. He had been due to undergo surgery at the Bon Secours Hospital at Barringtons in Limerick city on his private health insurance. The family is now being told, however, that due to Covid-19 the surgery cannot be carried out and that man now has to join many others on the public waiting list, a list that is not moving at the moment. This is causing major stress to the family and it is utterly unacceptable. I would like some clarity as to how people with private health insurance will be treated at this time, particularly those with life-threatening illnesses.

At the outset of the Covid-19 pandemic, it was right for the Department to strike a deal with 19 private hospitals to increase bed capacity. Now, however, there needs to be a little flexibility regarding those awaiting elective surgery. The word "elective" almost denotes flippancy and casualness, but for someone waiting for a hip replacement or any type of colonoscopy, there is nothing flippant or casual about that. Elective surgery is essential and we need to get that backlog moving. Without an easing of the elective surgery restrictions our health system will be hit with an unmanageable tsunami of cases when the Covid-19 pandemic shifts. I fear that this will disproportionately hit the University Limerick hospitals group, including Ennis hospital in my constituency. The waiting times in University Hospital Limerick have increased by 10% over the past year in respect of outpatient cases and by 12.6% in Ennis hospital in my constituency. These waiting times are only set to get worse as the pandemic drags on, and I would like to know what actions the Minister proposes to take.

I wish also to draw his attention to the fact that administrative staff in our country's now very quiet private hospitals are being laid off. This is fundamentally wrong, given that their places of employment are being very well reimbursed using Exchequer money by the Minister's Department. Will he intervene in this and will he consider using these staff to help with contact tracing?

I should point out to the Deputy - I know he is a new Deputy so I would not expect him to be totally familiar with this - that he alluded to the actions of somebody outside of the House who is not in a position to defend herself. Whatever our feelings might be about the individual or her actions, it is not appropriate to refer to that person here in the House. I just draw the Deputy's attention to that. It is a subject we might all have strong views on. I call Deputy O'Reilly.

I have very strong views on that topic, but we could be here all day discussing them. I want to address several pressing issues with the Minister. I am conscious time is tight. I am sharing time with Deputies Ward and Paul Donnelly, dividing the slot into seven minutes, four minutes and four minutes. I hope we can ask our questions in the seven minutes and if the Minister cannot then respond, I hope he will respond in writing. I want to be respectful to my colleagues and their time. Can he please issue a directive today to hospitals to ensure that nurses, who went on strike, fought hard for their pay increases and deserve them, get them? It is utterly ridiculous at this stage. It is all very nice to stand in here and give them a round of applause, but, as I said previously, nothing conveys appreciation for the work they do like decent pay and conditions. Nurses fought hard for these pay increases and I hope the Minister will be in a position to issue a directive today to say that they should be paid.

I have two questions about nursing homes. How many people have been seconded to the nursing home sector from the HSE to date? The Minister has given the figure of 200. I had a different figure given to me by the HSE, however. I want to know the up-to-date figures and I also want to know if the Minister is planning to second a geriatrician or a geriatric consultant to work in any of the nursing homes. They have spoken to me and have said they are willing to do this work. Their expertise will be invaluable in this regard and the Minister should look at that issue.

My next question concerns a decision to move patients from hospitals into nursing homes at the very start of this pandemic. Patients were moved from hospitals into nursing homes.

Yesterday, on a conference call, I was told by the HSE that every patient who was to move to a nursing home would not be moved until he or she had two tests negative for Covid-19. Will the Minister confirm if that was the case from the very beginning? I lost a relative who died in a nursing home of Covid-19. His family and others in the nursing home are convinced that Covid-19 came into the nursing home when patients were initially transferred. Last night, Dr. Holohan seemed to row back a bit on this and suggest this may not have applied to all patients.

I have two questions on testing. I have said before and I do so again that the Government must stop blaming people for the fact that they are starting in some way to think about the relaxation of restrictions. The Minister and others in government put this thought into people's heads. There were mixed messages and I know that although work is being done to prevent it now. We did hear mixed messages about the schools reopening.

I am mindful of the view recorded in the NPHET minutes, indicating that all "agree that testing and tracing is critical to tackling the virus spread". We know testing and tracing is important. Will the Minister state if the capacity is in place to move from disease surveillance testing to actively testing in the community so we can identify the total spread and transmission of Covid-19 and then contact trace every person involved?

My second question concerns the contact tracing app. I am a big fan of this app and I want it to work. I want maximum buy-in but we should be honest, as the Government has not exactly covered itself in glory with respect to data protection, particularly when we consider the public services card. We need maximum buy-in so I ask that the data protection impact assessment be published well in advance and that the Government will allow organisations like the Irish Council for Civil Liberties, Digital Rights Ireland and those with an expertise and interest in ensuring this is done right to give full input.

My final question relates to non-Covid-19 mortality rates. Has there been an increase in non-Covid deaths compared with the same death rates for this period last year or in other years? There is a worry among patient representative organisations that there may be significant health deterioration and even additional fatalities as data indicate a significant reduction in people accessing health care.

I have two people very close to me who are at home cocooning. I would feel much more comfortable when they can eventually come out if all the people around them were wearing masks. Has the Minister a view on the wearing of masks in the community? Will there be a steady and available supply of those masks so we might all be able to comply?

Should we go to the Minister or does the Deputy's colleague wish to contribute now?

We can go to the Minister as I had seven minutes.

I have approximately three minutes. The Deputy raised a number of matters and I will write to her about some of them in the interests of time, as she has asked me to. The number of staff redeployed to nursing homes moves up and down and I saw a number of over 200. The number was 61 last week but I will send the Deputy the figures broken down by community healthcare organisation. I do not want to build expectation around this but I had a very good meeting on home care and I hope that piece will really help. Much work has been put into getting that agreement right. I will write to the Deputy on that and the matter of geriatricians. It sounds logical to me and I am conscious of the fact that we have a geriatrician leading from a clinical perspective in the HSE. I will seek her view on the matter.

I met representatives of the Irish Nurses and Midwives Organisations, INMO, about nurses' pay as recently as in the past fortnight. My Department has corresponded with the HSE clearly on the matter and my understanding is that 3,400 staff nurses have been appointed to this new scale in our public hospitals, up from approximately 700 in February. Approximately 220 have been appointed in our community healthcare organisations. There was an agreement in this regard and they need to be paid, so this must be processed. We are very keen to see that done very quickly. The contract is voluntary and it does not require somebody to complete an application process but I want everyone who has applied to go on the payroll very quickly. We have corresponded with the HSE and I will write to the Deputy on the timeline as well.

I sympathise with the Deputy on her loss. On the transfers from public hospitals to the nursing home setting, I am aware of the question people are asking. There are a couple of things to mention. First, we should remember that we were trying to move older and vulnerable people out of what was likely to be the surge setting or danger zone in acute hospitals to a safer place. That was definitely the motive followed by everybody.

The Deputy is certainly not doing this, but I know many people are asking who brought the infection into the nursing home. Was it staff coming in, visitors coming in or other patients? The reality is that it is very hard to keep infection out of long-term residential care settings. I am assured by the HSE that testing guidelines were followed and clinical assessment carried out in all situations, but I will confirm the questions I do not know. The commitment the HSE gave was that there were two negative swabs carried out from that point in time. I will answer that in writing to the Deputy.

I will make one point. Dr. Tony Holohan has a graph showing the time at which infection came into nursing homes versus the rest of the community. Certainly it looks like many of the transfers would have happened long before that trend and indeed that an incubation period would have passed. That seems to be the general view.

On testing, there is now a roadmap for getting to 100,000 tests a week. That does not mean we will be doing 100,000 tests a week. I am conscious of not making the mistake other people in other jurisdictions have made about this, but we will have capacity to do 100,000 tests a week by the third week of May - by 18 May - as outlined by the HSE. I believe we sent the Sinn Féin leader a briefing note on that.

I take the opportunity to thank the people of Dublin West for not just electing me once but twice in the space of three months. This is my first time addressing the House since returning. Because of the limited time, as the previous Deputy alluded to, I ask the Minister to respond to my questions in writing to allow my colleague to come in immediately after me.

The Minister's big announcement of €1.1 million for mental health supports might have grabbed a few headlines but it will not deliver for front-line mental health services which were already struggling to provide a service pre-Covid-19. This is particularly noticeable in youth mental health supports. As of December, pre-Covid-19, 2,327 children were waiting for an appointment with the HSE child and adolescent mental health services, CAMHS. Over 100 of these kids have been waiting for 18 months and some have been waiting for more than two years. In my area of Dublin Mid-West, pre-Covid-19 our local youth mental health service, Jigsaw, was moved from a five-day comprehensive service based in north Clondalkin to a probable one or two-day-a-week satellite service. Jigsaw has seen a 420% increase in young people trying to access its service online since the outbreak of Covid-19. Why is this? Our young people are still unclear where they stand on the leaving certificate examinations. They are missing school, missing their friends and missing their sports. Some young people are witnessing and experiencing an increased level of domestic violence at home and they have no safe place to go to. Young people have lost loved ones and have not been able to attend the funeral and grieve properly due to the current restrictions. I take this opportunity to add my condolences to anybody who has lost somebody in these challenging times.

There are many other examples - I do not have time to go into them today - of why our young people would need mental health services more than ever during the Covid-19 pandemic. These are some of the questions I would like the Minister to reply to me in writing. What additional resources is he directing to front-line youth mental health services? What additional resources will he direct to front-line mental health services post Covid-19? How will the Minister reduce the waiting list for CAMHS? Will he intervene and retain the services of Jigsaw in north Clondalkin?

Our young people are very resourceful and are often not given the credit they deserve. For example, young people across Dublin Mid-West - it is probably the same in the Minister's constituency - have been painting positivity rocks. I do not know if the Minister has seen them. They are really good. They contain words of encouragement for our fellow citizens in this time of tribulation. I brought one to Leinster House and left it on the plinth for people to see. It simply states, "We're in this together." That is really good advice from young people.

This is my maiden speech. However, I will dispense with most of the usual expressions of thanks because I want to have as much time as possible to outline the concerns of those in my community working and living in care settings. I extend my condolences to everyone who has passed away in my constituency and throughout the country. I heartily thank everyone who has supported me throughout the years I have been campaigning in Dublin West. They know who they are and I hope some of them are listening this evening.

I have been deeply concerned by the emails and phone calls I have received in recent days from parents, carers and staff of private residential care homes and private care home providers. I was contacted by a home care worker who provided support for an elderly person the previous week. He just found out that this person has sadly passed away from the coronavirus.

The elderly person was ill but the care worker was not told that it was Covid-19. He did what every caring person would do and asked his manager what to do in the circumstances. He was told to go to see all the clients that he was scheduled to visit that day, possibly putting them at risk. I was also contacted by two parents of very vulnerable and high-risk children. They stated that their care worker, who came into their home that day, had been off work for two weeks. They were not informed by the HSE, the company or the worker that she had had Covid-19. Rather,they were only told that she had been on sick leave.

A very experienced and professional residential care worker told me yesterday that staff have been told that they do not have to wear PPE even though it is on site and available and that new staff who have no experience have been taken on. He also stated that, contrary to normal best practice, there is no shadowing with an experienced and trained member of staff and that this is leading to poor hygiene and could have poor outcomes for residents. He stated that staff have been directed by the HSE to wear equipment one day for exchange the following day. The staff are confused and there is much frustration while they try to care for residents in very difficult circumstances.

Officials from the HSE visited a particular care home but only spoke to its management rather than also consulting the staff. It is very important that such staff are consulted because they are the ones working with people on the ground. Last week, I spoke to a family member of a home care assistant who summed up the situation very well. She self-isolates as best she can between shifts. She is too tired, furious and upset to put into words how she is feeling. She has not hugged her children in weeks. They miss her but they are proud of her. She is risking far more than I am, than the Minister is and than she ought to have to risk.

What does the Minister have to say to these front-line workers for whom we clap every week? They have heard many big announcements but there has been poor delivery on some of those announcements. Do they all now have the PPE they need? Are there sufficient staff to provide the proper care that patients need? Will the companies which victimise workers who speak out be sanctioned? Can families availing of home care packages feel safe in the knowledge that home care workers who come into their home will not put their children and elderly relatives at risk? Will the Minister acknowledge that the private care system cannot cope with a pandemic and that we need to move to a one-tier system of care for our most vulnerable citizens?

Does the Deputy wish the Minister to respond? The clock is ticking.

I ask that the Minister respond in writing to any of my questions which he cannot answer now. Will he considering providing specialist support services for children with autism spectrum disorder, ASD, along the lines of those to be made available to the children of essential workers? Parents who are at home with children with ASD are under severe pressure and experiencing real difficulties.

I am conscious that people at home watch these proceedings and hear the questions that are put but do not have access to written replies I send to Deputies. We must divide the allocated time better. I came here to answer questions. If I do not know the answer to a question, I will revert to the Deputy in writing, but I need some time to answer the questions orally.

I ask the Minister to do so briefly.

I ask that the allocated time be divided properly.

Deputy Ward raised the issue of Jigsaw. I am due to meet its representatives on Thursday and I will revert to the Deputy thereafter. Mental health, particularly youth mental health, is a key priority. We wish to support Jigsaw in what it is doing.

Deputy Paul Donnelly is correct in the context of ASD. The reality is that many children have been out of school and may not have been able to access normal health supports. We need to consider what an intervention for them would look like over the summer months. I am working on that issue across Government.

I acknowledge the significant work done by people in home care and residential care settings. There are regulatory authorities to which complaints can be addressed. This week, HIQA started inspections and visits in line with standards, which is important.

I have put on the record of the House the increase with regard to PPE and dealt with the issue of staffing. I will revert to the Deputy in writing on the remainder of his questions.

I understand Deputy Heydon is sharing time with Deputy O'Donnell.

That is correct. I commend the Minister and his officials on their ongoing work.

I want to raise the concerns of nursing homes in the Kildare and Laois area. I have raised some of their concerns with the Minister directly. He is aware that they are under huge pressure. The staff are doing great work and showing great dedication in difficult times. From having spoken to nursing home owners and managers in my constituency, I know their main issues are financial and staffing support, and recognition for their staff. The Covid-19 temporary assistance payment scheme has generated some confusion because there is a short period. I know everyone is working under real pressure, the officials in the Department who are putting schemes in place, the National Treatment Purchase Fund, NTPF, and the nursing homes. However, we have to have due consideration. I ask the Minister's officials to bear in mind the pressure the nursing homes are under in trying to manage the problems they have as well as the forms they have to fill out. Nursing home staff and management are pretty exhausted now, as everyone else is, and are working to the pin of their collars. While the main form is due in today, I have had a request that forms B and C for the NTPF be simplified as much as possible and be reviewed to ensure they cover the actual cost of the crisis for nursing homes. The costs of the private transitional winter initiative and delayed discharge beds also need to be addressed, as well as those of the empty beds, to ensure their future viability, because while there is the initial crisis here now, there is also the challenge of making sure we have a viable operating nursing home sector in three to six months.

Nursing home providers are worried about the future for their residents and staff. Their hard-working, caring and dedicated staff also need to be recognised and rewarded. In time we would like to find a way of doing that. Many are sacrificing time with their own families to live in and ensure the highest standards. Many of these workers are not on the highest of wages, yet the hours they are doing are pushing them into the higher tax bracket. This comes into the area of finance as well. I would be very supportive of measures to make sure that the people working those long hours are not subject to the higher rate of tax or that some rebate could be given to them, to give them due recognition. They are the front line for the nursing home sector caring for our most vulnerable loved ones in those settings.

Staffing is a major issue. I know Deputy Heydon has raised this with me. There are four ways we are trying to assist nursing homes: through the direct redeployment of HSE staff; an agreement reached in recent days with home care providers to allow home care staff to be redeployed; to ensure a faster turnaround time for testing for staff and a priority for that so that the many staff who do not have Covid-19 can get the all clear and go back into the workplace; and the funding scheme that the Deputy referred to. I am very open to extending the timeline for that funding scheme. I did not want to do that too early because I want people to get the applications in and pay the money out. We are paying it out within 24 to 48 hours. I am meeting with Nursing Homes Ireland twice a week, and we have provided many clarifications about the scheme that it asked for. We have to have checks and balances but I will continue to keep that under review. I have no doubt that there are broader funding and policy issues in respect of nursing home care that we will consider in let us call it peacetime. For the moment, however, the scheme of up to €72 million worth of funding for private nursing homes over a three-month period is substantial. I am eager to ensure that it is not bureaucratic and I think we have made some improvements in that regard in recent days.

This is a public health crisis but we have to strike a balance. The Taoiseach spoke today of five conditions he will consider in respect of easing restrictions: the progress of the disease, healthcare capacity and resilience, testing and contact tracing capacity, the ability to shield and care for vulnerable groups, and the risk of secondary morbidity and mortality . Where does the Minister see those? He referred to Covid-19 being with us for a long time. How long does he expect that it will be a daily part of people's lives and in respect of the business sector?

Will the Minister clarify the area around elective work? For many people in Limerick and north Tipperary, some of the elective work that needs to happen is veering into the acute area. Where does that fall into the issue in terms of private hospitals? How can that capacity be used? The Minister referred to preserving that capacity.

Regarding people over 70 who are cocooning, I have elderly parents. They do not like to be called elderly, but they are. I have not seen them for over a month. The same is the case for many other people. In terms of lifting the restrictions, is the Government looking at ways in which family members outside the 2 km limit can see elderly relatives and check up on them while not coming into physical contact with them or undermining public health?

On testing and tracing, the University of Limerick is willing to provide testing and laboratory facilities on site for the community. Is the Department looking at regional testing? We must get back to some sense of normality in terms of business and daily life and in that regard, contact tracing and testing are key. We must get up to the 100,000 limit as quickly as possible because at the end of the day, peoples' lives are being impacted. Will the Minister look at it on a regional basis? One of the other issues coming up relates to third level students, many of whom will shortly be finishing their online exams. Most of them will not be going abroad to find jobs and there is a worry that many of them who are renting houses will not be observing social distancing. Is that being looked at or considered? I ask the Minister to address those points.

I am pleased we are in a position in the Dáil where Deputies can ask when we can recommence elective work because if one looks at the modelling, as of today, had we not lowered the reproductive rate for this virus from just over 2.0 to where it is now, we would have seen 2,200 people in our ICUs today and would be in a very dire situation. That is not to take away from the very difficult and sad situation of the 103 people in our ICUs today and the worry that their families have for their well-being. We think of them. The Deputy is right that, thanks to the massive work of the Irish people, front-line staff and public health experts, we have a situation whereby we do currently have vacant capacity in our public hospitals and significant vacant capacity in our private hospitals, for which we are now paying for the next number of months. We need to get the balance right. We need to recommence some non-elective, non-Covid work because one can get sick and die from things that are not Covid-19. We do not want a situation where we come through Covid-19 as best we can as a country only to find that there is a very sad situation with secondary deaths from Covid-19, although we know that there will be an element of that. We must get the balance right. We must keep a certain amount of vacant capacity, particularly critical care and isolation capacity, in case a second wave does come. On Saturday we had a meeting with medical leaders from across the country, including a leading doctor from Limerick, about how we can have the non-Covid workstream alongside the Covid one and we will be using our private hospitals for that as well.

On the issue of NPHET, the roadmap and the timelines, I am not going to speculate on the record of the House today when I know that the plan will be published tomorrow, other than to say that it will be grounded in public health because it has to be. This is a public health emergency and the moment we decide to take any tack other than public health is the moment when we begin to lose the progress that has been hard won and hard gained at huge expense to the people. I hope that we will be able to provide a degree of certainty tomorrow in an uncertain world. If we can get the virus into this condition, what does that mean we might be able to do in society again? It is important to get all of us thinking, not just the Government and the Oireachtas, but sports clubs, schools and businesses. What does this mean for me? How might I have to adapt how I run my life, my business or my organisation? There will be a lot to discuss in that.

I am very conscious of the fact that over 70 is not old. I am very conscious that there are lots of people over the age of 70 who are very active. I am also very conscious that they see it as a bit condescending when politicians tell them to stay at home but we are doing it on the grounds of public health advice and nothing else. I am conscious of their health and well-being. It is not for me to predict what NPHET will do or to become NPHET but I know it is an area that the team is continuing to monitor very closely. Of course, people can travel and visit relatives to meet their care needs.

On the issue of Limerick and a laboratory, I would be very happy to take those details and talk to the HSE. We now have 27 laboratories across the country and are very eager to find any more capacity that we possibly can.

Last week I asked if we could find a mechanism to pay our radiography students in the same way that we found a mechanism to pay our nursing students, given that they are putting themselves and their families at risk by working.

The Minister told me he would ask his Department to come forward with proposals for other students usefully working in the health service and whom we need. He said, "I hope to bottom that out before we meet here again". I am here for an answer, not for me but for the radiography students who are wondering when they are going to get paid.

Last week, I also asked the Minister about extending the power to prescribe to optometrists. He told me he would speak to his Department and revert to me directly. I do not want my speech to be too accusatory but there is a pattern to this. The Covid-19 query system has replaced Dáil questions because we cannot put down questions. I am putting down these Covid-19 queries but I have not had an answer to queries I put down last week. We have passed the deadline. I have had answers from all of the other Departments, but not the Minister's Department. Clearly, something is not working. Perhaps other Deputies could say whether the same thing has happened to them. I have not had answers to my Covid-19 queries to the Department of Health and I should not have to come in here and put them all to the Minister.

Last week, the Minister said he would update the House on progress with the mobile app which is key to being able to relax restrictions. Information I have received about the app has been scarce and I read in a newspaper this week that it will be a decentralised rather than a centralised app. The Minister suggested I raise this matter with the HSE during the weekly meeting with health spokespersons and I, along with Deputy Shortall, did so. A director in the HSE promised me that I would be supplied with a copy of the specification, which I look forward to getting.

If we decide to go with the decentralised model, I welcome that because there are only two countries in Europe, I understand, who are insisting that their health authorities should be able to see the data provided by contact tracing apps. If we tell people that we are going to spy on them or that the health authorities are going to see all of their data they will not buy into this and will not use the contact tracing app.

The Minister said we are all in this together and it is important that we pool our resources and work together. Yet, we are not having an open discussion about the app. I have asked questions, including about its basic specification, and I am not being supplied with any information. I will boil down my question to this. Will the Minister commit, before he launches the app, to publish the data protection impact assessment and the technical specifications?

The lockdown measures are due to expire on 5 May, as I understand it. We are a few days away from that date and there is very little information about what is going to happen. It is very hard for people to plan in that situation. I listened to what the Minister said today about that. We do not know what the criteria for the relaxation of restrictions will be. We do not know what different phases there are. We do not know the different variables and metrics involved and how they interact to make a decision.

The Minister talked about getting the R0 below one, which is great. What about other variables such as the death rate and admissions to acute hospitals and to ICU? How do all of those things interact? The interaction of different variables is a model and I understand that Professor Nolan is working on this model with NPHET. Yet, after weeks of me and other Deputies, including Deputy Donnelly, asking about this, we still do not have sight of the model. Given that we cannot see it, as it has not been published, we do not know the mechanism by which decisions are being made.

The Minister points to NPHET, which is a black box, and says medicine and science is in a room and it makes decisions based on various variables that interact in a way which cannot be revealed to anybody. As a result of that, the public is looking on and many people would like to scrutinise this. As Deputies, we should be able to ask questions and ask why something is happening. It would be useful if we worked together and were all in this together. If we could scrutinise and see the decisions being made, it could create greater buy-in from the public and all of us into the very difficult restrictions which are being made or the decision not to relax restrictions, as the case may be. Our European neighbours are taking a much more open approach to this than we are.

I will not go into the same level of detail on testing for Covid-19 as other Deputies, but I want to ask about the Irish Blood Transfusion Service and blood donation. I understand it is still taking place. I ask the Minister to publicise the fact that people can still give blood and that it is a reason for people to leave their homes. A lot of people have a great need to contribute something or feel they are doing something for the cause. Can the Minister investigate whether we should screen blood donations for Covid-19 antibodies and if it would provide more information for the system in order that we could determine the extent of the spread of the disease and how we are getting on with it?

The therapeutics, that is, the drugs to deal with Covid-19, are an important milestone in the roadmap to getting out of these restrictions. I understand that there is a very promising drug, Remdesivir, created by Gilead Sciences. I also understand that Gilead has extensive production facilities within this country. In the same way that PPE became a huge stumbling block for us in making progress with this disease, I am worried that the production of these antiviral drugs will also cause a slowdown or be a blocking point for us in making progress. What measures will the Government take to plan for the manufacture of these therapeutics in the Irish system?

I will not ask about face masks as my Sinn Féin colleague has already done so, but I will mention that the European Centre for Disease Prevention and Control has shifted position and published differing advice. The advice has changed in different countries and Germany is now telling its citizens to wear face masks in public. I feel sorry for people who are working in positions such as checkouts, where hundreds of customers are going past them all day. Those customers should be wearing masks in order that they do not cough on those people. I would like the Minister to make a change in that policy. People will forgive him for having had a different position earlier on.

Public parks are still open and it is important that people have somewhere to go which they do not have to pay for, particularly when they are restricted in the number of things they can do. However, private landscapers are not allowed to work. Those who work in public parks have been designated as essential workers, but people who work in private parks have not and many housing estates have parks which they cannot use. They have been locked and chained up for months because they have not been taken in charge. I do not want the Minister to make no changes next week. I would love if he could issue an executive order that allows private landscapers and gardeners to work, with sufficient precautions, in order to reopen these private parks.

I would like to follow up the issue of any questions not being answered with the Deputy directly. I assure him that this is not the case. The Taoiseach and I met his party leader yesterday for two hours, as we generally do once a week. We also have the HSE briefing, two hours of questions and statements in this House, and a daily press conference with the Chief Medical Officer to update the public, but I am very eager that the information flows.

I said I would try to sort out the matter of the student radiographers before I got here. There are about 55 of them and we have been looking for that mechanism. Let me be clear that student nurses did not get paid for being student nurses. Student nurses were offered the opportunity to be employed and paid as healthcare assistants, and many thousands of them have taken us up on that offer. I have a proposal whereby we offer student radiographers the opportunity to be employed as assistant radiographers, and I have asked that my Department and the HSE meet SIPTU on that as their representative body. That is the proposal I would like to put forward. My Department and the HSE will engage with SIPTU, if they have not already commenced that engagement.

I have an 11-page note on the mobile app because I knew the Deputy would ask me about it and I said I would update him on it. In the interest of time I will have to share it with him but I will share it with him and any Member of this House now. We want to get this right. It will only work if there is public buy-in. I commit to coming back to this House prior to launch to take any questions and to publish any information that is relevant and helpful. This will only work if the people of Ireland download the app and buy into it, otherwise it will just be something nice that people will get a launch out of but which will not make a blind bit of difference. We need buy-in from people.

I take the Deputy's point on the criteria but the criteria for the easing of restrictions have now been clearly articulated by the Chief Medical Officer. We need ICU admissions to be lower than they are. There were 70 people in ICU with Covid-19 when we brought in the current restrictions and there are still 103 today. Despite the progress, there are still more people in ICU now than when the Chief Medical Officer thought it necessary to advise the Government to lock down. There were 160 people in hospital with Covid-19 at that time, and there are still, on average, around 700. We had about 200 cases a day on average then, and we still have that many and more now. The behaviour of the disease is still not where we need it to be. As the Deputy rightly said, it is not only one metric; we are looking at a number of things.

Regarding blood transfusion, I take this opportunity to encourage people to donate blood. It is, as the Deputy says, a reason to get out of the house, but it is also a good and life-saving thing to do.

On the issue of face masks, there will be no pride here. If the evidence changes and our experts believe it should be done, it will be done. I believe they are going to look at the matter again tomorrow. They have already changed their advice in relation to healthcare professionals, based on international expertise. A number of countries have changed their view on face masks or face coverings for the population at large and I think it is likely that that is going to happen here.

At least in certain circumstances, an advisory or guidance would be issued. I do not envisage us making the wearing of face masks mandatory, only that advice and guidance would be given so that people could make informed decisions.

I wish to pass on my sincere condolences to all those families who have lost loved ones to Covid-19 since the House last met a week ago. The crisis continues and the sadness mounts as we continue to battle against this appalling virus. To reiterate, the Minister has our support in leading that fight, as do the CEO of the HSE, the CMO and all the workers on the front line and in support capacities in our health service.

We also support the work of the NPHET. For the past week and a half, we have raised issues concerning its transparency and decision making. We welcome today's publication of the minutes of NPHET meetings for the month of April. When questioning the Taoiseach today, our leader, Deputy Kelly, raised further concerns. I echo them, although I will not repeat them now. We look forward to seeing increased transparency, which I am sure the Minister will support.

NPHET is the decision-making body for tackling the Covid-19 crisis, but the Minister has overall responsibility for Covid-19 and all other health matters. In that regard, what measures are being put in place to manage the knock-on effects of this crisis for people with non-Covid-19 illnesses? What are the consequences of people not turning up for appointments and of operations being cancelled? Has much modelling on this been done? The Minister raised the question of how that currently unused capacity would be activated. We have severe concerns about secondary deaths. How is the Minister judging and managing that responsibility against the demands of Covid-19 with the directives that are coming through the NPHET?

We have major issues with the income supports for HSE workers, a matter that has been raised with the Taoiseach today as well as more recently in this debate. Will the Minister commit to issuing a directive under the relevant health Act to ensure that the pay deal for nurses agreed last year will be paid this May? Ten days ago, the Labour Party called for a €1,000 pandemic payment for health workers to coincide with May Day, which is tomorrow. Unless the Minister has a surprise for us in his closing remarks, that is probably not going to happen, but has he considered this proposal? It has been done in other countries.

What plans has the Minister for income supports for healthcare workers who have been unable to attend work during the pandemic because of their own pre-existing conditions? We want to ensure that they will not be impacted unfairly by such matters, which are outside their control, and that not only their incomes but also their certainty of work is protected.

Is there planning under way in the Department of Health for the healthcare workers who came home to join the fight against Covid-19? They showed the utmost selflessness and bravery in taking the decision to leave places where they usually had secure and, in many cases, well-paid employment to join our domestic fight. Will the Minister give assurances that they will have jobs once we have passed the stage of pandemic reaction and moved towards returning our health service to more regular business? Many people who were working in the HSE prior to the outbreak of Covid-19 had been pushing for the restoration of pay. We want to see progress on that front.

Deputy Ossian Smyth discussed student radiographers. That situation requires urgent repair by the Minister and his Department. Our position has been consistent and clear that student radiographers working on the front line in the battle against Covid-19 deserve the same respect as nursing, midwifery and medical science professionals and students. The Department and the HSE must recognise and respect the role that student radiographers are playing every day in the battle to stop the spread of Covid-19. I was encouraged by the Minister's remark that he had at least offered something similar to student nurses using the same principle. I would be interested in seeing whether that can get us to where we need to be.

I wish to discuss PPE. Last Wednesday week, the Department of Health issued a directive that all healthcare workers should wear face masks when working within 2 ft of a person. This policy change had implications for all health services. We have heard about acute, residential, outreach and clinical services, for example, but many home help agencies have been struggling during the crisis and many have lost staff. They are continuing to offer support to priority patients and all unnecessary calls have been stopped, as per the national direction. Many home help agencies have been struggling financially. Not all of them are private enterprises with pools of money on which to draw. Every community healthcare organisation has a not-for-profit home help agency under its umbrella, often set up by well-meaning, former healthcare professionals who want to help their local communities. Now the agencies must source face masks themselves or wait in line for the HSE to offer same if and when resources allow.

GP surgeries and nursing homes can purchase face masks from suppliers and are not liable for VAT, for example. Home help agencies need to be afforded the same exemption as soon as possible. If home support agencies are not given assistance, it will absolutely mean an increase in hospital admissions for non-Covid-19 related reasons. The number of older people currently supported by home support agencies is phenomenal and issues need to be addressed as soon as possible as the knock-on effect could be catastrophic.

I am also hearing that the primary insurance company of home care support agencies has issued advice that if healthcare workers do not have personal protective equipment, PPE, such as face masks, the agency is not insured. I am interested to know if the Minister has a comment on that or if he can investigate it further.

To move to screening, CervicalCheck has been suspended since the end of February or the start of March, initially to allow for the switch to human papillomavirus, HPV, testing in April. Unfortunately, we do not know when HPV testing is going to be introduced. Women need certainty when it comes to this essential screening service. When will it be coming back on stream and is there a plan for that? I know that an awful lot of the radiographers who work in screening have been redeployed to deal with Covid-19 and are doing a wonderful job, but I am interested to hear if we have a pathway out of this.

We still have no plan for dentistry. Dentists have been crying out for PPE in order for them to return to work. The Chief Dental Officer has offered direction in terms of emergency dental work, but there is also serious and routine dental work that is important. Speaking in a personal capacity and as someone who has had complex dental needs in the past, I and many people like me need routine dental work in order to prevent serious or emergency dental work down the line. In the absence of routine visits, we are potentially storing up serious and emergency dental problems in the not-too-distant future. We have already seen the somewhat stark protests, let us say, of dentists in France and I do not want to have to see my dentist taking part in similar protests here for basic PPE.

I turn to ask about direct provision and vulnerable settings. We have heard about the direct provision centre in Cahersiveen through the media and I would appreciate it if the Minister could speak to that. Have many clusters of the virus developed in direct provision centres or other vulnerable settings, such as prisons? I received a long and detailed response from the Minister, Deputy Flanagan, last week about the measures that his Department has put in place in conjunction with local authorities, the HSE and approved housing bodies for direct provision centres. I hope that those measures are being implemented and are working.

We will need direction on the use of personal face masks and whether we will need to wear them in shops or on public transport. There has, until recently, been contested medical advice on the utility of wearing masks in public to control the virus. It now seems that there has been a shift towards a view that we should be wearing them, at least in some capacity. It has been mentioned that the public will understand a shift in the Government's position on that, but we need clarity and to bring the public along with us. Will we have sufficient supply for members of the public so that they are not waiting in line behind front-line workers, staff from nursing homes, dental and home care workers?

I thank the Minister and, if he does not manage to get to every question, I would appreciate it if he would correspond with me.

I thank the Deputy. I agree with his views about transparency and NPHET. Minutes of meetings are kept and published. NPHET makes recommendations, but I remain the decision maker on Government policy and am accountable to this House, to be clear. I have not gone against any of the recommendations from NPHET, nor do I intend to, because I am taking a public health-led approach to this, but NPHET is not a mysterious object. It pulls together the best expertise from HIQA, the Health Products Regulatory Authority, HPRA, and the HSE. I think I counted approximately 20 people with "Doctor" in front of their names on NPHET. It then gives advice and recommendations to me and the CEO of the HSE. Those letters are also being published because it is right and proper that people see them. NPHET is doing a superb job, chaired by Dr. Tony Holohan, to whom I express huge gratitude.

The Deputy also asked about non-Covid-19 illness and he is entirely right to do so because a recent survey that we carried out showed that approximately 28% of people have put off seeking medical treatment. That is not a good thing and our GPs are worried about it. What are we doing about it? We are preparing a plan for non-Covid-19 care, alongside Covid-19 care, in the acute hospitals, using the private hospital capacity. We are also, through the setting up of community assessment hubs, trying to ensure that Covid-19 patients can go to a community assessment hub and non-Covid-19 patients can continue to go to a GP. We have seen a significant drop-off in the numbers of people attending their GP and that is how cancers can be missed and referrals to hospitals not given. I am hoping those community assessment hubs will help.

I also agree with the Deputy on the enhanced nurse contract and I will put the numbers on the record of this House shortly.

The Deputy asked about health workers with pre-existing conditions. I have discussed this with the HSE. I expect those responsible in the HSE to show maximum flexibility in terms of how they deal with that matter. I think they are doing so but I would like to hear about it if they are not.

The Deputy also raised the issue of home help and how some may need funding supports. That is a fair point. I started my engagement with those involved yesterday on what that might look like. I will investigate the question on insurance. The dentists are on my mind. I intend to meet representatives from the Irish Dental Association and the chief dental nurse in the next week.

I will have to write to the Deputy regarding the question on direct provision because I am out of time. I expect that we are going to receive the guidance and clarity on the issue of face masks that people rightly want in the coming days.

I am raising with the Minister the question of testing and tracing. This is the strategy on which everything else is based. An enormous national effort is being put in based on the premise that the strategy of test and trace would actually operate, but it has not operated at anything like at the scale that is required. We have been told that the target figure for capacity should be 15,000 tests per day, which is 105,000 per week. We are currently testing fewer than 42,000 per week. There is a huge gap to be made up and people are becoming frustrated. People are making extraordinary sacrifices. They are doing everything they are told and yet the State is not delivering on its side of the bargain. Frustration is growing, understandably, because of that. This really needs to be dealt with as a matter of urgency. The public are putting in an enormous effort. We know now, according to the national public health emergency team, that unless the target is reached we cannot start to unwind the restrictions. That is the first point about test and trace.

The second issue relates to tracing. What are the current numbers regarding those being traced? Can the Minister provide detail on that? We have not had any detail on that whatsoever. Can he tell us about that now?

The third question is on nursing homes. There is a population of approximately 60,000, between staff and residents, in nursing homes. I gather that the Minister used a figure of 28,000 earlier in respect of those who have been tested. When are the others going to be tested? Can the Minister give us a target date for completing that testing?

Those are my questions on testing. Does the Minister accept that we cannot start lifting restrictions until we have full capacity in place? When exactly will that happen? When will the Minister complete nursing home testing? What is the current level of contact tracing?

The public have put in an extraordinary effort, but those in the HSE have done so as well. I have watched them move mountains to try to robustly put in place a testing process from something that did not exist previously, and they have done a very good job.

We all share the frustration and we want to be further on than we are - I agree absolutely. Yet, when we look at the international comparisons, we see a number of countries are lifting restrictions but have done fewer tests than we have. According to our world data website, we rank fourth highest in the European Union out of 22 EU and UK countries in terms of the number of tests completed per million of population. Many countries are lifting restrictions but doing fewer tests than us.

I do not accept the premise that restrictions cannot be lifted on 5 May because of testing. My word is one thing, but the Chief Medical Officer would not accept that either. He made it clear that the reason he does not believe he will be in a position to advise the lifting of restrictions is because of the behaviour of the virus.

Deputy Shortall is entirely correct to state that testing is a key component - I do not dispute that at all. We need to get to the point of having the capacity to test 100,000 per week or thereabouts or 15,000 per day. I hope Deputy Shortall got our briefing note this morning. The HSE has given a roadmap on how it intends to get there. It was agreed with the Department of Health to have end-to-end capacity for 10,000 tests per day this week, beginning on Monday last, 27 April. It is agreed to move to an ability to have 12,000 tests per day from Tuesday, 5 May, and to have an ability to do 15,000 tests from Monday, 18 May. This does not mean we will be doing that many tests each day. It depends on the case definition and a variety of other things. The point is to have that capacity in place. I hope this is in the note Deputy Shortall got. The HSE has also given the swab-to-result times and the end-to-end turnaround times. It is the case that we have hit bumps in the road - there is no doubt about it - but I believe we now have an agreed trajectory to get to 15,000 tests per day by the third week in May. That is good news. It will absolutely be required. The HSE officials need to continue to update on that matter and they will.

Deputy Shortall also asked about testing in nursing homes. My understanding, from conversations with the HSE officials, is that they expect to complete that this week. The expectation was to complete that this week.

The Deputy knows the HSE was starting with nursing homes with outbreaks and then moving to nursing homes with a case to test everyone there. Then it was moving to test at least staff in all other nursing homes and residents where clinically appropriate.

If the Deputy does not mind and in the interests of time, I will send her the answer about contact tracing.

The Minister spoke about the behaviour of the virus. Dr. Tony Holohan raised this as well. We can only know about the behaviour of the virus if there is a proper test and tracing system in place. As I said to the Taoiseach earlier today, this is a circular argument. We need to get down the number of people in hospitals and, in particular, intensive care units. We will only succeed in doing that if we can tackle the virus at community level. However, we are failing to do that because of the absence of sufficient testing. It is great that we have flattened the curve and reduced the transmission figure. That is largely due to the fact, however, that people are locked down. To lift the lockdown, we have to have that system in place. Again, the Minister needs to honour his part of the deal in that regard.

My next question relates to staffing. There are certainly big problems in nursing homes. The Minister spoke about this earlier. There are 460 nursing homes but the scheme with the HSE has only brought just over 200 new staff. That is one staff member to every two nursing homes. When one actually looks at the number of nurses involved, there are only 85 nurses. Nursing homes desperately need nurses. Of course, they should be required to have more nurses. It would be interesting to see what HIQA has recommended in this regard. There are only 85 nurses on that scheme, which is one nurse to every five nursing homes. That is wholly inadequate. What steps is the Minister taking to improve that figure?

On trainee nurses and those who were due to graduate this year, a proposal was put to the Minister that it would be possible to bring on stream about 500 nurses if he was prepared to agree with an eight-week early graduation for those nurses. That would lead to a significant influx of nurses. The Minister has done this with medical students and medical graduates as well as with gardaí. Why will he not do it with nurses?

I want to add my voice to that appeal to the Minister to give a direction to pay the money due to nurses, particularly HSE nurses, as well as those in Cork, Limerick and the Saolta group. It is no good patting people on the back. They should be paid the rate for the job, and they are not getting it at the moment.

Another problem in staffing is the whole question of childcare. Will the Minister get together with other Ministers to sort this out? A significant number of healthcare staff, now along with other public servants who are partners of healthcare staff, are out of the workforce because of the failure to make provision for childcare. It is a shambles and it needs to be dealt with.

The last area I want to raise with the Minister is the whole question of mental health. All of the indications are that people who have existing mental health problems are in severe difficulty. A whole range of new mental health problems are emerging as a result of Covid-19 such as anxiety, depression and fear, particularly in the case of young people. Recent surveys showed that over 50% of young people are complaining about these conditions as a result of Covid-19. There is a need for a significant mental health response from the Government. Has the Minister had any engagement with mental health reform? If not, will he arrange that in order that there can be a mental health response to the current problems? This involves, for example, ensuring that counsellors are regarded as essential service providers and that arrangements are made for one-to-one counselling to take place at a safe social distance. That needs to happen quickly.

We need a clear framework in place to take us through the coming months and possibly years to deal with the considerable overhang of mental health difficulties which are arising as a result of this pandemic. In that regard, will the Minister give a commitment to publish the review of A Vision for Change and to commit to funding it?

I must check where the review is because I know it was ready to go to Cabinet.

It is completed and it was due to go before the Cabinet. The question is whether it is appropriate to bring it now or if it should wait for a new Government. I think it would be appropriate to bring it now. I will check that and come back to Deputy Shortall. I will meet with Mental Health Reform before we next meet. I am scheduled to meet Jigsaw as well. I think it is on next Thursday.

In response to the question on childcare, in the time available to me I can say that we have an in-reach childcare proposal. I hope that is something on the roadmap that will be published tomorrow that can be prioritised at the appropriate time so we can provide childcare, in the first instance, for healthcare workers and then for other professionals.

On the enhanced nurse contract, I gave the figure of 700 that signed up in February and now it is 3,400. I have been very clear to the HSE. I will consider issuing a directive but I have been clear that I want that to increase.

To respond to the question of allowing nurses to graduate early, this is something that I was very sympathetic to, but when I looked at the working group that had been set up that had student nurses on it, as well as the colleges and the Nursing and Midwifery Board of Ireland, NMBI, on it, on balance, it came down against it. I will share the information with Deputy Shortall and I am happy to engage with her offline on it.

Last week when we discussed the nursing homes the Minister reassured me that citizens in nursing homes were not being treated differently from other citizens. I am not yet reassured and I remain unreassured, if that is the right term. According to the latest figures from the NPHET, there have been nearly 600 deaths in nursing homes. I noted in today's debate that the Taoiseach stated there are obvious difficulties in nursing homes and sometimes medical directors, perhaps not even a GP or a medically qualified person, may be present. That is in contrast to the reassurance the Minister gave me last week. Accordingly, I want to ask the Minister again, who is making the decisions not to move acutely sick residents to a hospital setting. The question remains about the type of treatment that is available in nursing homes and whether it is equal to the type of treatment available in a hospital setting. I refer in particular to an article in The Irish Times on Monday concerning a memo from Professor Michael Barry of the HSE on the prescription of an antibiotic called azithromycin. I am sure the Minister knows the article. He said we must be careful about prescribing the antibiotic in community settings to ensure the safe use of the agent itself and the continuity of supply. There is a global shortage of this antibiotic. Which is more important - the safe use of the agent or the continuity of supply? If that agent is administered in hospital settings, why is it not available in nursing homes? It seems to me that the statement about nobody being left behind does not tally with that fact.

My second question to the Minister relates to direct provision, which we also discussed last week. I said at the time that I believed this could turn into our next catastrophe after nursing homes. We all saw on the news last night the terrible scenes from Cahersiveen where the occupants of a direct provision centre were screaming to be taken out of there because they believed it was highly infected. They were correct because when they were moved from a Dublin centre on St. Patrick’s weekend, there was at least one case in the centre in which they previously resided, yet I understand they were all moved without having been tested and now there are multiple cases in Cahersiveen. In last week's debate the Minister said to me that there would be 19 response teams across the country, led by senior nursing supports, to assist nursing homes and long-term residential care facilities. Will he now send such response teams into direct provision centres and ensure those who are seeking to be moved out of them will be moved out? I know it is the responsibility of the Department of Justice and Equality, but it is also the responsibility of the Department of Health to ensure people receive the right treatment and that any clusters in direct provision centres receive the same treatment response as the Minister promised for nursing homes.

As the Deputy knows, HIQA has started its visits to nursing homes, both private and public. It published a new assessment framework, I think last Tuesday, and it has started those visits. HIQA is the regulator. It has a direct line to me and I meet it at least once or twice a week. It is in a position to highlight any issues of concern it may have. I repeat and stand by the comments I made in this House last week on clinical decisions deciding the care people get.

Regarding the Professor Barry letter to which Deputy Smith referred, I will provide a written response to that to ensure accuracy.

I am glad Deputy Bríd Smith raised the issue of direct provision because it allows me time to respond to it. However, I need to let Deputy Paul Murphy in as well.

Since the beginning of the Covid-19 pandemic, the Department of Justice and Equality and the HSE have worked closely together to support the health and welfare of asylum seekers and refuges availing the State's accommodation service. The Department and the HSE are following the Health Protection Surveillance Centre's Covid-19 guidance for homeless and for vulnerable group settings, including direct provision settings. That guidance is published on the HPSC's website. The guidance exists precisely because it was recognised that congregated settings, such as direct provision centres, present specific challenges. Together, they have put in place a range of measures in the Department's accommodation centres to address any cases of Covid-19 where they arise. This includes provision of self-isolation facilities in centres and a number of off-site self-isolation centres around the State.

In all matters related to Covid-19, the Department of Justice and Equality is working with the HSE to implement the latter's public health advice. The established procedure across all centres when a person is suspected of having the virus or is confirmed as having the virus is that he or she is moved to a dedicated off-site self-isolation facility. Supports are available for the duration of the person's period of isolation until such time as the HSE considers the person can return to his or her centre with no risk to other residents or staff.

All residents considered to be especially vulnerable to this virus on age grounds or special medical grounds have been cocooned. The direction from the HSE's national social inclusion office is that non-family members sharing a room in centres are considered to be a household during the Covid-19 crisis and should implement social distancing measures on the same basis because they are already close contacts.

Residents have been made aware, as have we all, of the appropriateness of social distancing, good hand hygiene and cough etiquette. Information and posters have been distributed to all centres. Centre managers have been advised to increase the standard and frequency of cleaning throughout the centres paying particular attention to communal areas. A regular supply of hand-sanitisers for centres is in place. The Department of Justice and Equality has put in place a national clinical telephone service to provide public health advice to support centre staff and it is used to advise, support and work with locations where vulnerable groups are present relating to the implementation of the guidelines.

The Department of Justice and Equality and the HSE want to protect the identity and medical confidentiality of residents as required by law but, obviously, will comment on outbreaks if there is a public health reason to do so. Generally, residents of centres are subject to the same current public health measures to which we all are in relation to remaining 2 km from one's home. The Department of Justice and Equality and the HSE will continue to work together closely on this for the benefit of residents and centre staff.

I want to ask the Minister about the cost of the private hospitals. The Taoiseach confirmed to me two weeks ago an estimated cost of €115 million per month for the leasing of the private hospitals. I then later asked the Minister for Finance why we are paying more than four times as much per bed as they are in the UK, which he was not able to answer. I then wrote to the Minister for Finance, copying to the Minister for Health, seeking the publication of the final agreements with the individual hospitals, a detailed breakdown of the €90.2 million which has been already given to the private hospitals and asking him again to explain the discrepancy between the €44,000 paid per bed in Ireland and the €10,000 paid per bed in Britain. I will give one example as to why we need to see these figures. The Beacon Medical Group was bought by Mr. Denis O'Brien for €35 million, according to The Irish Times. If they get €44,000 a month for 200 beds, the State will have paid more than €35 million in four months but will not own a bed at the end of that process. Can we get the full final agreements? Can we get a breakdown of the costs so that we can see if there is profiteering going on?

I thank Deputy Paul Murphy. I have done everything I can to be transparent in relation to this. First, payment will be on a cost only open-book model whereby the hospitals will be reimbursed only for the operating costs properly incurred during the period. The costs that will be covered will be limited to normal costs of operating the hospital. Since the rationale for the arrangement relates to the Covid-19 pandemic for which no one can provide a definitive time horizon, it is not possible to indicate a precise cost estimate attaching to the arrangement but the final cost will be verified by an independent firm of accountants appointed by the HSE and the private hospitals. There is also an arbitration mechanism in place in the event of any disagreement.

Under the heads of terms, private hospitals are funded to 80% of their estimated monthly costs in advance by the HSE. As the Deputy says, €90.2 million was advanced to the hospitals for April. We will independently verify that and claw back if we find any issues as we audit it. This will continue to be examined by a committee of public accounts in due course and will be subject to the normal scrutiny by the Comptroller and Auditor General, and I lay an agreement before this House.

Directors' pay at Beacon in 2018 was almost €1 million.

Are we paying the directors' pay? Are we paying the bloated pay of the CEO on top of that? These companies often officially claim to be making no profit but make intra-group transfers through transfer pricing, interest payments and fees to other companies owned by the same person. With that in mind, are we paying for any rents or interests to Mr. Denis O'Brien, Mr. Larry Goodman or any of their companies? Specifically, do the payments we are making include rent or interest payments made directly or indirectly to companies owned by Mr. Denis O'Brien or Mr. Larry Goodman which are registered in Luxembourg in order to avoid paying tax?

I will ask for the HSE or the Department to respond to the Deputy in writing on this matter in the coming days. I want to be clear that nobody is meant to be profiteering as a result of this. The whole purpose here is to ensure that nobody can make a profit and we pay solely according to the cost-only open-book model. We were in a very lucky position to be able to acquire the use of these facilities. Thank God we have not needed to use their ICU capacities yet. The HSE will respond directly to the Deputy in the coming days.

I note that there are 25 minutes left for this and there are three groups. In the interests of public health and on the basis that the Business Committee and all of the Members have agreed to two-hour sittings, with the agreement of the House I will have to reduce the ten minutes to eight. Again, it is in the public interest. There are 25 minutes left and three groups. If that is agreed, we will proceed on that basis.

I do not agree to that.

I am offering it to the House as a fairness measure because the final group, that is, the Independent group, will be short on time otherwise.

What happened during the other sections?

When I arrived in the Chair we were running nearly 20 minutes late, but the allowable period for debate has not changed. Time is moving on. The time left for debate is now 24 minutes. There are three groups left.

All of the questions ran over and I do not think anyone-----

I am putting it to the House on the basis of the advice that this session should not sit for more than two hours at a time. That is our agreement as Members.

I do not want to spend too long debating it, but Deputy Connolly can understand my rationale.

Actually, I do not. This is the second time-----

I did not ask whether the Deputy shared my rationale. I asked whether she understood it.

This is the second time my group has been penalised-----

I am not penalising the Deputy.

-----through Chairpersons not keeping time. I suggest that we take a break now, in compliance with public health requirements, and then come back into the Chamber.

There are 23 minutes remaining and there are three groups entitled to ten minutes each, amounting to 30 minutes. One does not go into the other. Somebody is going to get-----

If the Acting Chairman wants to comply, he can let us take a quick break.

The Deputy does not have to agree if she does not want to. We are not in a position to take a break. If the Deputy does not want to agree she does not have to, but it will mean that the Independent group and Deputies Danny and Michael Healy-Rae will lose time.

My group is the last one and this is the second time we are losing time. It is simply not acceptable.

Deputy Connolly should bring the matter up with the Business Committee.

I am bringing it up with the Acting Chairman.

We are losing time. Can we carry on?

I would like to pass my condolences to the families and friends of those who have sadly passed away as a result of the Covid-19 virus. I can only imagine the hurt and pain people must be going through right now. Many family members and friends in my constituency of Louth have lost loved ones. The hardest thing to cope with is the fact that they cannot have traditional wakes and funerals. I personally know the difficulties those people face because I cannot pass on my condolences to them during this period. Recent newspaper reports have highlighted the spike in cases of Covid-19 in the Border counties, with figures approaching those of the Dublin region. This is causing great concern and fear among those living in Border areas like Dundalk, Carlingford, Meath, Monaghan, Cavan and Donegal. Many people are suggesting that the cause may be the fact that Northern Ireland and the Republic of Ireland are not following the same course of action. In my home town of Dundalk it is quite obvious that the number of Northern Ireland registered cars has been on a par with the number of Southern registered cars in recent weeks. I would like to hear the Minister's views on this matter. Will he indicate whether he has discussed it directly with his Northern counterpart? Moreover, can the current regulations include a restriction on Northern registered vehicles travelling to the South? I wish to make it clear that I am not in favour of closing the Border. Nobody wants that. However, we need to do something to make sure that people on both sides of the Border are following the guidelines in place in both jurisdictions.

I am sure the Minister is fully aware that we are heading into a bank holiday weekend and that there will be a bank holiday in Northern Ireland the following weekend. The people in the Border area are concerned about what the HSE will do about this.

To be helpful, I will keep my answers snappy in order to try to make up time. I thank Deputy Fitzpatrick for raising this important matter. I agree that there needs to be good co-operation between the North and the South, between the Republic and Northern Ireland. The Tánaiste and I had a regular meeting today with the Secretary of State for Northern Ireland, the Deputy First Minister and the Minister of Health, along with our officials, to look at how we can continue to share information and co-operate. I am due to have another meeting at 6.30 p.m. with the Northern Ireland's Minister of Health about that sharing of information. The Garda Commissioner is conscious of the law here and enforcing that. I know that restrictions are in place in the North to be enforced by the PSNI. I hope that, through the good, close working relationship between the PSNI and An Garda Síochána, they could help to address some of the issues that Deputy Fitzpatrick has rightly raised. The Minister for Justice and Equality is due to speak to his counterpart about that matter shortly to see if we can provide clarity to people in the North and the Republic about current restrictions.

The country has been in effective lockdown for five weeks. I do not think I will be the only person to say this today. The people have responded to the crisis with great resilience and spirit, which can be seen in a way the numbers have been controlled to a certain degree. What most people are now looking for is a plan for the easing of restrictions and a return to normal life. I know that this is a difficult situation but I feel that people have the right to know what the plan is and to have a possible timeframe for the plan. Has the Government agreed a plan and a timeline in respect of it, and when can these be made public? We cannot have a situation where people are left in limbo, not knowing what is happening and effectively kept in lockdown indefinitely. I feel that we need to form a task force with a specific role of co-ordinating our exit from the lockdown.

The Government has not yet agreed a plan but I expect that it will do so at its meeting tomorrow. I expect that the Taoiseach will be in a position to share that plan with this House and the country, possibly as soon as tomorrow. The plan will be guided by the recommendations of the National Public Health Emergency Team. We will follow public health advice first, second and third. The plan will endeavour to set out a roadmap as to how to reopen parts of our economy and society in a manner that is consistent with good public health advice and the behaviour of the virus. I hope that it will provide a degree of certainty and clarity to people at a very uncertain time.

At the HSE briefing yesterday, I asked if testing could be increased in the Border area in light of the fact that numbers are spiking there. To my disappointment, I was informed that there were no plans to increase testing in the Border area specifically. I was informed that the same level of testing is being carried out countrywide. I do not agree with this approach. Why would one carry out the same level of testing in Kerry, where the numbers are lower, as in Louth, where the numbers are higher? Surely we must pinpoint the hotspots of outbreaks and take the necessary measures to contain the spread of the virus in these hotspots? I would be interested in hearing the Minister's view on this matter. Will he confirm if he has discussed it with the HSE and whether he intends to take the necessary measures to contain the virus in these hotspots?

The percentage of our population that has been tested is currently the sixth highest in the European Union. I have lost my document about that but we are currently very high up in the context of number of people here who have been tested. We are ramping up and significantly expanding our testing this week, next week and the week after, which I think will see many more people tested. We decide who is tested based on what is called the case definition, which is the view given to us by the National Public Health Emergency Team as what the priority groups should be. It is generally done on the basis of vulnerability, a person's connection with front-line work, whether he or she is working in a nursing home or the like, and an individual's symptoms. A particular area could be viewed as a hotspot today, whereas a different area could be identified as the hotspot tomorrow. That is generally the guidance. The Government will be guided by the National Public Health Emergency Team.

I have spoken to many business owners in Dundalk and surrounding areas. While the vast majority fully support the Government in its approach to date, they are worried about the long-term effects. One of the main concerns relates to the support and assistance that will be given to businesses to implement social distancing measures for customers and employees once they reopen. The support should not only be financial, it should also be advisory in nature and indicate how to implement strong social distancing measures in the workplace. Has the Minister any views on this?

I will leave the financial element to my colleague, the Minister for Business, Enterprise and Innovation, Deputy Humphreys, but I know she already has plans in that regard and will continue to work with the business community. From a public health point of view, Deputy Fitzpatrick is entirely correct. We need to provide as much support and advice to businesses, sports clubs, schools, etc. so they can adapt to what is going to be a new reality, at least for the time being, regarding physical distancing. When the roadmap is published tomorrow, or the national plan, I hope that will be an opportunity for sectors to engage with Government, in the widest sense of the word, on how they might adapt their approach to providing their businesses or running their organisations so that they can protect their staff or users during the period of this virus, but can still try at a safe point in time to reopen and get back to not normality, but maybe a new normal.

With so many deaths in nursing homes, I have been contacted by many of my constituents who have loved ones who got the Covid-19 virus in nursing homes, were transferred to hospitals and have recovered. The hospitals now want to transfer those people back to the nursing homes. These families are very concerned and want to know what assurance the Minister can give them that it is safe for their loved ones to go back to the nursing homes where they got the Covid-19 virus in the first place.

Very clear protocols are in place before a patient will be transferred from an acute hospital back to a nursing home. That is for two reasons. One is the well-being of the patient and to ensure he or she is clinically fit to be discharged from the hospital, while the other is the well-being of other patients and to ensure that the coronavirus has definitely left the patient and does not spread. I assure families that clinical guidance and assessment is taken in this regard. I also assure the people of Ireland that HIQA tells me that many nursing homes are dealing with Covid-19 very well. They are working really hard. We know more than 400 nursing homes are seeking various degrees of support and assistance, but we know that about 70 of them are in serious difficulty or face a serious challenge. That means that many of them that have the coronavirus or Covid-19, just like we could in our homes, are managing it well. I say that to try to provide some reassurance to families.

My last question concerns seasonal workers. Some 189 workers came in from Sofia last week on a Ryanair plane. They walked through Dublin Airport, got on buses and were distributed around the local areas. Some of them arrived in Termonfeckin in County Louth. The HSE restrictions state that these people have to go into self-isolation for 14 days and be restricted in their movements. These workers have been seen walking freely through villages and towns in Ireland. What did the HSE do, or was anything done to ensure that these people adhered to the 14-day isolation and movement restrictions? There is also talk of more people coming in next week and the week after. We do not have a problem with seasonal workers coming into this country, but we do have a problem if the HSE has these restrictions but they are not being done correctly. Will the Minister give us some assurance that we have learned from the mistakes that happened last week in the airport?

In the 27 seconds available to me, and I will write to the Deputy regarding this matter, I can say that we have now brought in a new passenger form. Anybody, regardless of whether they are a seasonal worker or an Irish person returning to the country, must fill in that form to state where he or she is going to be self-isolating for the 14 days. That form can be checked and followed up, and the Government is considering whether we need to regulate further to underpin that measure.

I call Deputy Danny Healy-Rae of the Rural Independent Group.

I have about five seconds left.

I want to ask the Minister about the direct provision centre in Cahirciveen. I appreciate that Deputy Niamh Smith asked a similar question. I ask the Minister to be concise, if he can. Seeing as this centre was sanctioned by the Department of Justice and Equality against and without the approval of the HSE or the Department of Health, will the Minister now close that centre and move these people to a safer place? All the world heard them crying out the windows and through a locked gate last night to take them out of that centre to preserve their health and sanity. That would also preserve those things for the people of Cahirciveen who have been greatly upset by this direct provision centre in the town which puts their lives and health in jeopardy. Will the Minister close the centre down and take those people out of there?

I thank Deputy Danny Healy-Rae. I will have to look into this matter some more and respond to him and Deputy Michael Healy-Rae in writing on this matter. I have been informed that all residents who have tested positive have been notified and have been moved to self-isolation facilities. If any further test results are notified by HSE public health as positive, immediate measures to self isolate will also be invoked.

The Department of Justice and Equality will continue to follow all public health advice and instruction, as it has done to date. In this regard, I am informed that the Department is in daily contact with the National Social Inclusion Office to manage the crisis in respect of direct provision centres. A wide range of measures has been put in place since the beginning of March. As outlined previously, work is under way to develop a protocol for mass testing, as this will be rolled out across approximately 80 centres. This is to ensure-----

It was Cahersiveen I was talking about and the Minister has gone all over the country now. May I ask the Minister another question as he will not give me a straight and direct answer?

I was going to-----

There are 2.2 million people paying for private health insurance. An eminent cardiologist-----

It is not appropriate for the Acting Chairman to be laughing with the Minister as the Chair is supposed to be impartial. A Member of the House is on his feet asking a question.

I smiled at the Minister because he had to take his seat.

I very kindly sat down while I was in the middle of answering a question.

An eminent cardiologist from Cork, Dr. Cróchán O'Sullivan, has done great work in treating people with heart problems and he is very concerned that only 50% of the usual number of people are now presenting with heart problems or worries about strokes, cancer or hip issues. I am concerned about people who are losing their sight and who cannot get their cataracts removed. What will happen now? We appreciate that private hospitals were taken over and we are not saying the Government was wrong in allowing that. However, it will have to do something about the people who were always getting sick before or who had different problems. How will the Government address the problems that have arisen for people who are now afraid because appointments have been cancelled? Will the Minister give some insight to the Government's thinking on this?

I will. The Deputy raised a matter but I am very conscious that on the floor of Dáil Éireann, our national Parliament, I am trying to balance the answering of questions with the protection of rights of individuals and requirements under law to protect the identity and medical confidentiality of residents. I know the Department of Justice and Equality and the HSE issued a joint statement on 23 April and I am told by the Department that officials are trying to provide as much information to local representatives as they can. That is the balance I am trying to strike and I am certainly not trying to avoid answering the Deputy's question. I would be more than happy to come back to Deputy Danny Healy-Rae on this matter in conjunction with my colleague, the Minister for Justice and Equality.

The Deputy is not wrong with some of his assertions on private hospitals. We have tried to ensure we have control of these private hospital facilities in case we need them, and we might still need them for a Covid-19 surge. The Deputy is right and I am thankful we have not seen it yet. We have not run out of ICU capacity in public hospitals, thank God, but we could well have done so. According to a model, we could have had 2,200 people needing ICU care today in Ireland and I am thankful that is not the case. We may yet need that, God forbid, if things go badly.

The Deputy is correct to ask, now that we have seen a different trajectory to the virus so far, whether we could use these hospitals for non-Covid care, including some of the issues raised by the Deputy. The short answer is "Yes" and it is our plan to try to direct more work into those facilities in the coming days and weeks.

I am aware that direct provision comes under the Department of Justice and Equality but public health testing for Covid-19 and guidance for tackling the disease comes under the Minister's Department. Will the Minister answer the following questions directly?

Does the Minister believe it was right that residents located in four different emergency accommodation centres across Dublin were transferred to the direct provision centre at Cahersiveen without being tested for Covid-19? Was there infection in any of these emergency accommodation centres prior to those residents coming to Cahersiveen? Why was there a delay in testing after the initial confirmed cases in the Cahersiveen direct provision centre? Why has the HSE not been forthcoming with information? The biggest fear people have with matters like this is not knowing. Does the Minister agree this matter has been very poorly handled? Does it not go completely against the advice of the National Public Health Emergency Team, the HSE and the Department to have members of different families self-isolating in the same room?

It is clear where you cannot have one person to one room, self-isolation is simply not possible.

In the interest of public health, which is now clearly at risk, will the Minister recommend to the Department of Justice and Equality that this direct provision centre should close immediately? This centre is not good for residents for whom I have considerable sympathy. It is also of grave concern to the people of Cahersiveen and the greater Iveragh Peninsula in south Kerry with more than 20 confirmed cases in the centre, if that is correct.

I am acutely aware of the privacy surrounding individuals and all of that. At the same time there is no reason the HSE should not confirm the number of cases. We have all heard 20, 22 and different figures. Let the HSE confirm that. How many confirmed cases are there? How many tests were undertaken? The Minister should always tell the truth about all these matters. Have all the people who were tested and proved positive gone to a centre in Cork or is that not correct? Are they somewhere else in County Kerry? As long as the Minister is not forthcoming with all the information, then that creates a vacuum.

I raised this with the Taoiseach earlier. I also spoke directly to the Minister for Justice and Equality today, as I did last Monday, about this matter. This is of the utmost importance, not just for the Department of Justice and Equality, the Department of Health and the HSE but also for the users of the facility who were sent there. They did not choose to go there; they were sent there. It is also important to their neighbours and to the people who have lived in Cahersiveen and the greater Iveragh Peninsula all their lives. All they want from all the Departments is to be told the truth surrounding all this. No matter how much it is beaten, twisted and turned, if it is wrong it will stay wrong. I ask the Minister to please deal with this and I will give him plenty of time to answer.

I appreciate that Deputy Healy-Rae outlined his concern being primarily for the people in the facility because in respect of everybody in our country, regardless of how they got to our country, whether they are a citizen or not a citizen, whether they are seeking asylum, we have a duty of care to everybody during this global pandemic and treating everybody equally in that regard. That is why I am very reluctant on the floor of the House to provide information on one residential setting - a direct provision centre - that I would not provide about a nursing home, a disability facility or a mental health facility. We need to respect their confidentiality and ensure the information that is published and commented on is the same. However, I will ask my officials if more can be said about this and I will talk directly to the Minister for Justice and Equality on the matter and come back to Deputies Michael Healy-Rae and Danny Healy-Rae.

I do not know about the issue of testing, nor necessarily should I because that would be confidential information about those residents. However, I know that as we ramp up our testing, we are targeting that extra testing at vulnerable groups of people more susceptible to the virus. I will write to the Deputy in respect of the question.

There are about five minutes for the Independent group.

I have two questions for the Minister. I have listened carefully to all his replies. I gave notice of my questions and I really would like them to be answered specifically. I ask him to clarify the position on testing and residential settings. I asked the Minister the number of residential settings and where they have been tested. In his speech he said that 18,000 samples had been taken. Where were they taken? Have the results been given? I ask him to clarify according to the question. I am conscious of time, but I point out to the Acting Chairman that the clock is not running, so we will gain from that by the looks of things. Are direct provision centres included in those 18,000 samples in residential centres? If not, why not?

Regarding private hospitals, the Minister gave us the heads of agreement. I have not seen the agreements. The Government is paying €125 million a month for private hospitals, and I welcome the extra capacity. However, in Galway the consultants have advised that they are functioning at 25% capacity which means that 75% is idle. I have any amount of correspondence about essential surgery not going ahead, particularly in gynaecology and in cancer, despite having two hospitals 75% under capacity.

I do not share the trust that others have in the Minister and the Government regarding residential settings. I have meticulously gone through all of the briefings and even the most recent one fails to refer to nursing homes. It curtly refers to direct provision. The Minister stated that the 18,000 samples do not include direct provision centres in spite of the debacle in Cahirsiveen. Since March I have repeatedly raised the issue of direct provision with the HSE via email. It referred me to the Department of Justice and Equality. Residential direct provision centres and nursing homes should have been top of the list.

Last week, the Minister stated that he would answer questions on the development of the app. Will he share with me the briefing note he has on the app? Is the app open source?

The importance of NPHET was raised. The Minister stated that he is the decision-maker but that he has always taken its advice and does not intend to ever not take its advice. As such, who is the decision maker?

Who advises the Minister on mental health issues? The pandemic is taking a significant toll on people's mental health. I understand there is no psychiatric representative on NPHET although there is a psychiatrist on it. However, although I am a barrister, I am not here to represent lawyers. The psychiatrist is on the team as the chair of integrated care. In light of the toll the pandemic is taking on people's mental health, it seems very strange to me that the Minister is not receiving advice on mental health and that NPHET does not contain such a representative.

Deputy Harkin raised the issue of the capacity of private hospitals with the Taoiseach earlier today. Those hospitals are working at 13% capacity. The Minister referred to the importance of people being able to undergo elective procedures. Where can the private consultants who used to work in the private hospitals carry out such procedures? As Deputy Harkin stated, the contract they are being forced to sign does not enable them to so do in the rooms they used heretofore or in the private hospitals out of which they previously worked.

I will email an 11-page briefing note on the mobile app to the Deputy this evening and make it available to other Members on the appropriate forum.

The Deputy made an interesting point regarding the representation of psychiatry on NPHET. I will discuss the matter with its chair. The Deputy is correct that there is a significant mental health challenge. I am due to engage with several mental health advocacy groups in the coming days. Deputy Browne suggested last week in the House that there is a need for a mental health task force to consider how to deal with the mental health fallout. I will revert to Deputy McNamara on the issue. I am advised on mental health by the Chief Medical Officer from a clinical point of view. There is a mental health division within the Department of Health. The Deputy's point on NPHET and mental health is well taken.

On being the decision maker, I am the decision maker in the sense that I am accountable to the House. If I choose to accept the decision of NPHET, that is the decision I make. It is not the case that an unelected group of people are the decision makers as has been somewhat suggested. I decided at the start of this public health crisis that we would be led by our public health response. The plan we will publish tomorrow will be more than a public health response. It will be a Government plan for which the Government will be accountable. It will factor in a range of matters that are compatible with public health and it will follow public health advice. It will also deal with broader matters such as the economy, as the Deputy mentioned.

On the issue of nursing homes, I am not sure to which briefing note Deputy Connolly was referring. Currently, I rightly spend more time on nursing home issues than on any other relating to the pandemic. I have twice-weekly meetings with Nursing Homes Ireland and meet HIQA at least once a week-----

That does not answer the question I asked. I am seeking an answer to the question I submitted in writing.

That is fine. The assertion made by the Deputy this week-----

My time has been curtailed. I ask the Minister to reply to my question in writing.

I will reply to the Deputy. She claimed that nursing homes were not mentioned in a briefing note. I can send her any number of briefing notes relating to the work we are doing on nursing homes.

The figure I have is that 28,000 swabs had been completed in long-term residential care settings as of 27 April. I apologise if I misspoke when quoting the figure initially. I expect that number to have increased since then and will provide the Deputy with the up-to-date figure as soon as I get it.

As of 26 April, 11,500 laboratory results had been returned. At the moment we are prioritising long-term residential care facilities, private, public and voluntary nursing homes, and the disability and mental health facilities. As we broaden the case definition we intend to expand to more vulnerable groups, including those in direct provision.

Sitting suspended at 6.25 p.m. and resumed at 6.30 p.m.