Covid-19 (Health): Statements

I welcome this opportunity to update this House once again on the Covid-19 disease and our response to it. I wish to start by expressing my condolences to the family and friends of those that have been lost to this disease since I was last in this House. It is an individual loss but there is also a sense of national loss. We share in your loss.

Today, I will update the House in two ways, by providing the latest information on our ongoing modelling work and by sharing some key messages from my recent discussions today with the Chief Medical Officer, Dr. Tony Holohan. Members will recall that the R nought, or reproduction rate, was previously in a range of 0.5 to 0.8. I am advised that range is now as low as 0.3 to 0.8 in some estimates and the overall rate is considered stable around 0.5. The other data coming through in the modelling is the number of admissions to hospital and intensive care. I am pleased to announce that both of these have halved in the last week. Last week hospital admissions were around 40 a day whereas this week that is around 20 a day and last week ICU admissions were around four to six a day whereas it is around two a day this week.

In long-term residential care settings, the number of cases is declining. Based on the preliminary data, it is declining from approximately 100 new cases a day in early April to approximately 50 a day towards the end of last week. These significant decreases are welcome signs of progress. They are the tangible result of so much hard work across our health service and, indeed, across the entire country. I want to convey my genuine thanks to all those working so hard.

I want to share with Members four key messages from my discussions earlier today with the Chief Medical Officer regarding the point the country is now at. First, as the public health measures in our society begin to be lifted, our personal behaviour will become more important than ever in order to protect ourselves and each other. If we continue to wash our hands, practise coughing and sneezing etiquette and maintain social distancing, we can move more safely to our next phase when 18 May arrives. Second, the levels of the disease in our community continue to decrease. This gives us an opportunity to go after the disease where it is and focus our attention on places at a higher risk of outbreaks, such as workplaces and other congregated settings. Third, the World Health Organization has stated that this disease may be with us for a long time. It will be with us in the form of either lower levels of transmission or waves of higher infection rates. In order to be prepared for this, we must continue to remain vigilant as individuals and as a society and we must be ready to reintroduce public health measures when necessary. Fourth, as a country, we have pushed back this disease by working together and protecting ourselves and each other. As we continue to do this into the future, we continue to be stronger than this disease.

The sacrifices we have made, the work we have done and the solidarity we have kept have pushed back this disease enough so that we are now able to begin to tentatively plan for the reopening of our society and our economy. However, let me be clear: this progress is fragile and this plan depends on all of us remaining resolute and relentless in our national effort to suppress this virus. Our roadmap has been published and we are working to move forward with it but we do so with all due caution. The protection of the health and lives of our citizens will continue to be our primary concern. When we come to consider any further easing of restrictions, we will continue to rely on our expert public health advice and we will have regard to: the latest data on the progression of the disease; the capacity and resilience of our health service in terms of hospital and ICU occupancy; the capacity of our sampling, testing and contact tracing programme; our ability to protect and care for those who are most at risk from the disease; and, importantly, an assessment of the risk of secondary morbidity and mortality as a consequence of the restrictions. We will make our decisions based on the advice and data, along with our consideration of what is best for our society as a whole.

We have pushed back this disease collectively but it has certainly not gone away. It can return with ferocity if we do not remain vigilant and retain our ability to be flexible and agile in our response. We will not risk losing the ground we have gained against the disease. The people would not wish us to do so. All our decisions will continue to respect the hardship and the sacrifice that so many have made to bring us to this point.

As already mentioned, one critical element is our ability to test and contact-trace so that we can limit the impact of future outbreaks of Covid-19. Our target testing capacity remains as advised by the National Public Health Emergency Team, NPHET, on 17 April: the ability to perform 100,000 tests per week operating on a seven-days-a-week basis for a minimum of six months. The HSE has developed a plan for building its capacity towards that target and I am pleased to say it is now delivering real results. Significant progress on building and increasing testing capacity has been made in what objectively must be seen as a short space of time. The result is that capacity has expanded to 12,000 a day and turnaround times have significantly improved. The HSE will be stepping up capacity to 15,000 tests a day in the next two weeks. Turnaround times will continue to improve and we should see average turnaround time from swab to result of between one to three days by 18 May.

We are continuing to widen the net of groups being tested to meet this capacity. This is important and has been welcomed by our general practitioners and health professionals. Now that we have extra capacity, we are widening the criteria in terms of who can be tested. This is good as we continue to aggressively go after this virus where it is most likely and where it will do most harm. We will continue to strategically target testing at vulnerable groups. Let me be clear: those testing priorities will be decided by public health experts and NPHET. They will not be political decisions. We will target testing where it can do most good in terms of going after the virus where we are most likely to find it and in groups in which it is most likely to do harm.

The behaviour of this disease in our residential facilities continues to be our area of greatest concern, despite what I think people would have to acknowledge is a significant improvement based on the modelling data on the reduction in the number of new cases. Our 23 response teams across the country, led by senior nursing support, will continue to provide senior clinical expertise, infection prevention and control and public health input to prevent and manage clusters in nursing homes and other residential facilities. I have no doubt when we get into the questions and answers that we will have an opportunity to outline some of the benefit we are now seeing from the home help agreement in the redeployment of staff from that sector into our nursing homes, which has begun in earnest this week. As the House will be aware, we have prioritised testing in our long-term residential care settings. That has yielded a real benefit in getting on top of this virus. Crucially, our regulator, the voice that we, the Oireachtas, put in place to oversee safety in nursing homes, namely, HIQA, will have ongoing oversight of the response in these facilities through its Covid-19 quality assurance regulatory framework. Its visits to nursing homes have started. I had a very good meeting with HIQA on that yesterday.

Last Tuesday, we were able to increase the distance which people may go to exercise to up to 5 km. We were also able to provide advice to those who are cocooning on how they can safely take some exercise as long as they take those necessary precautions in the interest of their own health. I wish to say a special word to people in this "cocooning" category. I know this is an uninvited label and a very much unloved one. I am not sure where the word came from but I have yet to meet anyone who likes it, myself included. People in the category are well aware they have an increased vulnerability to this awful virus but they do not associate their ordinary, non-Covid lives with vulnerability. I refer, for example, to people in their 70s and 80s who are in good health. Following the advice on how best to stay safe contrasts starkly with a life lived normally, actively and resiliently. I hope the increased activity suggested by the recent advice helps, and we want to build on that. We will continue to provide honestly advice on the best way for those most adversely affected by the virus to stay safe. We do not do so to cause offence in any way but, rather, in order to impart the best possible medical advice. I hope that as we further suppress this virus together, we can get closer to those normal lives as quickly as possible. We were able to bring in these changes and begin to plan tentatively for the reopening of our society and some of our economy because our country has acted as one in doing what it takes to suppress this disease. We can continue to move forward safely and look forward to better days if we stay the course and remain vigilant.

I will conclude by expressing my gratitude for the continued unity of this House in supporting the public health advice while rightly scrutinising the Government's response. I very much welcome the establishment of a new Oireachtas committee, which I know has been set up to aid that effort. On that note, I ask everyone to stress the difference we can all still make between now and 18 May in weakening this virus as much as we possibly can. We now know how to do it as a country - wash your hands, cough and sneeze properly, keep your distance, stay at home, stay safe, mind one another and protect one another. That is how we will make sure that these days between now and 18 May really count. The weaker we can make this virus during this time, the greater chance of success it gives our national plan in order that we can press "Go" and proceed with trying to get back to some degree of normality, and the greater the opportunity will be to save lives and keep people well. I know that is what we are all about.

With the Ceann Comhairle's permission, I will take the first six minutes with the Minister, after which my colleagues would like a back-and-forth with him, if they may.

I, too, start by expressing my deepest condolences to the friends and families of the many women and men who have tragically lost their lives since we met here last Thursday. On that point, I wish to talk to the Minister about cancer services. The HSE told us yesterday that GP referrals to the rapid access clinics for patients with suspected cancers have fallen by more than half since Covid-19 arrived. This means that many people with cancers will have those cancers missed, at least in the short term, and we know that matters greatly. The HSE has said far fewer people are going to their GPs with their suspected concerns and that some people may not be aware that full GP services are open. We all know that other people are simply afraid to go out still and are very cautious about catching this awful virus. A UK study published in recent days, which I am sure the Minister is aware of, shows that the UK has had an even bigger fall in access from GPs to their rapid access clinics. Worryingly, the study also predicts that England alone could see a 20% increase in cancer deaths just in the next 12 months because of this lower number of referrals.

If that were to happen here, and please God it will not, we would be looking at approximately 2,000 more deaths from cancer in the next 12 months alone. In short, if we do not fix this and get referral rates back up, we could end up with a situation where more additional people will have died from cancer than from Covid-19.

On top of that, the screening services have been suspended, as the Minister knows, for reasons we all understand. Oncologists are also saying that many of the services they use, including diagnostics and operating theatres, while available, are taking longer to access than they normally would.

Is it not now time to reopen the screening services and get the diagnostics and identification going again? Would the Minister agree that it is time for us to launch a major, national public education campaign with the same level of focus and professionalism as has been done for Covid-19 to encourage people to go to their GPs if they have concerns about their health? What can be done to address the serious blockages that are still in the system for oncologists as they try to get their patients diagnosed and treated as quickly as possible?

I thank the Deputy for raising what is a massively important issue. He is right that it is entirely possible that this country, and indeed many others, will come through the Covid pandemic, albeit with undoubted tragedy, pain and hurt, only for more people to pass away or get very sick from other illnesses through secondary morbidity and secondary mortality. We need to work collectively against that.

As a result of the considerable efforts of the Irish people, we have, thankfully, not yet seen our hospitals and intensive care units overwhelmed in the way they could have been, although that does not take away from the personal tragedies that have occurred. We also have some capacity now in private hospitals and that is something about which the Deputy has been engaging with me. We absolutely need to now have non-Covid care running alongside Covid care. At the meeting of National Public Health Emergency Team, NPHET, on Tuesday of this week, the blanket ban on non-Covid related procedures, treating cancer and other diseases, was changed. Assessments in that regard will now be based on a clinical and operational assessment. The HSE is now finalising its non-Covid care plans.

Specifically on the Deputy's question about cancer, the first message we must get out is that GP services are open and safe, and that GPs want to see their patients. GPs have led on the establishment of our community assessment hubs which provide a pathway for care for people with Covid in the community to keep general practice Covid-free. That is further, welcome reassurance that GPs are providing.

The national cancer control programme has today done exactly what the Deputy has suggested and started a major public awareness campaign. I would welcome the Deputy's input on how we can make the campaign as good as possible. The campaign is telling people not to delay, or ignore symptoms, but to pick up the phone and use the available cancer services.

The reopening of screening is going to be a clinical decision taken by the national cancer control programme in consultation with NPHET. I would like to see it up and running as quickly as possible but I am conscious that it needs to be done in a safe way and at an appropriate time.

I do not want to use up the Deputy's time but there are a number of issues under consideration and being worked through between the Department, the HSE and the national cancer control programme, including medical oncology services, continuing with the relocation of day wards where necessary, and continuing with provisions made for physical distancing in radiation oncology services. Maintaining urgent surgical oncology services is a priority, with many of those services now relocating to the private hospitals. Cancer care is absolutely a priority, as is getting non-Covid care running alongside Covid care, and a lot of good work has been undertaken by our healthcare professionals.

I thank the Minister. It is good that the national cancer control programme is doing that and we heard its representatives on the radio this morning. I am proposing something far more ambitious because considerable resources, professionalism, talent and money have been brought to the public communications around Covid-19. There are advertisements in every newspaper, on every radio programme and on the television, and we are all out talking about it. Every door has a big yellow sign on it referring to Covid-19. That is fantastic and deserves credit. My point is that, with the best will in the world, the national cancer control programme could never replicate that kind of campaign on its own. If what we are looking at is the potential of more people dying of an additional cancer rate than die from Covid, can we deploy the full resources of the Government, as has been done for Covid-19?

We move on to Deputy Butler. The Minister might try to include a response to the Deputy when he is responding to Deputy Butler.

Once again, I would like to speak about nursing and care homes. I acknowledge the Minister's statement to the effect that, based on the preliminary data, the number of cases has declined from approximately 100 a day in early April to approximately 50 a day towards the end of last week. I pay tribute to and thank the fantastic staff in all the nursing and care homes throughout the country for the work they have done over the past two months. They have gone far beyond the call of duty.

On Tuesday last, I visited St. Carthage's House in Lismore, a care home for 42 residents. It is a fantastic facility for people with low to moderate dependencies. I called to deliver hand sanitiser supplied by Irish Distillers and distributed through Irish Rural Link. Unfortunately, couriers were unable to deliver due to the alcohol content so I took on the delivery for the Waterford area. Delivering the hand sanitiser outside the premises, observing social distancing, I commented that the staff were in terrific form. They told me that all 42 residents and staff had been tested, results had come back and every one of them was Covid-19 free. The concern for residents and staff had been ongoing for weeks, since the pandemic started, and it is the same in all facilities. There should be regular testing of staff and residents in nursing and care homes, perhaps on a monthly or bimonthly basis. The pandemic has borne down heaviest on older people, particularly those in nursing homes and residential facilities. The most recent figures indicate that 740 nursing home residents have passed away having contracting the coronavirus. That is more than half of all the confirmed deaths.

I am aware that testing has been ramped up in nursing homes in recent weeks and I understand that more than 90% of residents and staff have now been tested. That is welcome, but it is an exercise that should be repeated on a consistent basis. Does the Minister agree that there should be testing on a consistent basis, perhaps monthly or bimonthly? Hopefully, it could be done in-house because the faces of those at St. Carthage's who knew they were Covid-19 free were a joy to behold.

I will take Deputy Cahill as well and the Minister might combine his answers.

I thank the Ceann Comhairle. I sympathise with all the families who have lost loved ones as a result of this virus.

I raise with the Minister concerns about St. Brigid's Hospital in Carrick-on-Suir. I have been contacted about the hospital by a local councillor, Kieran Bourke, and some of the staff at the hospital. St. Brigid's is a facility of the highest reputation and standards within the system. It acts as a step-down facility from acute care for the south Tipperary and south Kilkenny areas. In the current crisis, it was appointed as a step-down facility for Covid-19 patients who had left acute care. We were informed two weeks ago that the demand for such Covid-19 step-down beds at St. Brigid's had decreased, that the hospital had been temporarily suspended and that admissions for step-down Covid-19-related care there would resume when required. However, it is now believed that beds are physically being removed from St. Brigid's to be used at Our Lady's Hospital in Cashel. Will the Minister ask the HSE to make it clear that there is no threat to the future of St. Brigid's and that when the Covid-19 crisis has ended, it will return in full to its previous service within the community?

I thank Deputies Donnelly, Butler and Cahill. To conclude the conversation with Deputy Donnelly in regard to cancer care and, in fairness, I know he said this also, it need not go the way that it potentially will go in other countries because of the efforts the people here have made and the leadership that our healthcare professionals have shown. We now have an opportunity to really ramp up our non-Covid-19 care plans alongside our Covid-19 care plans, and I want to assure the Deputy of my Department's and the HSE's real appetite for doing that. I do not want members of the public to be unnecessarily concerned. The health service is open. The health service has spare capacity available, which is not something the Minister for Health is usually able to say. GPs are urging people to call them. Community assessment hubs are in place. The Irish Cancer Society, Cancer Care West and others have come together to ramp up their services and supports. I want to acknowledge that and thank them for it. A major advertising campaign will start next week, but I very much hear the Deputy that it needs to be a significant and very visible one. I give my word to him that we will ensure that is the case and I will revert to him on what that might look like.

I thank Deputy Butler for telling me about her visit to St. Carthage's House and for the work she has been doing to help in the context of delivering hand sanitiser. The experience she has articulated is one that I have seen across the country when I engage with nursing home owners and at my twice-weekly meeting with nursing home owners also. It is that sense of relief and reassurance that a negative result can provide.

Thankfully, we saw the positivity rate of testing overall, not just in nursing homes, drop back to approximately 3.7% last week. The overwhelming majority of people are getting the peace of mind that they do not have Covid.

The Deputy is right that testing is only a point in time and one needs to keep going back and doing it again and again. The short answer to the Deputy's question in this regard is "Yes". There will be a recurring programme of testing for long-term residential care facilities. NPHET is due to consider a paper on how best to do that either at its meeting tomorrow or Tuesday of next week. It will be finalised within the next week. We will be also talking to the nursing home sector, HIQA and others about how lessons can be learned in regard to streamlining the process. Deputy Butler is correct, too, that there is a real appetite from nursing home staff nurses to do the testing themselves, which would greatly assist everybody. We will take them up on that offer but we need to work out a way to do it most appropriately.

Deputy Cahill spoke about St. Brigid's Hospital in Carrick-on-Suir. I will take his concerns directly to the HSE with a view to seeking clarity on the intended usage or restoration of the facility to its former purpose post the pandemic. I will revert directly to the Deputy on that either today or tomorrow.

I appreciate the Minister's indication that he is looking into the possibility of a major campaign. Oncologists are frustrated. Everybody understands why the blockages have appeared in the system as they have, but there appears to be a disconnect between the public narrative that cancer care services are operating as normal and what the oncologists and, more importantly, their patients are experiencing. There are a lot of delays. It would be fantastic if the Minister could look into that.

On the turnaround time for testing in nursing homes, it is great that NPHET is looking at a paper on retesting. The turnaround time in hospital settings is 24 hours more or less. If a patient or member of staff is tested, the result is available within 24 hours. In the nursing homes at the moment, the waiting time is regularly five or six days and sometimes more than a week. I raised this directly with the HSE yesterday and was told that its target is to bring down the waiting time to three days by the middle of this month. The target should be one day. That is the target in the acute hospitals so that if there is an outbreak, it is identified and people can be isolated, contacts can be traced and there is no big knock-on effect on patients and staff. The nursing homes have exactly the same need. One of the reasons the HSE gave for the longer waiting time for nursing homes is that the ambulance crews need to go out, but the homes have trained clinical staff and can take the swabs themselves. Will the Minister push the HSE on this and put it to NPHET that the target for nursing homes should be not three days but 24 hours as it is for the acute sector?

I will do so. The Deputy has hit the nail on the head, as did Deputy Butler, that if we can get to a point where nursing homes are in a position to use their own staff, as I know the staff are willing to do, it will further remove the potential delays. The national ambulance service has been incredible and its staff have done an amazing job, but if we can take out that piece and do the testing in-house, it will speed up the process. The HSE's own testing target is to have an average wait from swab to result of one to two days from the week beginning 18 May.

I am sharing time with Teachtaí Ó Murchú and Andrews. The first issue I wish to raise concerns nursing homes. Two weeks ago, I was advised during a teleconference with the HSE that patients were not transferred to nursing homes unless they had received two negative results for Covid. Some of the information that is coming to me is anecdotal and I also have information from a member of my family. The very firm belief among people I have spoken to is that at the very start of this crisis, in preparation for the surge, patients were moved without being tested into the nursing home sector. The belief in the sector among some staff members, which is in accordance with the experience of my family member, is that the virus was brought into the nursing homes from the hospitals.

I have raised this issue previously with the Minister. Can he confirm that testing is now being done in every single case? Will he advise whether it is his intention to examine the possibility, as raised by me previously, that the virus may have come into nursing homes by dint of the preparations that were made at the very beginning of the crisis when people were moved out of hospitals? I am being straight with the Minister in saying I am not convinced the testing happened as is being claimed. It is what the HSE told me happened when I spoke to officials on a conference call and I accept that it may be practised in some instances now, but I do not believe it was practised at the time, and that is an issue that needs to be examined.

The next issue I want to raise concerns direct provision. I thank members of the Fingal Communities Against Racism for the good work it continues to do with our neighbours in Balseskin. Yesterday, when I asked the HSE how many people in direct provision had tested positive for Covid-19 I was told that number was 150. At a later briefing, journalists were told the number is 88. I understand this is an ongoing situation but perhaps the Minister would provide the exact number.

I have been contacted by a woman who was moved out of a centre to a hotel to self-isolate. She was told that this would be helpful because she would be closer to a hospital and she could quarantine for seven days. This woman has three young children and they are all living in one room. The woman and one of her children have serious respiratory conditions. She is worried that other people who are self-isolating because of suspected infection are being housed in the same hotel, which is contrary to HSE advice. This woman is terrified. She has requested a transfer, as anyone would. The woman has been told that transfer requests cannot be processed due to Covid-19. This transfer is being requested because of Covid-19. That is what makes it urgent. This woman is living in one room with three children, who have only noodles and bread to eat because that is all she can get. She does not want to return to Balseskin where there were 93 confirmed cases of Covid-19, representing an infection rate of approximately 40%. She wants to protect her children and she needs help. How many positive cases of Covid-19 are there in direct provision? Will the Minister, as a matter of urgency, ensure that the additional capacity created in places like Citywest can be utilised by people in direct provision, DP? Will he ensure that the mixing of people who are cocooning with those who are transferred out of direct provision because they are suspected cases of Covid-19 stops immediately and will he urge the Department of Justice and Equality to facilitate transfer for health and safety reasons?

I want to raise again with the Minister the issue of geriatricians being part of the teams that go into nursing homes, which I raised with him last week. If the Minister has responded, I apologise as I have not seen a response. It would be a really good idea and very beneficial.

The final issue I want to raise concerns section 39 agencies and charities, which have been struggling for some time due to loss of income through funding cuts over the past decade. Will the Minister consider establishing a Covid-19 fund for these charities to help them get over the difficulties that they face? Will he restore the €20 million funding cut to section 39 agencies and guarantee the HSE funding to the sector? The Minister will appreciate that their normal channels of fundraising are pretty much closed to them. They are desperate and they need help to continue to provide vital supports in the community.

I thank Deputy O'Reilly for her questions. On the section 39 agencies, I will examine the issue and revert to the Deputy on it. On the point regarding the geriatricians, I have written to the Deputy on it. The short answer is that we are examining how we can do something not too dissimilar to what the Deputy suggests.

On nursing homes, I have discussed with the Chief Medical Officer the need for the National Public Health Emergency Team to review the issue of long-term residential care in nursing homes, about which the Deputy rightly stated there is a lot of anecdotal information, including, for example, the visitor restrictions. In fairness, the data and the graphs that have been produced by NPHET and the Chief Medical Officer show that the timelines do not align. My gut feeling is it is a case of delayed transfers of care and people being discharged into the nursing homes sector. The short answer is that we are going to examine the matter and revert to the Deputy on it. It does seem that community transmission is the most likely reason. Obviously, essential workers are doing an incredible job but their having to go into healthcare facilities seems to have been a factor. We will produce a paper in relation to the work, which we will share with the Houses and the committee. We will publish it as well.

On direct provision, first it is really important, for the benefit of those who sometimes like to talk down the many brilliant people who come to our country from over jurisdictions, that we acknowledge that there are 160 healthcare workers resident in direct provision centres across the country. When we are applauding and thanking healthcare staff we should be cognisant of the fact that 160 healthcare workers are coming through direct provision. I thank them for the contribution they are making to the Irish health service.

That is a different issue.

It may be a different issue but I want to thank them. As I have already acknowledged, there is a lot happening around the country that I do not like when it comes to not extending a céad míle fáilte to people from other jurisdictions. I want to thank them in that regard.

Deputy O'Reilly asked for specific figures.

To ensure accuracy, I prefer when figures are given out by the Health Protection Surveillance Centre, HPSC. The figure I have is that there have been 164 confirmed cases of residents in direct provision and I am happy to share that figure with the Deputy. A range of measures are in place to address any case of Covid-19 if and when it arises, and this includes the provision for self-isolation facilities in centres. There was a meeting with the Department of Justice and Equality on this issue yesterday. There are a number of off-site self-isolation centres throughout the State and Citywest has been used for that purpose, although not solely for that purpose. The Department of Justice and Equality is working collaboratively with the HSE to implement the public health advice. The established procedure across all centres for a person suspected or confirmed to have the virus is that, where advised by public health, they are moved to a dedicated off-site self-isolation facility, where supports are available for the duration of the period. I will revert to the Deputy on her other specific questions.

I call Deputy Ó Murchú, who is sharing time with Deputy Andrews.

I want to deal with the tragic situation at Dealgan House Nursing Home in County Louth, about which I have written to the Minister. Staff in Dealgan House have at times been working in nightmare conditions and continue to do their very best to care for the residents, some of whom they see as family, and I want to pay tribute to them.

According to figures that have been shown to me in the last few days, 26 people have died in this nursing home and they are believed to have died from Covid-19. These are mothers, fathers, siblings and grandparents. Unlike other nursing homes that have featured in the media, I have not seen official figures for the number that have died in Dealgan House. This is a feature of the lack of communication that has surrounded this issue, which has added to the worry and trauma.

It is almost three weeks since red flags were raised with me in regard to Dealgan House. Families, some of whom have lost loved ones, have come to me or contacted me about their worries. Nursing staff, care assistants and ancillary staff have also come to me. I want to thank every one of them for having the fortitude and the bravery to speak out and, today, I am looking to speak for them.

Operational control of Dealgan House was taken over by the RCSI hospitals group on 17 April. In a statement to the media, the RCSI said it would review its involvement at the end of May. Since the start of last week, I have been told by staff at Dealgan House that there will be no more RCSI staff by this coming weekend. I have been told that senior management and disease control specialists from the RCSI are already gone. I have repeatedly asked the hospitals group for clarity on this point and while it says it remains in control at Dealgan House, it will not say for how long and, crucially, has not outlined when and under what conditions the RCSI will hand back operational control to the owners of the nursing home.

I would like the Minister to address this directly. Staff, residents and families are desperate for answers about the RCSI plans at Dealgan House and I hope the Minister will be able to provide information about the future role of the RCSI at this home. I also seek answers as to how the situation in Dealgan House came about. I have been informed that, as early as 7 April, the owners of Dealgan House were in contact with the HSE and they discussed the developing and worsening situation at the home. Is the Minister aware of these contacts? Does he know why it was not until ten days later that the RCSI hospitals group took control? Why and by whom was the decision taken?

There are growing calls from families and staff for an investigation into what happened at this home.

Thank you. We will have to go to Deputy Andrews.

I have one minute left.

If you want to keep talking and get no answer, you may do so.

That is fair enough. I just want a direct answer in regard to the RCSI timeline and what conditions will have to be met before it leaves.

The Government has made many big announcements and big commitments in the last few months but these announcements and commitments are not being reflected in action on the ground. A case in point is the announcement about testing. We were told we are to get 100,000 per week and we are also told it will be 15,000 per day. Of course, while this sounds great, in practice, the situation is very different on the ground. I was contacted recently by a person who had to wait 22 days to get the test results, and that was after chasing up the hospital to get those results. Others are waiting 12 or 15 days for their results. As testing figures seem unclear and not very exact, I wonder how many results a day are being communicated to those tested.

It seems that it could be different. It is probably a better way of measuring how effective testing is.

Another big announcement was that the State had done a deal with private hospitals. This sounded fantastic but the reality was different. I have been contacted by staff in private hospitals who have said those hospitals were significantly under utilised over the past eight weeks. When we consider that almost 50% of those who have died from the Covid virus were resident in nursing homes we must ask why the hospitals have been so under utilised. The son of a nursing home resident contacted me to ask whether the Government had abandoned the nursing homes. Unfortunately, the answer seems to be "yes". In this context, will the Minister commit to using all of the resources in the private hospitals to support nursing homes?

Homecare workers are not required to wear masks, which has been mentioned. This is a real concern for many people who have vulnerable family members receiving support. It is also a concern for the homecare workers. A homecare worker may have to make up to 30 visits a day. Will the Minister state why masks are not required?

We need the time for the Minister to respond, if the Deputies want answers.

I have two more brief points. Pieta House does amazing work for mental health but, unfortunately, because of the postponement of the Darkness into Light walk it is down funding and needs to cut jobs and front-line counselling services. Pieta House has traditionally provided services where the HSE is weak. To ensure the vital services that Pieta House offers are maintained and the jobs are protected will the Minister intervene and work with it to ensure the vital services it offers are maintained and sustained over the coming months and years?

The publication of a refreshed A Vision for Change is vital to develop a cohesive post-Covid-19 response plan for mental health. Will the Minister commit to the establishment of an implementation group for the refreshed A Vision for Change to develop a post-Covid-19 response plan for mental health?

I ask for the clock to be stopped while I explain to people that which I think should be pretty clear. If four minutes are available for a question and answer and the whole four minutes are consumed in asking a question then a Member cannot expect to get an answer. The Minister has one minute and 22 seconds to answer the two questions.

Maybe some people do not want the answers. I can speak fast but not that fast. In response to Deputy Ó Murchú, I extend my sincere sympathy to the families, friends and staff in Dealgan nursing home, which he referenced. I will have to liaise with the HSE on the specific question on the RCSI's involvement. I know it has been playing a proactive role. The Deputy wants an assurance that the role will continue. I will revert to him directly or through the HSE on this in the coming days. To anybody who has any concern about any long-term residential care facility, I point out that HIQA is there as a regulator.

To answer Deputy Andrews's question on testing, we are delivering. I do not have time in 50 seconds to tell him in how many ways. Last night, a table was published by Our World in Data, which shows Ireland ranks fourth highest out of 25 EU countries and the UK in terms of tests completed as a percentage of the overall population. Rates can also be displayed as tests completed per 1 million population. We are ramping up our testing and improving our testing turnaround times. We could constantly do better and we need to do better.

Private hospitals are being used and in response to another question I am sure I will get a chance to talk about the utilisation figures. We do not move people from their homes to make a private hospital busier or anywhere else busy. We take these as clinical decisions and I would not like to overrule those clinical decisions.

On Pieta House, I am looking into that matter. I am very grateful for the very good work it does. On A Vision for Change, I am in the hands of the Oireachtas as generally we do not bring new policy decisions. Deputy Shortall raised this with me last week and I met the mental health forum today on it. We usually let a new Government bring the A Vision for Change policy. It is ready to go and I have an open mind on what is the best timing to do it. I will come back to the Deputy directly on homecare workers.

I thank the Minister and all of his team for the work they have been doing in very difficult circumstances over the past few months. I express my condolences to the families and friends of those who have been lost to this awful disease over the past few months.

My mother is 92 and is in a local nursing home. She happened to be in Sligo University Hospital. As someone who have benefited from the system, I pay tribute to all of the front-line staff and all of the stakeholders for their work and perseverance in a very difficult time and for their understanding.

That has to go on the record of the Dáil today. We are very much indebted and I hope in future times that we will remember the great service of all these nurses, doctors, gardaí and everybody who has played such a great role. It is also very heartening to see all the organisations that are trying to help out front-line staff in getting funding for meals and so on. On the way to Dublin today, I was listening to the radio and there was an item that really caught the mood. I refer to Daniel O'Donnell and his really kind gesture outside Dungloe Community Hospital yesterday, where he had his outdoor concert. It encapsulated all that is good that has gone on in the last few months. It was clear from the patients and staff that there was a great feeling. This is something that we should really appreciate and be thankful for. I thank Daniel O'Donnell and everybody for the amount of work they are doing.

There are a few questions that I wish to ask. Would the Minister agree on the importance of Irish-based US pharmaceutical companies to the Irish economy? Given the comments of the US President last week, does the Minister believe there is a role which these companies, which have highly-skilled Irish workforces, could play in better assisting Ireland in areas such as testing during the Covid-19 crisis? How can we get the message out much clearer and quicker that people who are sick or worried about their health condition still need to go to their doctor to be assessed? There is a worrying drop in the number of cancer referrals, for example. As we know, all cancer has not gone away. Is there a new approach to achieve this? Based on anecdotal evidence from GPs, I think 25% of people are turning up at their practices. Perhaps at one stage it was far too high, I do not know, but it is worrying that not so many are going because of this Covid crisis.

In respect of public hospitals, can the Minister outline to the House when private patients will be able to get private procedures by private doctors and consultants? I understand what needed to be done but people are looking for a timescale of when this will occur. We all have everybody ringing us up over the last two months about procurement of personal protective equipment, PPE, asking who they should talk to in the HSE. I understand there is a website or email address that we all can send queries to. Even today I have heard from people from Canada, China, India and the whole lot. We want to go through the right channels. Is there an email that we can send on? I know the email address but it is no harm that everybody around the country can send it in. We do not want conflicts of interest when people are asking. It is great to have an email or web address to send queries on to. It would be no harm to highlight that again. There is an issue regarding capital health projects under construction. When will they commence on-site and will there be any consequences for projects not yet started but identified under the Project Ireland 2040 plan? Does the Minister have any comments on that? With the hit to the economy from Covid-19 it could be an issue.

One issue that is coming up now and again concerns dental practices. They have been suspended by the National Public Health Emergency Team, NPHET. They have maintained emergency dental services and are providing advice over the phone and arranging prescriptions with local pharmacies. However, the whole practice has collapsed to nearly 5% of normal. Routine dental care will start from 18 May but there is an issue with practices getting PPE. The cost has skyrocketed and they seem to be in competition with other agencies and organisations. Seemingly it is very difficult to source and dental teams are going to need an awful lot of PPE in the post-pandemic world. What exactly is the HSE doing? Are there any arrangements with dentists? It seems to be an issue. They get no support or subsidies from the State. Their sole income is private practice on a fee per item basis.

I had not been fully aware that dentists' situation is quite different fromarrangements with medical GPs. Dentists say that they get no personal protective equipment, PPE, no financial support and very little guidance from the Government. I am sure there is guidance but perhaps the Minister could talk about that. We need the HSE to talk to the Irish Dental Association about new contracts for dental care post Covid-19. According to dentists it is long overdue. I look forward to the Minister's views on these points.

I am scheduled to meet with the Irish Dental Association tomorrow afternoon. As Deputy Feighan has said, guidance has been provided. Obviously we must follow public health advice but we want to have a conversation with the association, as we do with other sectors, with regard to how dentists operate in the new normal, at the appropriate time. I will not pre-empt that meeting but my officials and I will meet with the association representatives tomorrow.

On capital projects, we will be guided on our construction projects by NPHET in the same way as the rest of the construction sector. I have no plans to alter or pull back capital projects that are under way. They will recommence at the appropriate time from a public health and safety perspective.

Deputy Feighan's point on PPE is entirely right. The fact this virus will be with us for far longer than perhaps many people would have expected means we need to continue to seek more PPE. Ireland is doing relatively well in that regard when compared with others, but one can never have enough PPE. The website is the best way for people to submit their application and have it assessed. That is a whole-of-government effort as well.

With regard to private patients in private hospitals, we have offered guidance to the HSE about the obligation to continuity of care. If a doctor is seeing a patient, there is an obligation to continuity of care and, if it cannot be provided, for that patient to be transferred. I will send a note to the Deputy on that.

The Deputy is entirely correct on non-Covid care. I have spoken to Deputies Butler and Stephen Donnelly about this in earlier exchanges. We are finalising our non-Covid care plan. We are starting a major public awareness campaign, and Members may have seen some of it today. It will ramp up next week, especially around cancer care. The campaign will very much get the message out that GPs want to hear from people if they are sick. Please do not ignore a symptom and do not delay in contacting GPs. There is capacity in the Irish health services and a safe way of looking after people who are sick from illnesses that are not Covid, as well as looking after those patients who have Covid-19.

On the issue of pharmaceutical companies, the long and proud relationship this country has, including economic and social ties, with the United States is a two-way street and a two-way relationship. Many Irish companies create jobs in the United States and there are many excellent United States multinationals creating jobs here. We are engaging with all industry here, including multinationals, through IDA Ireland and Enterprise Ireland in the roles they might be able to play in providing vital equipment and in making sure Ireland is promoted as a location for research as we continue to work our way through this pandemic.

I will take the opportunity given to me by Deputy Feighan to pay tribute to the staff working in our nursing homes. Just because there is an outbreak in a nursing home does not mean it is a sign of failure on the part of staff. There are many incredible people working night and day in our nursing homes, and many nursing homes might have an outbreak of Covid-19 in the same way a family home might. They are dealing with it really well and working in very difficult circumstances with vulnerable people. Many of them, public and private, are doing extraordinarily good work.

I am sure that when this pandemic is over, there will be many lessons to learn and this Oireachtas will seek with us to learn them. Looking objectively at what we are doing in our nursing home sector and comparing it with many other countries, I believe that Ireland has been quite proactive. Providing PPE to private nursing homes is not the norm in many other countries. Redeploying staff from the public health service to private nursing homes is also not the norm in many other countries, nor is reaching an agreement with home care workers whereby we now have 145 home care workers going in to work in long-term residential care settings. I thank them for that. Testing asymptomatic residents and staff across our nursing home sector is not the norm and I am not sure there are many countries doing that at all. We have also put in place a financial assistance scheme with €4 million ready to pay out to private nursing homes, for which to date we have 277 applications processed. We have put a lot of supports in place and we will continue to support the sector.

I offer my condolences to all who have been bereaved so far by the Covid-19 pandemic. I share my sympathies, as Members across the House have expressed theirs.

I would like to revisit my colleague, Deputy Ossian Smyth's, and I am sure the Minister's, favourite topic, namely, the Covid tracker app. I thank the Minister for the publication of last week's document. Although it is not a technical specification that an engineer would recognise or use, it provided helpful and confidence-building information. We were pleased to note that Ireland will, in line with best international practice, use the Apple-Google framework for decentralised exposure notification. We look forward to seeing the full data protection impact assessment in due course and engaging in the pre-launch discussion in the House which the Minister promised. We continue to call for a set of technical specifications, ideally including the source code, which the Minister indicated would be published.

I will focus my questions on how the app relates to Northern Ireland. By way of background, we have particular concerns about cross-Border traffic and potential infection or exposure. Although it is too early to identify causes, the abnormally high excess mortality rates in counties Cavan and Monaghan underline the severity of the problem. As the Minister's report notes, international inter-operability of contact-tracing apps is desirable but complex and is likely to take many months to achieve. This is too long for us, given our unique border situation. The UK Government is, almost uniquely in the world, continuing with its plan to build a centralised contact-tracing app, which will not be inter-operable with any other contact-tracing app, including ours. It is at the discretion of an app developer, which in the case of the Covid-19 tracker app is the HSE, to decide in which app stores its app will appear. For example, earlier today I successfully downloaded the Indian contact-tracing app, which is known as Aarogya Setu.

Will the Minister confirm we will offer the Covid-19 tracker app in the UK app store in order that Northern Irish residents can download and use it? As part of the publicity campaign planned for the launch of the app, will he ensure that Northern Irish residents who may travel to the Republic, or who may interact with people who travel North from the Republic, are aware they can download and use the Covid-19 tracker app? Whether or not the app is in cross-Border use, are arrangements and protocols in place between the Irish and Northern Irish contact-tracing teams to facilitate tracking of cross-Border infection, exposure and risk?

My second question relates to therapeutics and vaccines. My colleague, Deputy Ossian Smyth, asked last week about how we were planning to acquire stocks of remdesivir, the antiviral drug that has shown promising early results in treating patients acutely ill with Covid-19. On the broader topic of access to therapies and vaccines, and assuming we do not want to get into a PPE-style procurement scramble for drugs, I ask the Minister the following question, for which I am happy to receive answers subsequently in writing. Do we have, or are we working on, plans to access locally manufactured supplies of therapeutic drugs or vaccines as they become available and are the drug companies here co-operating with the Minister in this regard? Should we consider keeping the Covid-19 testing centres active beyond the six months envisaged and until a vaccine is available, both so that we can keep testing at a high rate and so that we could use Covid-19 testing centres as vaccination clinics?

I note that the US President has announced he is willing to wind down the American coronavirus task force around the end of May. I do not for a moment suggest there is much we can learn from the American experience, but just as we have laid out a roadmap and criteria for reopening our economy and society, does the Minister have a view of how and when we can move from a crisis footing to a more normal operational phase as it relates to health service governance and operations? Specifically, for how long does he envisage that a NPHET-like structure will be required and how and when could we think about moving to a more long-term arrangement from our current crisis footing? I think we have all been struggling with the current arrangements as they relate to transparency and Dáil oversight, as I am sure the Minister will agree.

I thank the Deputy for his contributions. I am always in awe of the Green Party's knowledge of all things to do with the app. Every week it is very impressive. I hope that it augurs well if the party comes into government in respect of the progressing of these matters.

This app will be a big help. To make a point the Chief Medical Officer would make if he were here, this app will be complementary to what he would describe as the shoe leather, which is the ongoing work in contact tracing. Some countries talk about using these apps almost to replace the more traditional route of carrying out contact tracing but that is not our intention.

I will respond to the Deputy in writing on some of the questions about Northern Ireland. We want an all-island approach and we are working hard. I have had a number of engagements with the Northern Ireland Minister of Health, Robin Swann, and the Tánaiste and I have had a number of engagements with the First Minister, deputy First Minister, Secretary of State and Minister of Health. The two chief medical officers are engaging as well and the Deputy's proposals in this regard are eminently sensible. I intend that the app will be available to residents in Northern Ireland through the UK store. We will revert to the Deputy on some of the technical ways of making that happen. We are having some conversations with colleagues in the North regarding an all-island approach, of which this is one element.

I will get the Deputy an updated note on the therapeutics but, as of now, remdesivir has not been licensed or approved anywhere globally and has not yet been demonstrated to be safe or effective for treatment of Covid-19. In this country, access to remdesivir is facilitated through one of three mechanisms. The first is compassionate access for pregnant women and their children. The second is an expanded access programme assigned to two sites only, which were selected on the basis of a review exercise that was undertaken. The company imposed criteria in this regard, including that the patient needed to be ventilated and the clinical site could not be able to access the drug through a clinical trial. The third is the WHO solidarity study, in which I am eager that Ireland will participate. This trial is supported by my Department and is progressing in anticipation of being able to recruit patients in the coming weeks. Work is being undertaken by a group, with representatives from my Department, the Health Research Board Clinical Research Coordination Ireland, and our regulator, the Health Products Regulatory Authority, HPRA. The study will be sponsored by University College Cork, UCC, and the national primary investigator will be Professor Joe Eustace. The phase 1 sites will be University Hospital Limerick; Cork University Hospital; University Hospital Galway; Beaumont Hospital; Our Lady of Lourdes Hospital, Drogheda; the Mater Misericordiae University Hospital; St. James's Hospital; Tallaght University Hospital; and St. Vincent's University Hospital. It is a largely randomised study, in which remdesivir will be one arm. I will keep the House informed on this clinical study.

On NPHET, I do not have a definitive view on when it will no longer be required. I envisage it will be required for quite a period. My gut feeling is that it will be required at least for the duration of Ireland's published roadmap because we will require its view at every phase as to whether it is safe to move on to the next phase. We will also require massive public health surveillance during that time. I am not suggesting Deputy Leddin was necessarily saying this but I do not buy into some of the conspiracy theories I hear about NPHET. It is an excellent group of experts, with about 20 doctors on the committee. It brings together all of the relevant people from the HPRA, which is our medicines' regulator, HIQA, the Department of Health and the HSE. It also includes a few people such as the president of the Irish College of General Practitioners, ICGP. Its minutes are published, as they should be. Letters to me and to the chief executive of the HSE are also published, as they should be. We have made clear in our roadmap the governance structure with respect to how decision processes are made, which is a welcome development. Following the publication of the roadmap, I will go to Cabinet every three weeks with a report with a recommendation on whether we can move on to the next phase. There is a clear understanding of exactly how the Cabinet will make those decisions as well. I am conscious that I come to this House two hours per week and will, I presume, participate in the Covid-19 committee as well, along with officials, to try to continue to provide that information. NPHET is not unique to this crisis. It has been used in many other crises, including the CPE crisis. I value, as do the Irish people, the decision to take a public health approach, rather than what has happened in some other jurisdictions where they have played politics with the global pandemic.

I join colleagues in expressing my condolences to the families of all of those who have lost loved ones as a result of Covid-19 since we last met in this House. In particular, I join my colleague from the constituency of Louth, Deputy Ó Murchú, in extending my sympathies to the families of those who have lost their lives in Dealgan House Nursing Home. I would appreciate if the Minister shared with his colleagues in the Louth and Meath East Dáil constituencies his views and the views he receives from the HSE when he makes inquiries about this matter. That would be very useful. I am happy to work with Deputy Ó Murchú and others to try to resolve some of those issues in the public interest, in the interests of those who have lost loved ones and in the interest of transparency.

That is the next issue I wish to raise with the Minister. First, I ask the Minister to publish the letters written to him and his Department by the HSE chairman and chief executive on 19 and 21 April last. We in the Labour Party and my party leader, Deputy Kelly, understand that these letters point to issues relating to testing, the testing regime and wider governance issues. The Minister and Members will accept that, at present, this Parliament functions in a very restricted fashion. It is virtually toothless. Therefore, never has it been more important for Ministers and public officials to behave transparently and with absolute frankness and candour. The Minister has to front up and respond to Deputy Kelly's demand that these letters be published openly and made available. When does he intend to do that?

When Vicky Phelan speaks we all should listen. I listened intently to what she said on the "News at One" programme today. She urged anybody with symptoms that might be associated with cancer and other serious conditions to access the health service, make contact with their general practitioner and so forth. I add my voice to that call. I am worried, and other Members have expressed their anxieties here this afternoon, that while some health services are running, others are in what might be described as sleep mode. We have a roadmap to open hair salons and tattoo parlour services, for which I have little need, but no roadmap exists to reopen our health service. We are in danger of the non-Covid-19 and possibly avoidable deaths surpassing Covid-19 deaths. That should be a cause of great anxiety for everyone.

What is the position with the roadmap for reopening our health service? I want a roadmap to be made publicly available which will point out when full cancer services, critical care services across the sector, community services and others will be open. That will be very important. Will it be the Minister with responsibility for our health service who will ultimately make that decision with the HSE or will the decision be subcontracted out to NPHET? Can the Minister elaborate on his role in this regard? Is he in charge of making this decision or will it be subcontracted out to Dr. Holohan? Who makes the final call - the Minister with the HSE or NPHET?

I am troubled by the fact that we do not appear to have a publicly available roadmap for the reintroduction of full BreastCheck, cervical screening and bowel screening services. When will they fully return? Can the Minister let the House know the percentage of patients who were screened before the shutdown who have yet to receive their results from the screening programme? This is going to be important. As the Minister knows, every day matters when one is waiting for results from cancer screening. HPV screening was supposed to commence shortly. The Minister might tell the House when this critical system will be introduced and made available.

I wish to follow up on some of the remarks made earlier by Deputy Feighan about dental services. Like many colleagues in the House, I have been contacted by local dentists who are, by and large, private operators and who are very concerned about their situation at present. They are also concerned, and they provided me with on-the-ground reports, that the type of emergency services the HSE said would be available are not, in fact, available in all cases. I have had reports of cases in Drogheda and Dundalk where people have not been able to access those emergency services. The main concern is that as those dental issues become more problematic, we could have people referred to hospitals instead of being cared for in the community by our professional dentists. I will be interested to hear about the outcome of the Minister's meeting with the Irish Dental Association tomorrow.

I wish to raise two further points in concluding. One relates to face masks. Why does the Minister appear to be flip-flopping on the idea of face coverings? In Slovakia, a country of similar size to Ireland but with a very low number of Covid-19 deaths, people have been required to wear face coverings since the end of March. There might be no causal relationship but I believe we must take the precautionary principle and ensure that people are safe.

My view, based on evidence I have read that has been communicated in the public media, is that there is a very strong argument for very strong advice to emanate from the Government to encourage people, and potentially make it compulsory, to wear face coverings, particularly on public transport, in shops and so on.

As raised by Deputy O'Reilly, the position of section 39 organisations is dire. A perfect storm has emerged. Bearing in mind the funding cuts by the Minister's Department in the context of the 2020 HSE service plan, will the Minister restore the funding to the organisations and revoke the 1% cut, which is in effect a €20 million cut to the organisations? As Deputy O'Reilly appealed for, will the Minister set up a Covid-19 fund to ensure the organisations, which are doing critical work in our community, are properly resourced?

Deputy Leddin mentioned the app, contact tracing and the interaction between the North and the South. The Minister's position baffles me. Why did he decide not to include non-residents in the travel restrictions he introduced a number of weeks ago? There are major concerns in north Louth and other Border areas regarding this. We are all working really hard to abide by and comply with the public health restrictions on travel but there is nothing preventing somebody from the North, a non-resident, coming down here and spending as much time as he or she likes here without any intervention whatsoever by the authorities. I wrote to the Minister about this last Monday week. It is a serious issue. I have had reports of families from the North coming down south to north Louth to spend weekends with their families whereas there are grandparents in the Cooley area with grandchildren in Dublin whom they have not seen for weeks. It is deeply unfair. Will the Minister revise the position on this? I would be interested in hearing what he has to say.

There are many questions. I have two minutes and seven seconds in which to respond so I will do my best.

On Dealgan nursing home, I will certainly keep all the Deputies from the constituency of Louth informed. We will work through it on a cross-party basis.

Yes, I want full transparency. I have no difficulty with the letters being published. To be very clear, however, I must state, because I believe it could make life easier for everybody, that NPHET contains the HSE, the Department of Health, HIQA and the HPRA. It is chaired by the Chief Medical Officer but it is not just an organ of the Department of Health; it includes senior representatives from the HSE. It brings everybody together and it makes recommendations. It is right that it does. What is an appropriate level of testing? I would far rather NPHET was deciding than me. In other jurisdictions, it becomes political. Obviously, the decisions have to be operational. It is perfectly appropriate for the HSE to ask how something can be made happen and what the timeframe is. There is now an agreed plan and trajectory, and we are beginning to see the benefits of that.

The Deputy raised a very important issue concerning the roadmap for non-Covid-19 care and regular health services. I share his view on it. Let me be very clear, however, about what the national roadmap states for the period from 18 May, phase 1, regarding the resumption of these services. Who makes the decision? Ultimately, the operation of the health service is for the HSE but it will require the input of NPHET. As long as the virus is here, we cannot go back to the old way of providing the health service. Trolleys are lethal. We cannot have packed departments of outpatients waiting for appointments. The use of personal protective equipment must also be borne in mind. The input of NPHET will be required in determining how to offer a service safely. The same applies to the turning on of the screening programme. I share the Deputy’s concern about that but the decision on when it will be safe to proceed with the national cancer control programme will be made with the input of NPHET.

On the question on screening results, I truthfully do not have the figures so I will come back to the Deputy. I take the point made on dental services. I am meeting those concerned tomorrow and will revert to the Deputy afterwards.

On face covering, there is no flip-flopping. It absolutely will be a part. NPHET will work out how best to proceed, the appropriate scenarios and the guidance. Inappropriate use could actually be dangerous.

With regard to section 39 organisations, we have to be honest that the revocation of the 1% cut will not be achievable. I take it that we are in a very different world now. I will engage with the sector on that. I will come back to the Deputy on the regulations.

I want to start off with the subject of testing, on which we have never had a satisfactory answer. We have been told we will get to a point, on 18 May, when it is hoped we will be able to test 15,000 people per day and carry out the associated tracing. Last week, the Minister for Health and the Taoiseach were at pains to point out that this is about capacity to test rather than actually doing the tests. Many people would be of the view that 15,000 is the minimum number of tests we should be carrying out per day in order to get on top of the virus in the community. The likelihood is that there are thousands of cases in the community that have not been identified because the case definition has been so narrow.

Why does the Minister make that distinction? It makes me worried that he is not determined to get us to the point that we have been promised we would be at for a very long time. I would appreciate clarification on that.

Many issues arise about facts and figures. It is disconcerting that the Government is not upfront about providing all of the necessary figures. Three weeks ago, I made the point to the Minister that while the reports are on different age cohorts, for some reason all of the data for older people are for those 65 years plus, up to over 100. I asked the Minister if he would arrange to have it broken down into ten-year phases but I did not hear back from him. It took me a very long time to get answers on this and I finally got an answer by going through a circuitous route. We know that 93% of deaths are in the 65 years plus category. What I found out is that within that very large category, 14% of deaths were among those aged 65 to 74 years, 33%, a third, were among the 75 to 84 years age group and nearly half, 46%, of all deaths in this country are in the 85 years plus age group. They are very revealing figures. It would have been helpful if we had access to them all along because they point to what the strategy should be in terms of identifying people in those at-risk groups.

Last night we also got the figures for the different disease categories in terms of underlying conditions among people who have died. Again, that is very helpful. Those figures should be available and they should be the basis on which the targeted response is designed. We need more information on the daily testing rates and the daily tracing rates. The Minister should provide those to people and they will have more confidence that there is a clear plan that is being worked to.

Equally, in terms of the roadmap, we need to know what the criteria are for going from one phase to the next. Instead of generalised criteria being suggested, we should know what the figures are and what level we need to get down to in terms of hospitalisation, ICU and deaths that would allow us to move on? That brings me back to the point about timely testing and tracing. We need to ensure that in the three-week time lags between each phase, as set out, we allow sufficient time or that testing is done sufficiently quickly, and there is sufficient turnaround to have meaningful figures to determine whether it is safe or not to move on to the next phase. It is critical that that happens.

I also want to speak about direct provision, which others have mentioned. Again, we need figures in that regard. Last night the CMO said 88 people in direct provision had developed the virus. Yesterday at the briefing, a figure of 150 was provided. Today, the Minister provided yet another figure, that is, 164. It seems that the official figures being reported are strictly for direct provision centres. However, there is a reception centre in Balseskin, the biggest such centre in the country. Recent reports indicate that about 90 people there have been diagnosed and had to be moved out because such centres are highly unsuitable to start with, but they are particularly dangerous in the case of a virus. Could we have clarity and data about direct provision plus the reception centre figures being provided?

I reiterate a point made by other Members about the need to resume the screening programmes. The Minister said he will be guided by the expert advice. That is fine, but as part of that, the priority must be to provide follow-up screening for cancer patients who have already been diagnosed and treated. Follow-up screening is absolutely essential for those patients and I ask the Minister to give priority to the issue.

I welcome the fact that the Minister is going to meet dentists.

There are serious problems for patients who have delayed their treatment, building up more serious problems, as well as problems for dentists who, unlike GPs, do not receive capitation fees. The viability of whole dental practices is being called into question.

I wish to add my voice to the question of disability groups. About a third of disability services are provided by not-for-profit organisations. A number of Members attended a briefing they held yesterday. They depend hugely on fundraising, often charity shops and various events. Their capacity to fundraise has been decimated. Many will run deficits of about one third of their funding. The sector will be severely hamstrung in its ability to provide decent services for the very many thousands of people who depend on them, including people with disabilities, adults and children, vulnerable people, people with intellectual disabilities and mental health issues, and all of that. A Covid-19 fund must be established for that sector. They will not have an opportunity to make up that huge gap in funding that has been created by that loss of fundraising. Will the Minister consider meeting them? This is going to be a huge problem and it needs to be addressed at an early stage. The Disability Action Coalition is the umbrella group for those organisations. I appeal to the Minister to do that.

Will the Minister give the go-ahead for the flu vaccination to be made available free of charge? Every year 4,000 people are hospitalised with flu, which is more than have been hospitalised with Covid. We simply cannot afford to have another round of flu this winter when we are still trying to deal with the Covid issue.

I agree that we need to avoid a bad flu season at the same time as Covid. The Deputy will have seen my comments that I am engaging with Departments for a much more expansive immunisation programme around flu, removing barriers and so on. It has also been though the HSE board. I will return to her with an update shortly.

I met Mental Health Reform today at the Deputy's request and invitation and I am more than happy to meet the Disability Action Coalition before we meet again next week. I have started initial discussions with a number of organisations. I know, for example, that Enable Ireland, which has been really good in helping to redeploy its staff, has a network of shops, all of which have been shut. We are not blind to this difficulty - we can see it - but I am working my way through it with colleagues.

I will return to the Deputy on the matter of dentists. I will take on board her point on screening and the importance of the follow-up screening and will feed it into considerations. I will make available to the Deputy and the House the figures I have on direct provision.

On the roadmap, I have also asked whether it is possible to put out the necessary figures for ICU admissions, hospitalisation and cases before we can move from one phase to the next. The Chief Medical Officer's general view so far is that there is no such simple formula, that it is about a trend over a sustained period. The ICU figures have been falling nicely, but it is about the trend not the numbers alone. I take the Deputy's point and we will continue to provide as much information as we can.

I took the Deputy's request about the Health Protection Surveillance Centre, HPSC. I note that the Secretary General wrote back to her on the breakdowns. I agree that a category of 65 years plus is not enough. There is a very big difference between someone aged 65 years and someone who is aged 103 years. The Deputy's point is well made.

On testing, the only reason I make the difference is because the people who do the testing tell me it is the difference, as do the GPs. The capacity and the case definition will have to align. When we get to 15,000, we will be testing more than many countries, and we already are. I want to see the capacity used but I am not making a political commitment that I will not be able to deliver, that it will be 12,000 or 15,000 every day, because it will vary. The clear advice of-----

What about the objective?

The objective, which I believe outlined in my opening statement, is 100,000 tests a week for at least six months, and that is also the aim of the Chief Medical Officer.

I was quite amazed earlier when the Minister said that it is not the norm to look after private nursing homes or to provide them with PPE. My thought immediately was that I do not think it is the norm also to have 80% of nursing homes in private hands. That statement is a bit glib, to be quite honest, as is the whole plan and roadmap to come out of the lockdown as it relates to our senior citizens.

Some 740 senior citizens have died. That is a startling figure. The figures given to us this morning show that 118 of them were hospitalised. That is less than 16% but it is an increase on the previous figure we had. Has new guidance been given to nursing homes on bringing patients to a hospital care centre? I note the percentage of those dying with Covid-19 who are in residential care has increased from 58% to 62%. That is a worrying figure and I would like the Minister to comment on it. I am not reassured that the level of care in nursing homes and the guidance being given to them are adequate in every centre or case.

My next question is on workplace clusters. When I asked last week about Liffey Meats in Ballyjamesduff I was told that the Health Protection Surveillance Centre was to investigate. There have been six workplace clusters in meat factories. Yesterday, when I asked what was being done about this, the answer I was given at the HSE briefing was that the sector is important to society. I want to highlight that so too are the workers in this sector. What is being done to ensure these clusters do not develop into the type of disaster we are seeing unfold in the United States?

I want to ask about the clusters in direct provision, specifically the cluster in Cahersiveen which has been well publicised on RTÉ. Cahersiveen residents are now in lockdown and have no contact with the outside world. There are 26 cases in the centre, five of which are among staff. What are we doing to intervene in that centre?

I ask the Minister to comment on the issue of masking. The National Bus and Rail Union has written to the Minister and all Members asking that we ensure that masking becomes the social norm when we open up public transport. The idea of "I protect you and you protect me" has to be enforced in society. However, we have to supply the masks which cost anything up to €2.50 in pharmacies. We cannot expect citizens to fork out that money when everyone is broke. We need to supply millions of masks at public transport hubs. What is the Minister's comment on that?

I assure Deputy Smith that I am never glib when it comes to this pandemic. I was making a particular point because there has been a great deal of commentary - sometimes it is made in this House and sometimes it is made elsewhere - on whether the nursing home sector was left behind. I hear it and I want to respond to it because that is what we can do in here. I am not sure whether the Deputy could point to many other countries where there has been a widespread testing programme of asymptomatic residents and staff, a temporary financial scheme using taxpayers' money for private businesses, redeployment of staff, a home care worker scheme and personal protective equipment being provided. I am simply making that point. I am proud that we have taken a policy decision to make these interventions in the interests of keeping residents safe. That was the point I was making.

I am not aware of any new guidance being issued but I will check that. If I am wrong in that regard, I will write to the Deputy.

The Deputy asked for my view on nursing home cases. My view is that this has been at the absolute frontline of our Covid-19 battle in recent weeks and months and it remains a major focus and priority for me. As I said, we are now beginning to see the number of new cases in nursing homes decline. There are now approximately 50 new cases so far each day whereas there were 100 new cases a day previously. I believe that is as a result of the testing that has been done. We can see the benefit of that testing. We obviously need that to be recurring. We need to go back and we need to have a regular programme of testing. That is NPHET's plan.

On meat plants, as the Deputy is aware, the Government decided to categorise the manufacture, production and processing of food and beverages as essential services under the regulations. Food production systems in Ireland have continued to operate. No food shortages have arisen. Where essential work cannot be carried out other than in a workplace setting, such as in meat plants and food production and processing facilities, employers are required to have protocols in place for the protection of their employees in the context of the current public health crisis. These protocols have been put in place. Examples of action taken to protect employee safety vary from plant to plant but may include the reduction of throughput rates of plants; the extension of operating hours and other safeguards; checking of temperatures of people entering the plants; the provision of additional of personal protective equipment; the use of Perspex screens; and other additional facilities to support physical distancing measures. I will send the Deputy my note on the issue so as not to take up Deputy Paul Murphy's time.

Deputy Smith asked about the issue of direct provision and Cahersiveen. I had a meeting yesterday with the Minister for Justice and Equality, his Department officials, Department of Health officials and the HSE on direct provision. A great deal of work is being undertaken to ensure that where someone has been identified as Covid-positive, that person is self-isolated.

I am satisfied that is happening. There is clear HPSC guidance on vulnerable group settings, including direct provision accommodation. That must be followed.

Face covering will definitely play a role - of that there is no doubt - but what is a safe and appropriate role is to be determined by NPHET. I will take on board the point the Deputy made about cost.

Last week I asked the Minister about various aspects of the costs we are paying to lease the private hospitals. I asked whether we are paying the directors' pay, the CEO pay, rent or interest for the private hospitals. The Minister said I would get a response in writing from the HSE or the Department within days but I have not received one yet. Fundamentally, I am trying to get to the bottom of why the HSE is being charged €44,000 per bed when the NHS is paying about €10,000 per bed. I will pose those questions again to the Minister. I will add that, according to the HSE agreement with the private hospitals, each of the private hospital groups was due to produce its cost statement by today detailing its full costs for April. Have those statements been provided? What is contained within them? Will they be provided to Deputies or will they be published? Last week the Minister said these are all on an open-cost, open-book basis, so can people please see these costs? Also, does the HSE contract or does the final agreements mean the public is paying rent or interest on a debt to Denis O'Brien's Ragazza special purpose vehicle, SPV, which finances the Beacon and is registered in Luxembourg so it does not pay tax on profits? Similarly, are we paying either rent or any interest on a debt to the Goodman Group, another group of companies based in Luxembourg-----

The Deputy knows the House rules on mentioning names or companies.

I am simply asking whether we are paying-----

We have the right to know about this money in the context of a company that paid almost no tax on €170 million.

I hope to get another question in but first I will see if we get an answer.

There is a letter. If it has not gone out, it will be with the Deputy tomorrow. I apologise to him about that. Following negotiations between the HSE, supported by my Department and the private hospitals, an overarching agreement with the 18 private acute hospitals was agreed at the end of March. The details of the arrangement are contained in the heads of terms, which I laid before the Houses of the Oireachtas on 16 April. Under the agreement, payment to the private hospitals 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 the normal costs of operating the hospital, which are set out in the heads of terms. Therefore, where fees, rent or interest payments relate to the ongoing functioning of the hospital, they will be included in the cost. However, in direct answer to the Deputy's question, any intra-company interest payments are excluded. The rent and interest payments apply to pre-existing arrangements. The amount will be validated, assessed and paid to the extent that it is a proper operating expense for the hospital in line with the heads of terms. This applies regardless of who is the beneficiary. Final costs will be verified by independent firms of accountants appointed by the HSE and the private hospitals. There is an arbitration mechanism in place in the event of any disagreement. Staff continue to be employees of the private hospital. The heads of terms provide that the HSE will reimburse the costs of paying the salaries of staff and senior management at the private hospitals only at the prevailing rates and up to a maximum of €200,000 per annum.

The rest of the Deputy's questions will be answered in writing. I am sorry he has not received that letter so far.

Following up on Deputy Bríd Smith's question about workplaces, the Minister has obviously seen the clusters. We have been contacted by many workers in many different workplaces who have had difficulty getting anyone to inspect their workplaces. This is now becoming a very central issue in the context of a phased ending of the lockdown, a return to work and so on. Does the Minister agree that workplaces cannot open up until a risk assessment has taken place involving safety representatives from among the workers, with trade unions having access and workers being confident that it is safe for them to go to work without them being placed in danger of contracting the coronavirus due to insufficient social distancing and so on?

I think the Deputy is correct that there will need to be a very robust regulatory framework in place. It is in the absolute interest of our national effort and, beyond public health, even in the interest of our economy to make sure we protect people's health and do not allow anywhere to become a cluster for the spread of infection. I know work is going on between unions and employers, supported by Government, on those protocols. I am happy to keep the Deputy updated.

I raise the shockingly slow pace of Government formation in this State. Tomorrow will be 90 days since the general election took place. In the teeth of one of the largest crises the country has ever seen, we have a Taoiseach with no mandate and a Cabinet comprising some Ministers who are not Deputies. We have a Legislature which cannot legislate and a Dáil that has little ability to scrutinise the decisions of the Government. That struck me last week when the Taoiseach made his decision around the complex elements of the extended lockdown. The Cabinet made the decision, the Taoiseach drove it past the Dáil and presented his document on RTÉ television. We, in this Chamber, should have the ability to engage on all aspects of these important issues and we did not have that opportunity last week.

I welcome the new Covid-19 committee. It is a proposal that Aontú made two months ago and I am glad to see it finally coming to fruition.

One of the most frustrating aspects of the Covid-19 crisis is that we have a mammoth crisis and we do not have a mammoth response to it. There is a mismatch between the capacity being used in this country and the size of the crisis. I learned yesterday that 2% of the 2,000 people who have been trained to contact trace were doing so last Tuesday. A total of 40 people, out of 2,000 who have been trained, were contact tracing last Tuesday. That was not an outlier because only 70 people were contact tracing yesterday. We have very low numbers conducting contact tracing compared to our capacity.

Last week I learned that out of the 72,000 people who applied to answer Ireland's call to work on the front line of this crisis, only 51 people were in the employment of the HSE and doing that work. Ireland's call was launched as an opportunity to harness the solidarity and good will of healthcare workers around the world to get to the front line and fight this. It turned out, to be honest, to be a hollow PR husk. Only 51 out of 72,000 applicants were working as of last week.

There are currently 1,400 empty hospital beds. That is an incredible figure. There has been widespread cancellation of procedures and appointments. Serious hospital avoidance has been going on for the past number of weeks. It is frustrating to see the mismatch between the available capacity and the actual capacity involved in fighting this crisis. Nearly 2,000 people in the North and South of Ireland have lost their lives. I urge the Minister to ensure that we equalise that mismatch.

There is also the problem with testing. We are 40,000 tests below the objective set by the Minister nearly two months ago. The Minister and the HSE talk about capacity to test all the time and yet we are testing below capacity. There is unused capacity and that is no help whatsoever to anybody in this State. We should be sweating all the capacity we have to fight this crisis. Why, given the massive cost to the State of the continuing lockdown, are we not sweating the capacity available in the system?

The Minister and the Taoiseach have always stated that the decisions they make are on the basis of the best medical and scientific research and evidence. I asked the HSE yesterday what research it has done into the outcome of the massive hospital avoidance and appointment and procedure cancellations. I asked what is the modelling and forecasting for people's health with regard to what is happening. The HSE has stated to me that there is no modelling or forecasting happening in the HSE at the moment as regards the future impact to health, morbidity and mortality in this country. The Minister is making decisions on one important aspect of public health, namely, the development of this virus and the effect it is having on society, while not doing research on other aspects of public health. I have heard other Deputies say that it is likely that the number of deaths from other illnesses could exceed the deaths from Covid-19. That means the Minister is not making decisions on all of the facts and is neglecting the opportunity cost to the healthcare system.

Will the Minister commit to proper scientific modelling on the human cost of the mass cancellations and hospital avoidances happening in the State? Will he then develop a plan to allow us muster our resources, both human and financial, to be able to deal with the potential tidal wave of healthcare cases that will come down the road very shortly?

In terms of my final question for the Minister, 819 people have lost their lives as a result of Covid-19 in nursing homes throughout this State since the start of the Covid crisis. There is a long and tragic list of serious mistakes that have been made by the State in regard to those nursing homes, from the three-week delay to closing down the nursing homes to visitors, to the lack of the necessary staff and PPE, to the residents of the nursing homes and the workers within those nursing homes, to the massive delay in testing. More than two months ago we were told we would have blanket testing of nursing homes. That is just coming to completion as we speak. I refer to the delay in promised funds for nursing homes. More than two months ago we heard that millions of euro would be invested in nursing homes but only in the past ten days has that started to trickle into those nursing homes. I refer also to the absence of the critical engagement of Nursing Homes Ireland, who are the people who know what is going on in nursing homes. There has been a string of fatal mistakes which have had tragic effects in Ireland. Will the Minister commit to a proper public investigation of that mismanagement simply for the purpose of making sure that this never happens again in our country? Obviously, a public investigation cannot be held at this time because all resources have to be pointed towards the particular crisis we are in but when this crisis has subsided, please God, will the Minister commit to making sure that we have such a public investigation?

Certainly, when this pandemic ends there will need to be a review so that lessons can be learned right across Ireland's response because we would be stupid not to do that. We need to make sure that we know what we did well and what we could have done better. When one is operating in the middle of a pandemic, one is making decisions in real time and often decisions have to be made on the spot very quickly. It is important that we learn in that regard. I also believe an objective review would perhaps debunk some of the assertions Deputy Tóibín has made in regard to visitor restrictions and the impact that has had because NPHET has already done and produced charts in respect of the visitor restriction time and the time the virus became prevalent in nursing homes. There does not seem to be a correlation between visitors and the prevalence of the virus but, yes, there should be a review.

In regard to who speaks for nursing homes, Nursing Homes Ireland speaks for nursing home owners and does that very well. It is a very good organisation. In terms of who speaks to me in respect of nursing homes in the sector, it is the Health Information and Quality Authority, HIQA, the regulator, set up by this House. It has sat on the national public health emergency team since the very first meeting and is who I engage with very regularly.

The Deputy makes a fair point regarding secondary morbidity and secondary mortality. He will see in the Government roadmap published that that is one of the criteria which we will report against in Cabinet every three weeks before deciding to move from one phase, or indeed not being able to move forward. It is a very difficult challenge but, thank God, we are now in that position where we can ask how we can make sure that we keep non-Covid care going alongside dealing with this virus. Had we not suppressed the virus we would not have the opportunity that we are now having to talk about turning back on other health services.

I want to assure the Deputy that, in regard to testing, this country compares very favourably with many countries. It is not my data but the Our World in Data website ranks this country fourth highest out of 25 EU and UK countries in terms of testing completed as a percentage of the overall population, ahead of Estonia, Portugal, Italy, Latvia, Belgium, Austria, Germany, Spain, Slovenia, Finland, Slovakia, the United Kingdom, the Netherlands, Sweden, France, Romania, Poland-----


I can use my time as I wish - Croatia, Hungary, Greece and Bulgaria. This is a country which, despite the myth put out, is testing an awful lot because we believe we need to test, test, test. Setting up testing systems was bloody challenging, and does the Deputy know what the HSE did? It did not give up like other health services did. It decided not to give up on testing in the community but keep at it. I am very proud of the work it has done and we will swipe back capacity.

In regard to recruitment, the figures are much higher than just the Be On Call for Ireland figures because we have also hired 324 student nurses and midwives for the community and 722 student nurses and midwives for the acute settings. We have hired 1,097 nurses as healthcare assistants. We have hired 80 additional medical scientists. We have rehired 91 other people and we have hired 1,100 new doctors who have just graduated. When we are looking at recruitment I believe we have to look at the overall context.

I too welcome the establishment of the Covid committee because it will give us longer time than provided in these slots to answer some of the questions. I will revert to the Deputy in writing on the other matters.

When hospitals and other HSE facilities closed on 16 March, dentists were told to continue working. No PPE was offered to them, yet they had to provide emergency cover. All GPs are getting €30 per Covid telephone consultation and a capitation fee for medical card holders. The Minister said he is meeting with dentist representatives tomorrow and I will take it as read that these matters will be resolved.

I fully agree with what has been said about masks and the importance of masking up. I take the opportunity to thank a company called Irema in Limerick, whose details I have given to the Government and party leaders. Today, this company is putting in eight new machines, which amounts to a quadrupling of its production capacity. It is nice to see that the masks are being made in this country and we are not getting inferior PPE as we have had from other countries. I thank the management and staff of Irema for investing in the country's health and keeping us to the forefront. Well done to Irema.

On a disappointing note, I contacted the Minister's office to inform him about a company in Limerick with a mobile testing unit which has offered its services. I sent the same information to the HSE. This mobile unit is self-contained and has fridges, power, computers and all the facilities that are needed for testing. The company also supplies marquees so that testing personnel do not have to go into any premises. The testing can be set up outside in a courtyard and people can come out to be tested, which means a building is not required to do the tests. This was done last week in St. Joseph's Foundation in Charleville, where the whole system was set up in the courtyard, and it was an absolute success. As I said, the people doing the tests do not have to go into premises. They can even cover buildings if they have to with the facilities they have. The company has offered a 24-hour service with a three-hour turnaround and the unit can be brought to anywhere in the country. The staff are willing to work through the night and this would help the testing situation. Why are we not using these facilities that are being offered? I am disappointed that neither I nor the company got a callback in response to its offer.

The Taoiseach stated last week that we had lessons to learn from Covid-19 regarding the safety of older people in nursing homes. He said we need to look at the policy of helping older people to live at home for longer. However, last year, the only new home help hours given were recycled hours which became available when a person died. No new home help hours were provided. This resulted in many people who were medically fit for discharge and were written up for a home care package remaining in acute hospitals for long periods or entering nursing homes prematurely. Does the Minister now agree that this Government policy which denied home help to many qualified persons was wrong and forced many people into nursing homes and put them at risk? Will this be looked at going forward?

The Irish Dental Association has pleaded for urgent assistance for patients who are unable to access either routine or emergency dental care. Dentists across the country are dealing with a catastrophic collapse in their practices and may not be able to reopen their surgeries even after this crisis has passed. They are, therefore, seeking the support of the Government to allow some temporary respite at this time of huge financial insecurity for the profession. Is any action planned to safeguard the future of the dental profession?

My final question is one I raised on 13 March and which has reared its ugly head again and is very worrying for people. I spoke on the last occasion about trawlers coming into Irish ports, specifically Castletownbere in west Cork, at that time. I expect the Minister knows there was confirmation of an outbreak of coronavirus among the crew of a trawler just days after it landed its catch in Castletownbere. The French flag-bearing and Spanish-owned fishing vessel which landed in Castletownbere 15 days ago has been quarantined in a Spanish port since Friday after more than half its 15-strong crew tested positive for coronavirus. The 32 m Notre Dame Cedeira is tied up in its home port in the north west of Spain after eight of its crew were confirmed as having the deadly virus. The vessel left its home port on 10 April to fish in Irish waters. It was among a fleet of some 40 Spanish vessels that spent several days in mid-April fishing in an area of the ocean approximately 40 nautical miles south west of Mizen Head. The vessel headed to Castletownbere to land its catch of mostly hake and monkfish and arrived on 21 April. It spent three hours tied up before setting out to sea again.

During that time the crew would have interacted with local agents, forklift drivers, truck drivers and fuel delivery workers. People in the fishing towns are concerned that after all their efforts to suppress the virus they could now be at risk arising out of the contacts from this vessel and the many other vessels that tie-up in Castletownbere. My question today is the same question I posed on 13 March. What, if any, checks or procedures are in place, similar to those which I am sure are in place in respect of Irish boats entering other jurisdictions, to ease the minds and fears of those who reside in the towns and villages of these ports, including the residents of Castletownbere, Dingle, Killybegs and the many other ports around Ireland?

I thank Deputies O'Donoghue and Michael Collins for their questions. As rightly stated by the Deputies, I will meet the Irish Dental Association tomorrow. As the Deputies will know, the roadmap announced by the Government on Friday, 1 May, referred at a high level to wanting to increase the delivery of non-Covid care and services alongside Covid-19 care to meet demand. There are a range of practicalities that now need to be addressed, some of which we have been discussing today in this House. In light of the advice and opinions emanating from a number of stakeholders in regard to dental care and Covid-19, the expert advisory group to NPHET has been asked by my Department to consider whether advice can now be given which would assist in bringing clarity to these matters. I think that would be welcome and helpful at this stage. Dental services are currently confined under legislation to the delivery of emergency dental services. This legislative provision is among the issues to be reviewed in light of the decisions recently announced by the Government. We will get the expert advice through NPHET and I will meet the Irish Dental Association, following which I will report back to this House next week.

On the issue of face masks, I am pleased to hear of Irish companies making them. Given that we are going to need PPE for the foreseeable future, it poses an opportunity and a question for us as to how Irish industry and businesses can be assisted in producing them. I do not want to deviate too much from the role of my Department but I think we are seeking examples of this emerging across the country.

On the mobile testing unit, I will ask my Department to look into the matter again. I do know that all of these offers of assistance would be co-ordinated at a central point. The website takes these applications. I will correspond directly with the Deputy in an effort to assist in the matter.

I thank Deputy Michael Collins for raising the issue of home care and home help which, in fairness to him, he consistently raises in this House. He has done so in this Dáil and in the last Dáil and I know he feels very strongly on the issue. I must point out that in the last budget we allocated 1 million additional home help hours but I accept there is need for a discussion on the model of care for older people in our country post this pandemic and also in line with Sláintecare. However, this is not just an issue of the number of hours of home help provided, although I accept that is an issue. It is also about having a statutory home care scheme. Every politician in this House has probably said since entering elected office, if not before, that they want people to be able to grow old with dignity in their own homes. The only scheme we have ever legislated for in this Oireachtas is a scheme to support people going into a nursing home. We do need a statutory home help scheme. When we have a new Government, we should advance that as quickly as we can.

On the issue of dentists, I have already addressed that issue to Deputy O'Donoghue.

On the issue of trawlers, I will discuss the matter with my colleague, the Minister for Agriculture, Food and the Marine, Deputy Creed, following which he or I will revert to the Deputy on the matter. I do not know the specifics of the issue but I do know that for Covid-19 to be transmitted it requires people to be in close contact for a period of time. In light of the specifics raised by the Deputy it would be best if I engaged with the Minister with responsibility for the marine and reverted to him in writing.

We move now to the Independent Group.

I am sharing time with Deputy McNamara. We will take five minutes each. I do not agree with the Minister's commentary in regard to nursing homes. I went along with the Government, I did my best and then I began to ask questions. The Minister referenced that we are better than other countries and so on. We should not be looking at that. Rather, we should be looking at how we failed to prioritise nursing homes. I looked at all of the committee's minutes that have been made public. I pay tribute to the committee for its work. It met late at night and early in the morning. Notwithstanding all of that work, there was a neglect of the residential centres, nursing homes, direct provision, special centres for people with disabilities and mental health services. My question in regard to dentists has been answered. However, I want to put on the record that almost two months after the declaration of a pandemic we have not made any provision in regard to dentists and the service they provide. One sentence reads: "I cannot overstate the sense of despair and panic in the dental profession or the anger at what is seen as complete neglect of the reasonable concerns of our profession by the Government."

That is repeated ad nauseam. The Minister is to meet them but will he explain why there was no meeting with them up to now and how it did not come up at the specialist meeting?

Second, could the Minister please drop the word "cocooning" now that we realise it is insulting and unhelpful? The whole policy in regard to the over-70s has introduced an ageism and set equality way back. Can we learn from that and please drop the word "cocooning"?

I looked at all of the minutes. Residential centres and clusters in nursing homes were mentioned but there was no sense of priority or of dealing with them. What was even more astounding from the start to the finish of all the minutes I looked at was that direct provision was not mentioned once. Will the Minister tell me how direct provision never once surfaced at any of those meetings?

With regard to private hospitals, I live in a city with four hospitals. There are the two sister hospitals, Merlin Park and the regional hospital, as well as the private clinic at Doughiska and the Bon Secours, and they are all functioning under capacity, both the public and private hospitals. Will the Minister confirm where we are at in regard to the agreement? He gave us the heads of agreement and nothing else. Will he please give us the agreement and tell us how many consultants have signed up? I am getting representations from people in the city who have been diagnosed with cancer and who cannot get surgery, when we have hospitals functioning at 25% capacity.

Deputy Connolly and I are going to disagree on the nursing home issue, as is her right. I would make the point that we are recording, testing and getting an understanding that I do not believe many other countries have. When we get into the Covid committee, but also when we get past the pandemic, no doubt there will be lessons to be learned in regard to this pandemic. No country is perfect. However, while I am happy to learn the lessons, I believe we should learn them from listening to those like HIQA, the regulators and the other expert voices in terms of the work that went on. I am sure we will return to that on another day.

With regard to dental services, there has been engagement and I am meeting them tomorrow. Emergency services have been permitted. There was a public health view in regard to the risk from other services but, as I said, in light of the roadmap and where the virus is at, we have asked for expert advice to see how we can try to resolve some issues in regard to dental services.

On cocooning, I agree with the Deputy. While I am not passing the buck, I do not know exactly how the word arrived and why we are all using it on a daily basis. It is certainly not meant to be offensive. It is actually meant to be about imparting the best public health advice to a group of people who are not vulnerable people, but who are vulnerable to this virus.

I ask that we drop it.

Certainly, in the Government plan, the criteria that I now report against talk about how we "protect" and "shield". The short answer is that I am going to be conscious not to use it, as the Deputy requests.

In regard to direct provision, guidance was drawn up by the HPSC and a group was set up specifically on vulnerable users, including those in direct provision. The advice is very clear.

My question was why it was never mentioned once in any of the minutes from January to April that I have read.

I cannot say what the Deputy does or does not read, and I do not mean that in a rude way. I know a significant body of work was done by the HPSC in drawing up and publishing guidance and we know there has been a lot of work by the Department of Justice and Equality in that regard. My Department gives out the guidance.

On private hospitals, I will send the table I have with me to the Deputy. We are meant to have, and are purposely choosing to have, some vacant capacity for a potential second wave.

On 26 March, this House gave the Minister very extensive powers to bring in regulations to protect people from Covid-19. He did not do so for almost two weeks and people continued to behave responsibly. On 7 March, he brought in regulations and, on 10 March, he continued them. The next day, he said that when the R-nought rate went below 1, we would see an easing of restrictions. We did not see that for several days but everybody has continued to behave responsibly and to make huge sacrifices, and our health services have risen to the challenge.

I have heard the Minister say several times today that we are the fourth in Europe for testing.

Is all of that not being undermined by our failure to introduce any restrictions at our airports? There is a new story today that 34% refuse even to give an address. There is no law in place whatsoever.

I will point the Minister to Austria, a country a little bit like Ireland. It is a relatively small and neutral open trading country that relies on transit and its openness to the world. Austria is now opening up in a way we can only dream of. At the same time, Austria has a very extensive testing procedure in place at its airports. People cannot pass the frontier unless they have a test that is less than four days old to say they do not have Covid-19 or they can undergo a test at the airport. We have none of this. Austria has an open border and workers regularly cross the border with Bavaria in Germany, and have done for decades, just as we have a border we want to keep open with Northern Ireland. Austria has a sensible policy of maintaining exemptions for people who have to cross the border to work or see family members and for truckers carrying goods, as we could have. However, we do not have a sensible policy. We have a policy that undermines all of the efforts of our people and all of the efforts of our health professionals.

The Minister has extended these regulations until 18 May. If he does not bring in regulations by next week to deal with the frontier, I am telling him now that I will put the regulations that are in place to a vote in the House, as I am entitled to do, because I feel that all of the sacrifices required under those regulations, and the sacrifices people are making outside of the regulations because they see the necessity to do so, are being undermined by the failure of the Minister and the Government to introduce restrictions in our airports, where 34% of people pass by our HSE officials whistling Dixie and not even telling them where they are going. I ask the Minister to reply.

Yes, I would like to. The Deputy is right that the Houses passed legislation on 26 March giving me the ability to set regulations. He also knows that same legislation refers to what I need to take into consideration when setting regulations, which is obviously the public health advice I am given, which came after that. In fairness, on that issue, the Deputy will see we moved quite swiftly on regulating once we had the measures to put-----

My criticism is simply about the airports.

That may be but-----

I was pointing out that people behave irresponsible without regulations.

That is fine but I just want to point out there was no delay on that. With regard to airport restrictions, we are going to regulate in this area, but I also believe it will require the input of a number of Departments. The Departments of Foreign Affairs and Trade, Justice and Equality, Transport, Tourism and Sport, and Health have met on this matter with the Attorney General. The Deputy is right that at the moment self-isolation in Ireland is something people are doing voluntarily. I believe the overwhelming majority of people are doing it but it is not enforceable by regulation. We have brought in a new passenger locator form. The Deputy is also right that it is being filled out voluntarily by some and not by others. This will become a bigger issue as the country reopens. The amount of traffic through our airports now is very low, and we see in the figures the amount of transmission through travel is very low, but I accept this is likely to change as we reopen and as other parts of Europe reopen. I do not disagree with the Deputy on the need for regulation in this regard and the Government is working its way through deciding how best to regulate. I am happy to keep the Deputy updated and I note his intention.

The Government announced childcare facilities for essential front-line workers. Essential front-line workers are defined as healthcare workers only. These regulations are applied by members of An Garda Síochána. They are excluded. Why is that?

It is because the Government has decided, based on public health advice, that we would introduce it on a phased basis. Any time anybody goes into somebody else's house there is a risk of transmitting the virus. We are trying to minimise that spread. We are starting with front-line healthcare workers, but as the Deputy will see in the plan, we intend to expand childcare schemes further as we go through the plan. I take the point the Deputy has made about An Garda Síochána. We are starting with front-line healthcare workers.

Sitting suspended at 6.35 p.m. and resumed at 6.55 p.m.