Covid-19 (Health): Statements

I welcome this opportunity to update this House once again on the Covid-19 disease and our national response to it. First and most important, I express my sympathy to the family and friends of those that have been lost to this disease since I was last in this House. The ways of mourning we hold dear have been taken away from us, compounding the deep sadness of the bereaved but I hope they know, and I hope it helps to know, we all as a country grieve with them.

It is now more than ten weeks since the first case of Covid-19 was confirmed in our country on 29 February. I know it seems much longer since the days when this virus did not dominate our lives and we were free to be together and to go where we pleased without the concerns that are now a routine part of daily life. I do not think that there is anyone among us who would not like to wake up one morning and find that all this is over and that we can go back to living the lives we led before Covid-19. Unfortunately, we have been given a different challenge and a harder road to follow. It is one where we have had to adapt our everyday lives and be ever vigilant about this disease so that, in simple terms, we do not give it to anyone and we do not get it from anyone.

Our reward for the sacrifices made and the hardships suffered in these weeks is that fewer people have this disease and fewer still have become ill from it than would have been the case if we as a country had done nothing. Our modelling work shows that 12,300 lives would have been lost by this day last week if the infection rate had continued as it was. As a country we can be proud of what we have achieved.

I can update the House on the reproduction rate, or R nought, that we have become familiar with. This is now in the range 0.4 to 0.6. This is a remarkably stable number which has below 1 for the past weeks. The number of hospitals admissions per day has fallen again from 20 a day when I was here last week to 15 a day. ICU admissions are also now averaging around one to two per day from four to six a day two weeks ago. We are moving to a new phase in our response, but we must we must be honest with people about the impacts this will have.

Every movement carries increased risk of exposure to this virus so while we want society and the economy to reopen, we must be conscious that the public health risk has not gone away. This virus has not disappeared.

We must now try to chart a path to a new normal. This will be a long road and, frankly, the final destination is unknown, but we do know that every step must be taken carefully because unlocking a lockdown is fraught with danger and risk. As we have seen elsewhere in the world, a small recurrence of the disease can cause the need for an immediate and serious response. Depending on what the public health advice may be, and the Government decision tomorrow, 18 May could well begin what will be our biggest national test to date.

Our best line of defence is the Irish people. Their individual behaviour, help and assistance will be our greatest chance of success. Staying at home, washing their hands, keeping their distance, painful and difficult as some of these measures are, are the best things people can do to protect themselves, their family and their community.

For now, we must continue to adapt our way of living to this disease so that we can hold on to the ground that has been so hard won. We have come this far and achieved this much because we followed the clear public health advice that we were given and faced the reality, as a people, of what the evidence was telling us. We did this despite the cost to all of us as individuals and the cost to our country.

Our reality today is that we have made great progress against this disease but it certainly has not gone away. We must continue to be ahead of it and to carefully watch its behaviour as we consider taking the first steps in reopening our society and our economy. We have published our roadmap and we have been clear from the outset that it is slow, gradual and careful. This is for no other reason than to make sure we have a safe pathway to regaining what is necessary and what is best in our lives and in our society.

Last week, we published our Return to Work Safely Protocol. It provides clear guidance to employers and workers on the measures that must be taken to prevent the spread of Covid-19 in the workplace. The protocol was developed through the co-operation of the Health and Safety Authority, the Department of Business, Enterprise and Innovation, the HSE and my Department. It is designed to be used by all workplaces to adapt their procedures and practices to provide protection against the threat of Covid-19.

Let me be clear. The protocol is not static. There will be ongoing engagement at a national level between stakeholders on its implementation and it is subject to change in line with the latest public health advice or other developments in order to maximise the protection it will afford in our workplaces. While we want workplaces to be able to open in accordance with the roadmap and at the right time in the roadmap, they can only open if that protocol is adhered to and if it is safe to do so.

As we come to 18 May and consider the next steps to open our society and our economy, we will continue to rely on our expert public health advice and carefully assess: 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 the risk of secondary morbidity and mortality as a consequence of the restrictions. It is against those metrics that I will report to Cabinet tomorrow.

The HSE plan for building its capacity to 100,000 tests per week by 18 May is on target, as it outlined this morning. It is fair to say that we have made much progress in terms of increasing the capacity when it comes to testing along every step of the process. Turnaround time is now the absolute priority and I am pleased that the HSE outlined its plans in that regard this morning also. We can move forward with confidence if we know that we have the capacity to quickly contain new cases of Covid-19 in the future. That remains the absolute priority in an area that will require constant attention and vigilance.

We are continuing to focus on the behaviour of the disease in our residential facilities so that we can be best placed to protect those most vulnerable to it. As the initial roll-out of testing in our nursing homes is completed we will continue to protect both residents and staff through our response teams and under the ongoing oversight of our regulator, HIQA. The focus of our testing will now move to other residential facilities and settings so that we can identify and contain any clusters of this disease.

Across phases 1 and 2 of our roadmap we have committed to increasing the delivery of non-Covid-19 healthcare services alongside Covid-19 care to meet demand. This will require very careful planning to ensure that our health services can be delivered in a safe way. Our health service responded to this pandemic with commitment and innovation. We need to build on that innovation as we move forward with resuming non-Covid-19 care. As set out in the roadmap, we will use our modelling capability to assist in predicting demand to inform our capacity planning.

We will continue to deliver care and services in new ways, for example, through telephone consultations and virtual clinics. We will develop new models of care to meet demand and alleviate the concerns of patients, service users and healthcare workers.

Let me be clear about one thing: our planning for future services does not mean that anyone should wait until any date in May, or indeed, for any date at all, before seeking assistance if he or she have any symptoms from any illness that are not Covid-19 related. I urge any person who has symptoms he or she is concerned about to contact his or her GP today or attend an emergency department now. Our healthcare service is there for such people.

It is a privilege to be in a position to see how our country has come together in the face of the threat of Covid-19. I hope the sense of community and care we have experienced in recent weeks continues; in fact, it is going to be essential. I hope our future can be shaped by the actions of us as individuals in recent weeks, where we have worked together to solve problems facing us, where we have trusted each other to play our part, and where no problem has been insurmountable. Every day, thousands of unrecorded acts of kindness and solidarity make it a little easier to come through a difficult day. We have endured much loss and hardship in the weeks since 29 February but we have also shown incredible resilience as a people and a country. I am very conscious there are still questions, some of the most simple and heartbreaking ones, that we cannot answer. When can our children hug their grandparents again? When can we hug one another again? I wish I could answer those questions today but I can tell people we can hold each other safe. We need to hold firm, stay home, stay safe, and protect each other.

Fianna Fáil and Sinn Féin have 15 minutes each, followed by ten minutes for all other parties for questions and answers. I remind all Members to allow time for their questions to be answered and ask the Minister to be brief in doing so. I call Deputy Stephen Donnelly.

I would like to start by adding my voice and expressing my sympathies and condolences to the friends and families of the many women and men who have lost their lives since we stood here last Thursday.

I would like to talk to the Minister about the private hospitals. Taking over the private hospitals in March to guard against a surge was the right thing to do. It was a big, bold move and it was the right thing to do. Health officials agree that that capacity is no longer needed for the surge, and that only 20% of it would be required in the future if there were a second wave, which hopefully there will not be. The obvious thing to do would be to end the contract and put in place a contract that has an option to get an extra 400 beds if required. However, that is not happening. The HSE is giving a new reason now for retaining control and paying for the private hospitals, which is that it wants to use them to treat public patients. That is an excellent sentiment but we might both agree that the implementation has not worked out as we would have liked. I have heard of many cases relating to this issue, as I am sure the Minister has. A young man from Cork in need of urgent spinal fusion cannot get the operation. A young woman from Wicklow in need of urgent blood services cannot get access to outpatient procedures. A father from Offaly is in urgent need of stents but his consultant cannot schedule a surgery for him. Deteriorating eyesight, possible cancers and urgent heart conditions are not being treated at the moment. Beds are empty, operating theatres are dark, doctors' rooms are shut, and because of this, patients are unfortunately suffering a great deal. Many are deteriorating and it is entirely possible that some will die if they do not get access to the medical treatment they need. We are paying €115 million a month, which is a large sum of money, for healthcare facilities that we are currently not using and that it looks like we do not know how to run. Half of the doctors have not signed up, many who have signed up are not operating at the capacity they would like because they cannot access their rooms and somewhere between half and two thirds of the beds in private hospitals are empty. Indeed, there are several hospitals around the country where there are no patients in any inpatient beds. It feels like we have arrived at the worst of both worlds. I am not attributing any blame here. This is about solving the problem. Public patients are not being seen in private hospitals and public money is now going to be used to treat private patients in private hospitals, the cost of which would normally be picked up by insurance companies. My priority, like the Minister's, is the treatment of public patients, but the National Treatment Purchase Fund, NTPF, has identified just 5,000 patients who could be transferred to the private hospitals. In comparison, in 2018 the NTPF procured 21,000 procedures with just €50 million. Clearly, this is not an effective use of healthcare resources or public money.

The Minister stated previously that he, his Department and the Government are looking at this with a view to making a decision as to whether to continue at the end of June. I put it to him that given how badly this is going and how much suffering we are seeing for patients as a result, it is time to act now and cancel it. Does the Minister agree that it would be prudent to cancel the private contract, retain the option for the 400 beds if there is a surge and give the money we save to the NTPF to allow it to identify not 5,000 public patients but tens of thousands of public patients who could be treated? This would do three things. It would get our full healthcare facilities up and running, which we need. It would get the maximum number of public patients treated and it would get the insurance companies rather than the State to pay for private treatment of private patients in private hospitals.

I suppose the short answer is that I do not agree but I appreciate the sentiment expressed by the Deputy in terms of wanting to make sure we treat as many public patients as possible in private hospitals. We, the taxpayers, effectively own or at least own the use of all the private hospitals in the country until the end of June. Under that agreement, we have the option of extending that agreement for at least a month and an option after that for extending for a further month based on a mutual agreement. As more than 300 private doctors have signed up, it is a minority of consultants who have not taken up our offer, which is a pro rata salary starting at €141,000 per year and going to in excess of €170,000, so we are offering to pay people to work in these hospitals.

The Deputy is right. Thankfully, we have not seen the surge we feared. That is a fair point but as the Deputy rightly says, we may yet see a surge so we believe we still need that capacity. We are beginning to see a very significant number of people being treated in the private hospitals. There is a bit of a myth, which has not been put forward by the Deputy, that these hospitals are empty. For example, in April 2020, the Bon Secours Hospital in Cork had 82% inpatient occupancy and now it may even be greater. UPMC Whitfield in Waterford has 55% occupancy, the Mater Private Hospital Cork has 57% occupancy and the Mater Private Hospital in Dublin has 60% occupancy. I can circulate this list to the Deputy rather than taking up all of the time. It has been a strategy of the health service to keep vacant beds for the reasons outlined by the Deputy. We are now looking across the public and private hospitals as to how we can bring back non-Covid care. We will be using some of this capacity, including for some of the things we spoke about last week in terms of cancer care. I had a very long meeting with the Irish Hospital Consultants Association, IHCA, last Friday evening where I made it clear to it that the type A contract is the only contract on offer but I did provide clarification regarding continuity of care. We have also given the HSE flexibility where there are some private rooms to which a consultant may wish to have access to continue to use to treat his or her patients and we could meet some of those costs but consultants cannot get a fee if they are treating patients. We cannot pay twice. We have all this extra capacity. It has to be used. There must be equity of access. We cannot effectively own private hospitals and allow a difference in care between private and public. I take the point that there were issues that needed to be teased and ironed out regarding continuity of care and I have written back today to the IHCA regarding that.

As mental health spokesperson, I pay particular tribute to those front-line staff working in our mental health facilities and sympathise with and offer my condolences to those who have died since I last spoke in this Chamber. I will focus on what is sometimes referred to as the third and fourth wave in any pandemic, which has a particular impact on the mental health of our society and individuals. A report by the WHO's mental health department warned of another looming crisis. Its director stated that "the mental health and wellbeing of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently" and that the world could expect to see an upsurge in the severity of mental illness, including among children, young people and health workers. The UN has warned that the coronavirus pandemic risks sparking a major global mental health crisis. Here in Ireland, the St. John of God service has seen a dramatic increase in admissions to its Dublin mental hospital, half of which are related to Covid-19, including a number of healthcare workers. The Mental Health Commission, a State agency, has stated that it has been highly critical of the inconsistencies in staff testing and has criticised unacceptable delays in Covid-19 testing in mental health units. Clearly, the mental health impact of Covid-19 is already being felt in our society; both as a population and on those who are already vulnerable. On 23 April, I requested of the Minister and he agreed to the setting up of a mental health task force to guide the mental health recovery of our nation.

I have to say there was a significant amount of general interest among our mental health community about that. Have any steps been taken towards establishing such a task force and, if so, what steps? I have also written to the Minister about the matter since then.

What steps are being taken to ensure our mental health staff and patients are being tested as needed and are getting results without delay, bearing in mind the criticisms the Mental Health Commission made of the Department?

The mental health charities have seen a significant reduction in their capacity to fundraise and, in some cases, are already reducing services. What funding supports are being put in place to ensure continuity of service?

My next question is not directly related to mental health but has an impact thereon. It concerns patients who are non-Covid-19 related but need treatment. I will give two examples with which I dealt in my constituency yesterday. One patient was diagnosed with pancreatic cancer in January but has received no treatment. Another patient underwent a serious back operation in February but has not been able to avail of the necessary pain management since then.

I thank the Deputy for suggesting the establishment of a task force on mental health which I, truthfully, agree with. I would like to meet Members of this House in whatever the appropriate forum is to work out how to advance that, or perhaps through the Business Committee. I met representatives of Mental Health Reform and Jigsaw last week and discussed the Deputy's proposal of a mental health task force with them. I do not want to speak for them, but some of them were of the view that it should be linked to the publication of the new version of A Vision for Change. That document is ready to be published but, from a policy point of view, new policy initiatives are generally brought forward by a new Government after an election. I am happy to engage with parties about when that should be published.

I take seriously the comments of the Mental Health Commission. I am conscious that it was testing long-term residential care facilities, starting with nursing homes, disability facilities and mental health facilities, so I hope and expect that the situation has improved. I will engage with the Mental Health Commission on that.

I am sure I will get a chance to comment further on non-Covid care later but we are looking at how we can safely resume non-Covid care alongside Covid care.

On the issue of funding, as a country, we are going to have to work our way through how we recognise the fact that many organisations which do superb work have seen a reduction in their funding but their services will be more important now than ever.

What is the medium-term outlook for the 2 million people who hold private health insurance in the country? That is a straight question. Many people have held private health insurance over a lifetime - 30 or 40 years in many cases.

The Minister might be in a position to comment on the guidelines for dentists.

A number of psychotherapists and counsellors have been in contact with me asking when they can begin to practise again. Can the Minister give a date for them?

Youth workers working in community settings, as part of drug task forces or with youth and community groups have not been considered essential workers as part of this crisis. That is a lesson we could all learn. When can they go back and interface with their clients?

I wanted to make one point that connects with the fact that society has made considerable sacrifices to protect the vulnerable, a good block of whom are elders. The great paradox is that having done that, the greater swathe of those who have succumbed to the virus are elderly people in congregated settings. The State mobilised an incredible cross-community effort in that regard and that same dynamism is going to be needed for the generation who face a trinity of calamities. The generation that has had to face the outcome of the financial crash and shoulder the burden of climate action will also have to deal with the outworkings of the consequences of the pandemic. The Minister might have a comment to make about where we, as a society, should go with that.

I will write to the Deputy about youth workers and I will liaise with the Department of Children and Youth Affairs, but he makes an important point.

Similarly, I will liaise directly with the representative bodies of mental health counsellors and the likes to try and provide guidance in that regard. It will all obviously come down to their ability to practise physical distancing safely. I know a number of counsellors have moved services online.

As to the future direction for private health and private health insurance in this country I have no doubt that it will always be a part of society.

That is the case even in a country like Britain where a national health service is in place. However, it is the clear policy direction of Sláintecare to try to create a universal healthcare system. In the medium term, I presume that will impact on people's decision as to whether they believe they need private health insurance. I am conscious, too, that a number of private health insurance companies have issued a rebate, recognising some of the changes in private hospital services to date.

I wish to raise the issue of women's healthcare. We learned this week that both BreastCheck and CervicalCheck were paused for the month of April. That is understandable in terms of the pandemic we find ourselves in, with the requirements for social distancing, PPE and all of that to be taken into consideration. Equally, we have to consider the thousands of women who have missed out on that all-important screening. Will the Minister outline to us today a comprehensive plan for how a catch-up will be carried out for the women who have missed out? In terms of figures, I understand no mammograms were done in April, as opposed to 13,000 in the same month last year. In the case of CervicalCheck, only a couple of hundred screenings were carried out, as opposed to 21,000 in April last year. In addition, we have heard reports of women waiting up to six months for their CervicalCheck screening result to come back. These are high-risk women and we do not want a repeat of what happened before with CervicalCheck. Will the Minister offer a response today that will give the women of Ireland some comfort in terms of how we are going to catch up with all of these missed screenings?

I cannot do the issue of screening justice in 22 seconds, but perhaps another Deputy will give me an opportunity to expand on it. I will respond to the Deputy in writing and I take very seriously the point she makes. The decision to pause screening was made on public health grounds and the decision as to when it is safe to commence it will also be taken on the same grounds. The truth is that it will probably mean doing screening in a different way in terms of making sure the protections are in place. The most important message I want to get out today is that screening is for people who do not have symptoms. If people do have any symptom, then my message, as I am sure the Deputy's will be, is for them to go forward today to their health services. A plan is being worked on by the national screening service and Dr. Colm Henry, the HSE's chief clinical officer, as to when it will be safe to resume screening.

On the issue of seconding staff from the HSE into the private nursing home sector and the long-term residential care sector, will the Minister give an update on how many staff have been seconded? Last week I spoke to him about the need to put geriatricians and geriatric consultants in place, which he agreed was a good idea. The response from the HSE tells me this is not happening and that staff are visiting but not actually being seconded to work in a more permanent capacity. Will the Minister address that because I still think seconding is a good idea?

Will the Minister indicate what testing system is in place for people being transferred on discharge from hospital into nursing homes? A young man contacted my office yesterday whose mother tested positive for Covid-19 and was treated in hospital before, thankfully, becoming well enough to be released. However, she was not tested again before being returned to her nursing home. I ask the Minister again, and I would like a fairly short answer, whether or not - and, if so, when - the system of two tests before transfer started. I know it did not start at the very beginning of the crisis. My belief, as I have said previously to the Minister, is that an opportunity was missed in this regard. I am concerned that the two tests which should be happening, as was previously advised to me, are not actually happening in hospital prior to patients' transfer back to a nursing home.

I want to ask about the details of the catch-up programme for BreastCheck, CervicalCheck and BowelScreen. We know that thousands of those screenings have been missed. That was done for good reason and we fully accept the public health measure. However, there needs to be a catch-up programme, not just when the services restart but in such a way that it will catch those women who were due to have a smear test or mammogram in the normal course of things. We are also hearing from people that they are waiting months to get their screening results back, and again that will cause problems. I want to hear from the Minister whether the capacity has been sourced or will it be sourced to ensure there is not another backlog and we do not end up back where we were.

Will the Minister comment, if he can, on the letter that was issued by the local department of public health to residents in direct provision in the Skellig Star Hotel in Kerry? These residents are unable to follow social distancing requirements because they are all squashed in together and it is physically impossible to do so. The letter issued by the local department of public health, which I am sure the Minister is aware of as it got extensive media coverage, advised the people in direct provision that it was basically their own fault that they had contracted the virus. That is just not acceptable.

Last Friday, the Government announced a €35 million Covid-19 stability scheme for the wider community and voluntary sector.

Many in the sector have raised concerns that the grant size of between €20,000 and €100,000 is too small for some organisations. Some of those organisations are very large and provide a lot of services. The Minister will be familiar with them. Will he commit to engaging with stakeholders in the community and voluntary sector around grant size to ensure sufficient money is provided through grants to ensure continuity of service?

I will accept an answer to my next question in writing if the Minister can give it to me. What arrangements are in place for home helps to access PPE? People have contacted my office about this. I have spoken to those living in my area who I have bumped into, at a social distance, about this. In some instances they have been told that they do not need PPE and can just wash their hands. That is not acceptable. I spoke about this a couple of weeks ago. Many elderly people need home help, but are afraid to let those who provide it into their homes. It would help if these workers had access to PPE. Many, because of ideological reasons on the part of previous Governments, work for private companies and are not employed by the State, but they deserve State protection. I would like to hear the thoughts of the Minister on that.

I will give the Deputy the latest figures I have for nursing home staff overall and then I will break them down for the private sector. The number of staff redeployed from the health service to long-term residential care facilities is 451, comprising 394 redeployed from the community and a further 57 redeployed from private nursing homes. In respect of private nursing homes, approximately 100 public staff have been redeployed from community settings to private nursing homes and a further 57 have been redeployed from acute hospitals to private nursing homes, making a total of 157. I am not sure that the two figures fully align.

The Deputy has raised the issue of discharges for some time. I will refer to the current relevant guidelines for discharge from hospitals to residential facilities. They are the interim public health and infection prevention and control guidelines on the prevention and management of Covid-19 cases and outbreaks in residential care facilities and similar units. The HPSC does a lot of things well, but snappy titles is not one of them.

On 10 March, the HSE issued preliminary guidance on the transfer of hospitalised patients from acute hospitals to residential care facilities in the context of the epidemic as it was then. The guidance included a number of procedures to be followed. For example, patients with Covid-19 should not be transferred to a long-term residential care facility until they had two consecutive tests indicating virus not detected. Patients who were symptomatic and contacts of a confirmed Covid case should be transferred only if the person had a test indicating the virus not detected and it was possible for the person to be isolated for the relevant incubation period. Patients who were asymptomatic and were contacts of a confirmed Covid case should transfer only if it was possible for the person to be isolated for the relevant incubation period and transfers from hospital with no evidence of the spread of Covid-19 should proceed as normal except for patients with respiratory tract infection meeting the then criteria for Covid-19 testing. In these cases, testing should be carried out on the result of the virus not detected before transfer. There is quite a lot in that, so I will put it in writing for the Deputy.

I heard the Deputy's comments on the national screening service during the week and I accept her bona fides in terms of what she wants to do. I am obviously not going to make decisions on the floor of the House on catch-up programmes and the like. The Deputy is not asking me to do so. It is really important that we follow the clinical and expert advice in this regard. Dr. Colm Henry, chief clinical officer with the HSE, is leading this. I spoke with the chief executive officer of the HSE, Mr. Paul Reid, yesterday about this matter. They are examining how to reintroduce screening in a safe way and at what point it should recommence. We note that screening has paused in Northern Ireland, Scotland, England and Wales and, I understand, in New Zealand and many other countries. The national screening service is participating in a national process, led jointly by Dr. Colm Henry and Ms Anne O'Connor, the chief operating officer, to restore health services safely. They are developing and updating their plans to restart the four screening programmes. They have confirmed that all four screening programmes are working on systems to invite people back for screening on a priority basis.

As the Deputy knows, it is important to say that not all screening services will come back at the same point in time because they are different, as she said. Dr. Colm Henry speaks about this much better than I do but, for example, the physical contact required for something like a mobile breast cancer unit for some screening-----

I understand that.

We need to prioritise those who are symptomatic, in the first instance, and get that message out.

I will write to the Deputy about the issue of home help and PPE. I have had a good engagement with the sector. I have had, perhaps, a different experience from that of the Deputy, but I will write to her about it. I am happy to engage with the sector on the €35 million scheme. I will write to her about the direct provision letter.

I am going to speak for two minutes and then leave two minutes for the Minister to respond. We all saw the generous support of the Irish public for Pieta House last weekend, with the big fundraiser on "The Late Late Show". Like many others in the House, I supported that charity last week. I was concerned to discover, however, that Pieta House had introduced redundancies for clinical workers prior to that fundraiser.

At a time when people's mental health is being adversely affected by the pandemic, what is the Government doing to help Pieta House retain these clinical support workers and how will the Government fill the void in mental health support created by these redundancies? The HSE funds Pieta House to the tune of €2 million per year. What, if any, discussions has the Minister's Department had with Pieta House regarding future provision of the service?

There is a bigger issue, however. If people trusted the Government to provide a comprehensive mental health service to begin with, there would be no need for Pieta House or other charities to plug the gaps. Being so dependent on charities to provide services that the State should be providing is a failure of this Government. Covid-19, as has already been mentioned, has seen an upsurge in people looking to avail of mental health supports and the longer this goes on, the bigger will be the demand for these services. Time, unfortunately, does not permit me to debate written responses I received from the Minister during the week on issues I had raised previously in this House. Will the Minister, therefore, support the reconvening of the Oireachtas Joint Committee on Future of Mental Health Care? Will he also support a special sitting of the Dáil in respect of mental health? We need a change in how mental health services have been provided in recent years.

I thank Deputy Ward for raising these issues. As he definitely knows, what committees are convened is definitely not a call for me or the Government, but I see no issue with his request. I think the Deputy's idea of a special sitting on the issue of mental health is a really good one. I do not want to use up the Deputy's time, but he asked me to engage with Jigsaw regarding Clondalkin. I had a very good engagement on that issue, and I will write to the Deputy, if I have not already.

The Minister replied to me on the other two issues, but as regards Jigsaw.

I will engage further with Deputy Ward on that issue.

I thank the Minister.

Pieta House does amazing work. I saw the recognition of that amazing work by the people of Ireland in their generosity last week through "The Late Late Show" fundraiser. Deputy Ward is asking, rightly, what the Government is going to do to match, or at least recognise, the incredible work Pieta House does. I am pleased to inform the Deputy that, in addition to the continuation of the existing HSE funding of some €2.03 million per year, as he rightly stated, the HSE and Pieta House have now formally agreed to additional funding of €114,608 per month, which is equivalent to €343,824 per quarter. Once the current Government staffing cost schemes, of which Pieta House is availing, have ceased, the HSE is committed to providing cash flow support monthly, with the position to be reviewed after each quarter. The funding is being provided to fund an additional 300 hours of high-risk clients, and a quarterly review will ensure that any client who commences a programme of support can have a reasonable assurance of its completion. The cash flow support is also contingent on the continuation of the process of engagement with the HSE to work towards creating a sustainable funding model for the organisation. This arrangement, therefore, will provide the necessary support to Pieta House as it and the HSE continue to work together. I hope that is some good news and that it will be of great assistance to many.

Mental Health Reform has indicated that the Covid-19 pandemic is leading to a surge in mental health issues and a recent report by the mental health department of the World Health Organization, WHO, to the UN stated that, "the world could expect to see an upsurge in the severity of mental illness, including amongst children, young people and healthcare workers". The report continued by stating, “The mental health and well-being of whole societies have been severely impacted by this crisis and are a priority to be addressed urgently.”

The mental health consequences of the lockdown and the well-being of individuals, particularly among the elderly who have to cocoon in their own homes as well as in nursing homes, will be a major factor in the increasing demands on services. The lack of contact for many elderly people with their families and friends is particularly devastating, and has made their isolation a greater burden for them to bear. It has been recognized that, in general, older people are especially vulnerable to loneliness and social isolation, which contributes to a downward spiral in their morale and mental well-being. This enforced isolation is causing even greater loneliness for many elderly people as they do not have the means to alleviate this loneliness by meeting friends and family or participating in social activities.

This is just one aspect of the types of mental health issues arising during this crisis. Those working on the front line of this pandemic are under greater stresses and pressures with regard to their mental health.

Service users or those trying to access mental health services are struggling to avail of those services that were previously available. How they utilise such services has changed substantially in this crisis as they cannot be counselled on a face-to-face basis. This is having a considerable effect on their mental well-being and ability to cope.

Anecdotally, I have been made aware of an increase in both suicidal ideation as well as deaths by suicide. I have also been told that there appears to have been little or no recruitment of peer-support workers, psychiatric nurses or psychiatric consultants, or putting in place of outreach services to address the increase in demand expected for such services and facilities. Under A Vision For Change, this was meant to have happened. This crisis makes it even more urgent. What are the Minister's plans to rectify this gaping hole in mental health services, what is the present situation in regards to recruitment and how many volunteers have been utilised from the 40,000 plus who signed up?

I thank the Deputy for raising important mental health matters. I particularly thank him for acknowledging that when we rightly talk about mental health the impact of this pandemic on people across the age spectrum, including older people, is, indeed, a major priority.

I would like the new Government to publish within its first month in office the A Vision for Change roadmap. I would like the House to convene whatever is the appropriate mechanism to make sure that we get on with implementing that document. That is a key step. I met Mental Health Reform, the organisation the Deputy referenced. It was their priority that we would see the A Vision for Change roadmap published and the structures we put in place in this House would arise from that. Truthfully, I do not have an answer in terms of how many volunteers and I suggest that I will correspond with the Deputy on that.

Regarding child and adolescent mental health services, CAMHS, 90% of mental health needs are being successfully treated in the primary care setting with less than 10% referred to our specialist mental health services. We have thankfully seen a reduction in the mental health waiting list for CAMHS but in the interest of time, I will send the Deputy a full breakdown on all the information I have.

I am sharing time with Deputy Feighan.

First, like everyone else, I sympathise with the families of the mothers, fathers, brothers, sisters or whoever who have lost their lives through Covid-19.

I will take up an issue in Limerick, which I represent. The Minister will be fully aware that we have had a capacity issue over a long time in University Hospital Limerick. Over the past week, the numbers presenting on trolleys are out of line with other areas in the country; on average, there was 28 over the past week. Today, there are 42 - 22 on trolleys and 20 not quite on corridors but in isolated areas. Nevertheless, there is a capacity issue. A 60-bed unit is being built. A total of 24 beds are being provided under the Minister's initiative relating to the Covid-19 response UHL, with a further 24 beds in Croom orthopaedic hospital. He might give an update as to when he expects that they will come into operation. People are beginning to present with non-Covid-19 issues. This is becoming a significant issue for us, particularly in Limerick and the mid-west. It is something I feel strongly about. I have been campaigning for additional beds for many years. The Minister might give a perspective on the status of the 60 beds. More acutely, where are the 48 beds for UHL and Croom? They are to come on stream as part of the Covid-19 response.

More generally, many businesses are looking to reopen but they want to open safely. Public health has very much taken up the area of public health safety. I commend the Government on how it dealt with containing the virus but as we move into a phase where we will be living with this coronavirus for a period, how do we manage it?

What changes to the dynamic does the Minister foresee in public health in terms of proactively advising on reopening businesses in a safe manner, taking the need to control the virus into account? The virus will be there. We need to get people back to work and back to normal life, get children back to school and so forth. Perhaps the Minister might address that. I also ask him to deal specifically with University Hospital Limerick, where today 42 people are on trolleys.

I thank Deputy O'Donnell for the questions and for raising the issue of capacity in University Hospital Limerick, as he has done for many a year. I note his comments about people waiting in the emergency department, ED. From my own recollection of visiting that hospital and its relatively new ED, my understanding is that sometimes the most appropriate place might be to isolate someone within the ED, where there may be a single isolation room or the likes available. I will certainly ask for a report on the issue and work with the HSE and hospital management to do anything we can to support them. In many ways the Deputy's question highlights the need to keep the capacity we have our private hospital facilities, at least in the short term. I am conscious of the fact that there is a private facility in Limerick as well. Having that extra capacity will be crucial in the short term as we try to bring on more capacity in the public health service. I went with the Deputy to look at the 60-bed extension at University Hospital Limerick, which must be nearly completed by now. I know that was due to open later this year. I will certainly get the Deputy an update on that and on the 48 beds.

We are going to have to provide health services in a different way. People talk about resuming non-Covid-19 care. I do not think anyone means this, but it is not just a matter of switching it back on as it was. It is going to have to be about doing things in a very different way. We cannot go back to having packed emergency departments and outpatient waiting rooms when we are trying to minimise the spread of infection and allow infection control. This will mean more testing in hospitals for patients and staff, more protective equipment, better scheduling of appointments and trying to do more with telemedicine, as we have seen. It may also mean a continuing enhanced role for initiatives like the community assessment hubs that have opened across the country.

The Deputy's broader question was about how we can get our country open while keeping people safe. There are a couple of points here. The protocol launched last week showed how a safe workplace can operate. That is a framework, not a static document. It is very helpful. It is an agreement between employers, unions and the Government on what needs to be done. It is enforceable. If a business wants to open, it has to be able to abide by it. That protects employees as well. I refer also to testing and tracing. This will mean that if a cluster of cases or an outbreak does occur, a possibility the Deputy raised with me in this House last week, we can very quickly get on top of it. The third point is as important, if not the most important. It concerns individual behaviour. We have to make sure that we as citizens continue to practice a good public health response so that we can limit the spread of the virus.

Our thoughts are with the families and friends of all those who, unfortunately, have passed during this crisis. I hope that we can all work together to mitigate the issues around this crisis.

Last week I raised with the Minister personally the challenges faced during this crisis by members of the Irish Dental Association. One of the many challenges concerns the availability and affordability of personal protective equipment. Dentists are competing with so many different groups and are finding it very difficult. The Minister said he would meet with the organisation. How did that meeting go? Can he share the outcome with us? Was it successful?

Second, businesses such as hairdressers, hotels, pubs and restaurants will have to make a lot of decisions to comply with the public health regulations. This will require advance planning and these industries will need much clearer information than what is set out in the road map. I understand that it will be very difficult to give clear information, but I noticed something today when I was in a service station to get a coffee on the way to Dublin from the north west. No matter what I did, I found it very difficult to maintain a 2 m distance from other people. Seemingly, only 1.5 m is required in Germany. Perhaps we can reduce that distance a little bit. That is up to the experts, not me, but if the requirement in Germany is 1.5 m perhaps it is time to look at that. It is going to be very difficult to bring some of the businesses back together. Perhaps 1.5 m is not enough either or perhaps it is time to reduce that 2 m. Again, that is up to the experts.

I thank the Deputy for raising these matters. I had an excellent meeting with the Irish Dental Association last week. I was hoping to meet its representatives again today but the meeting had to be moved to tomorrow. They raised three issues. A lot of the dentists need funding to get their business back up and running. I discussed with them some of the supports announced by the Department of Business, Enterprise and Innovation relating to adaptations, rates and so on, and I have undertaken to write to the association about that. I talked to dentists about linking them in with the HSE. I know some dental practices have been receiving PPE. As the Deputy rightly said, they were not asking us to give them PPE, but they were wondering whether there was a way to secure it at an affordable rate. I am hopeful that we can make some progress on that tomorrow when we engage.

The most important issue they wanted to ask me about was the expert advice. They want to reopen, we want them to reopen, and the question is how we can do it safely. We asked the expert advisory group to NPHET to provide specific, bespoke advice about how a dental practice can reopen in a safe manner. I hope to have that for them tomorrow and if not then, then certainly early next week.

On some of the points that the Deputy made about complying, it will be difficult for all of us to comply and live alongside the virus. I hear different stakeholders on the radio every morning telling us how difficult it will be. I know it will be difficult. We will all have to work and live in a different way alongside this virus. The WHO could not be clearer in that regard. That means we will have to support people. In the first instance, sectors will have to come forward to their line Department, such as the Departments of Agriculture, Food and the Marine or Transport, Tourism and Sport, with their proposals and ideas, and where necessary, if they want to seek advice from the NPHET, that Department can do so. Our roadmap is iterative. It is not a finished document or the final word on the matter. We will continue to engage with everybody in the country about how we make a success of it.

With regard to the WHO recommendations, we continue to recommend two metres. There are different schools of thought on this but we believe that 2 m at least is important to stop the spread of the germs from one person to the next.

I have four questions for the Minister on behalf of the Green Party, about testing, tracing, isolation and funding for our community and voluntary sector. We all agree that being innovative and effective in each of these areas is key to our continued success in suppressing Covid-19.

There has been a lot of discussion, including in this House, about testing capacity, volume and turnaround time. I would like to discuss how we can increase our testing capacity and reduce our wait times by considering alternative testing technologies. I note that for all our testing to date, we have used the highly sensitive and specific RT-PCR technique. This is very accurate but it is laboratory-based and, as we have seen, it takes time, especially when sent to Germany for processing. In order to reopen workplaces and be able to handle possible subsequent surges of Covid, we need more and more rapid testing options. Ideally, these could be processed in doctors' offices or in front-line clinical facilities rather than in laboratories. Amazon has announced that it intends to build testing facilities for its employees and I am sure that other employers will follow suit.

At NPHET's request, HIQA completed an excellent report, published on 17 April, on the rapid assessment of alternative diagnostic technologies for the detection of SARS-CoV-2. This report considered, but for now rejected, so-called rapid antigen tests for Covid-19 until their efficacy is more widely proven. On 8 May, the US Food and Drug Administration, FDA, approved just such a rapid antigen test, which gives a result in ten minutes via a non-laboratory based test. This will enable the US to double its testing capacity within the next month. It has been described by leading US health experts as a game changer. In Ireland, this kind of testing could be used directly in settings such as nursing homes and potentially also larger workplaces, offering a real-time view of likely or probable infection, and saving valuable time for vulnerable people. We understand that these alternative forms of testing have less accuracy than RT-PCR. In the case of rapid antigen testing, it is approximately 85% accurate but gives very few false positives. However, the need for more and more rapid testing is so great that we need to re-evaluate constantly the risk calculus around different forms of testing.

In light of the FDA's recent approval of this approach, will the Minister ask NPHET and HIQA to look again at the possibility of endorsing rapid antigen testing?

My second question relates to tracing. In recent days, as our focus has turned to reopening, we have seen renewed scrutiny of our end-to-end times for testing and tracing and we clearly continue to be challenged in this regard. We continue to look forward to seeing and to discussing the Covid tracker app's data protection impact assessment, DPIA, technical specifications and source code and we would welcome any updates in that regard. I note that the publication last week by the National Health Service in the UK of the DPIA for its app has facilitated a healthy debate in the UK about the trade-offs between privacy and public health. I would like to focus today not on the app, but on the contact tracing back office and whether and how we can use technology there to complement the Covid tracker app. Once an individual has tested positive, he or she is engaged by our contact tracing operatives to find out who else he or she might have infected. According to recent reports by the HSE and in the media, this process can be slow, especially in complex cases. Several European jurisdictions, including to my specific knowledge, the Czech Republic, have rolled out computer systems designed to help automate and accelerate that process. These systems use, with an individual's consent, more detailed location and banking data to help jog a person's memory of his or her movements and develop a more complete picture of the possible infective contacts. Early experience in the Czech Republic is that this approach has greatly helped with the speed and quality of contact tracing and they are ready and willing to share their system with other countries. Is any purpose-built technology currently being used by our contact tracing teams and, if not, will the Minister ask the appropriate part of the HSE to investigate such technology?

My third question relates to isolation. We saw reports last week that up to one third of arriving passengers at Dublin Airport were refusing to provide contact information, as requested on the arrival form. We understand that further regulations will be introduced to make this information compulsory. The other side of this topic is the question of whether arrivals are actually self-isolating. Will the Minister tell us how many checks have been carried out to verify that arrivals are self-isolating, what form the checks take and what level of compliance was seen in the checks? We do understand that expecting gardaí physically to visit every person who arrives during a putative two-week quarantine is impractical. Given that we have increasing test bandwidth available, and noting that just 113 people arrived at Dublin Airport this Monday, should we not mandatorily test all arrivals at our airports? Any positive results could then be handled and contact traced in the normal manner. If we used rapid antigen testing, results could be received before visitors are allowed to leave the airport. Will the Minister recommend mandatory testing of arriving passengers at all Irish airports?

On Friday last, the Government announced a €35 million Covid-19 stability scheme for the wider community and voluntary sector. However, at the same time, it is pushing ahead with a 1% cut in the HSE's 2020 disability services budget, which announced a €20 million cut. This is at a time when public funding for disability organisations has largely dried up due to the inability to fundraise during Covid-19 and at a time when the funding recommendations of the Government's own report, the Catherine Day report, are largely not implemented. Is there a plan to reinstate funding for the community and voluntary sector at the appropriate level?

I will try to get through each of the Deputy's questions. Regarding testing, the HSE has done an incredible job, moving heaven and earth to get to the point now where it will have the capacity to do up to 100,000 tests a week. Today, the HSE announced a plan for how, from next week, it intends to have end-to-end referral to contact tracing completion in less than three days in 90% of positive cases. That is a truthful acknowledgement that in the remainder of cases there could be some more complex contact tracing and management. It also intends to have the target swab-to-result in less than two days, which would take account of the majority of cases which, thankfully, are negative. Currently, 97% of tests that have been taken are negative. This is an area that we want to continue to be scrutinised. I am aware the Covid committee will look at this next week.

In terms of more rapid testing, that could really be a game-changer. Deputy Leddin is correct; we were one of the first countries in the European Union to carry out a massive health technology assessment and to publish it. I know it was seen as useful not just in this country but also among other regulators that did not recommend one currently, but it is constantly under review.

The short answer is "yes". I will ask that it continue to be reviewed but I know it is already happening. There are two parts to my answer on the issue of tracing. I reiterate that it is my intention to publish the source code and data protection impact assessment, DPIA, for the app before it is launched. I will also ask if there is any further purpose-built technology which could be used in the back office to speed up contact tracing. Automation is seen as having the potential to shave further time off the process.

With regard to isolation and airports, the Deputy is right; this issue will become bigger and bigger as countries start to reopen. It is a relatively small issue at the moment. Approximately 3% of cases of Covid in Ireland have come through travel. One is much more likely to get it in the community but that is because there is not really any travel happening. As travel begins to recommence we will need to have very robust protections in place. I intend to see the passenger locator form put on a regulatory footing. That will be a matter for Government and I hope we can consider it in the coming days. It is my personal view that self-isolation should also be regulated and made mandatory. That is not the case today so I do not have the figures for which the Deputy asked. I will see if the border management unit has any.

We do not currently envisage testing at airports for some of the reasons the Deputy outlined with regard to the current testing process. That could be reviewed should a quicker test become available.

With regard to funding, not long before the last Dáil was dissolved for the general election we set up a group chaired by Peter Cassells to begin work and engagement between the voluntary sector and the State with regard to the Catherine Day report. As I have said in the House, I do not believe that 1% efficiency saving will be achievable in 2020 in the current context. I intend to engage with the sector including the Disability Action Coalition, which Deputy Shortall asked me to meet. I have a meeting scheduled with that group for early next week.

I have two groups of questions. Perhaps we will divide them and spend five minutes on each. The Minister will not be surprised that my first set of questions relates to the famous letters I have been requesting for three and a half weeks and which I now have. They are explosive. I can see why the Minister did not want to publish them and why I had to keep asking for them. They would have been revealed one way or the other because I had asked a parliamentary question in respect of them and half a dozen freedom of information requests had also been made in that regard. They come to the nub of the governance issues about which I have previously asked. In his letter of 23 March Paul Reid flagged to the Minister that "the Board is understandably concerned that its statutory governance role is respected." The most explosive letter is dated 19 April, when the CMO had announced that 15,000 tests a day or 100,000 tests a week were going to be delivered pretty quickly even though it had been said it would be delivered a month earlier based on the view of Dr. Cillian de Gascun. In this letter Mr. Reid says:

Regrettably, I was taken very much by surprise by Dr Holohan’s letter of 17 April 2020 [which I believe was the night he appeared on the "Late Late Show"] and also by the NPHET press conference which preceded the letter arriving. The directions as set out in the above letter and press conference are at odds with the process that we have been jointly engaged in at both the Government Cabinet Committee and in subsequent meetings with Secretary General Fraser. They are also at odds with the process in place with the HSE Board.

Worryingly, he also says that he is "extremely disappointed that these understandings appear not to have been respected." The CEO of the HSE wrote to the Secretary General of the Department of Health basically to say that the process that had been put in place through a Cabinet sub-committee and the board of the HSE was not being respected by the National Public Health Emergency Team, NPHET. Despite this, we have heard denials from the Minister, the Taoiseach and the CMO that any tensions existed. The chair of the HSE wrote to the Minister on 8 April, on 20 April and on 24 April. The Minister responded to him on 27 April. Given the crisis we are in, the period of time from 8 April to the 27 April is pretty significant.

I have real concerns about governance. Why did the Minister deny that these tensions existed when we can now see, in black and white, that there were real issues, particularly in respect of the roll-out of testing? The CMO publicly announced a process different from that agreed by the board of the HSE, which has full authority in respect of governance. The Minister stands over policy and it stands over governance. This process had also been agreed through the Cabinet sub-committee.

Why was there not a concern that the CMO made this statement which was counter to that? Why was the Minister not concerned about it?

Will the Minister outline to the House and provide the documentation regarding the appointment of everybody to NPHET? The Minister is over NPHET. The line structure stated by the Taoiseach is that it reports to the Minister. Obviously, there must be documentary evidence regarding how people are appointed to NPHET. I ask the Minister to provide that to us in respect of all those people - some very fine people. Will the Minister also explain to the House why in any form of good governance minutes are not agreed at the beginning of each meeting and then published?

I thank Deputy Kelly for the questions. I particularly thank him for acknowledging that many of the people on NPHET - I would go so far as to say all of the people on NPHET - are very fine people. They have done an incredible job in helping us save thousands of lives. I know how hard Deputy Kelly works and I know how hard I work. I have seen how incredibly hard these people work. About 20 of them have the word "doctor" in front of their names. They are working flat-out providing public health advice. I am very proud that we live in a country where we have not played party politics with people's health, and Deputy Kelly has not either. We do not need to look very far to see a very different approach being taken.

The National Public Health Emergency Team is chaired by Dr. Tony Holohan, the Chief Medical Officer. He gives public health advice; the Government makes decisions. I want to answer the Deputy's question directly. It is not just a body with the Chief Medical Officer and a few people from the Department. While I am open to correction, I think there are also nine members of the HSE on that. If the HSE wants to put another nine people on it tomorrow, that is also fine; it knows that very clearly. It is a collaborative body where we bring experts from the HSE, the Department of Health, HIQA and the Health Products Regulatory Authority, HPRA, together along with a few external people like Dr. Mary Favier, an ICU consultant, to advise Government.

The Deputy is right about the minutes; they should be published. They are now being published. The Deputy would like to see them published quicker, which is also a fair point. They are now being published.

They are six weeks behind.

I do not think the letters are explosive. The letters show people working extraordinarily hard in real time. I said on a Saturday at a press conference that there is, of course, tension. I have been Minister for Health for four years and Deputy Kelly has been in Cabinet. When has there never been back and forth between officials working their backsides off to try to save people's lives in a global pandemic? However, what have they done is to have achieved their target.

The letters should not be selectively quoted from because all of the letters are published. There are letters where the chairman of the HSE writes to the Secretary General conveying his admiration for the extraordinary work that is being accomplished, and it is stated that it is reassuring to know that we are approaching this crucial endeavour with mutual understanding. I think the process is better as a result of the engagement of the HSE and the Department on process, but it is a matter of process. I am very satisfied that NPHET is working extremely well with the HSE. I do not think we have ever had better leadership of the health service than we have with Paul Reid and Ciarán Devane chairing the board. If there is any further documentation I can publish, of course we will. I understand the CEO, the CMO and the Secretary General will appear before the Covid committee in this Chamber on Tuesday.

The Minister might produce the documentation I requested as regards the approval process for people.

The simple fact of the matter is that the Minister is still denying that in this process there is a governance process. There is the Government, there is the Minister, there is the board of the HSE and there is NPHET. A process was agreed as regards testing by the HSE through the Cabinet sub-committee. Then it went outside that process and was announced. That is essentially what these letters, in black and white for everyone to read, are saying. I agree with the Minister that the process has improved, but what I have just described should not happen. Surely the Minister would acknowledge that was an error and should not have happened in that way. It took an awful lot for a CEO and a chairperson to write letters like that to the Department.

I will run through my further questions. When will the Minister honour the pay agreements to all the nurses? I raised this with the Taoiseach.

How will the Minister proceed with Dealgan House? This is an extraordinary issue over which I have deep concerns and I have spoken to people about it. How will what happened there be investigated?

When will we have a date for screening? I will not hold the Minister to it. He knows how passionate I am about this whole area. When will we ensure we have dates because people are very worried about this?

When it comes to the whole plan for non-Covid health services, how will the Minister ensure that the remobilisation of our health services happens?

The biggest error in the roadmap published by the Taoiseach is that there was no roadmap for the health services. How is the pendulum swing between Covid deaths and non-Covid preventable deaths being measured? We are now in a Covid world, for want of a better phrase. People's behaviour has changed and so has the capacity of the health service. We need to move into another phase. How will we do so? How will the Minister manage issues such as the scheduling of appointments and distribution of resources? Stating that the facility in Citywest will be used to provide 1,300 new beds and University Hospital Limerick will be used in the manner proposed will not work. What is the Government's plan in that regard?

All those in the HSE, NPHET and the Department of Health who have been working on the Covid pandemic are patriots and represent the very best of public service but they are not infallible. None of us is. There are always ways to improve processes. There is back and forth between officials to ensure we get the right outcome, but that does not give credence to a conspiracy theory about there being negative tension. I am not suggesting Deputy Kelly believes that is the case. Rather, it means that experts in the HSE and the Department of Health are trying to achieve the best outcome. Everyone agreed that we need to carry out 100,000 tests per week. The question being asked by the HSE related to it wanting to ensure it could operate-----

Why make an announcement that-----

NPHET announces what it believes needs to happen on a public health basis. It does so all the time. It announces what it believes needs to be done and asks the other organisations to do it. NPHET is not Dr. Tony Holohan's outfit. He chairs the team but there are nine members of the HSE on it. Nothing is perfect, but it works well.

On nurses, my understanding is the number of nurses on enhanced contracts has gone from 3,200 when I spoke in the House on this issue last month to 4,500. Deputy Kelly is correct that the money is there and there should not be a blockage. The process needs to be sped up further.

The Minister can sign an order to ensure-----

I can make a direction under section 10 but from my conversations with the HSE I do not think that is required.

On Dealgan House, my understanding is that HIQA is due to inspect it. I will not be found wanting in taking further action if required. I am happy to discuss the matter with the Deputy.

On the issue of screening, I am awaiting advice from Dr. Colm Henry on how and when it will be safe to proceed and I will provide a timeline at that stage.

These sessions work very well. Many questions are asked and many answers are provided. I hope the Minister will answer all the questions I have for him today.

In his opening comments he correctly praised the Irish people for all they have done to flatten the curve and control the virus. The problem lies elsewhere. Unfortunately, the side of the deal which involves having a testing and tracing system in place with a fast turnaround of the tests at the scale required has not been kept. All we can do is keep our fingers crossed that by next Monday the long-promised arrangements and end-to-end tracing at that scale and in a timely manner will be achieved. I hope that will be the case.

It has been very frustrating to try to get answers from the HSE and elsewhere on what is happening on testing and tracing. There is no reason for the secrecy. It is essential for the system to be transparent if people are to have confidence in it and know their sacrifices are being repaid. As such, will the Minister consider requesting that all of the data behind the figures on testing and tracing be made open source? In my view, there is no reason why that cannot be done. Journalists and Deputies have tried to get to the bottom of some of the answers we receive and are always told that the information is not to hand. Why are all of the data not made open source such that everybody can view and interrogate them?

Last weekend, Paul Reid stated that we need to spend €1 billion per year on PPE. That is a staggering figure - €250 million per quarter. It clearly sets out the timescale in question and the scale of what is required. The implications of the figure are enormous for the wider economy as well as the health budget. Will the Minister consider establishing a group to see how much of that PPE can be sourced locally? The capacity may not yet exist.

Why are we not looking at bringing all interests on board, SMEs and all industry interests to see whether we can start producing that here, not only to do it in a more cost-effective way but to have confidence in supply? Can the Minister set up a group to consider that and to establish whether we can source it domestically?

The third area concerns private hospitals. I note the points that have been made earlier and the fact that the Minister is talking about a roadmap for opening up the hospitals to non-Covid 19 cases. That should absolutely happen as quickly as possible. Can the Minister give an assurance that there will be a single list used for inpatient, outpatient and diagnostics in such a scenario? I agree with what the Minister is saying. It is very much in line with the Sláintecare principles that we should have a single-tier service that does not discriminate against people on the basis of ability to pay. Will the Minister give a guarantee that it will be done in that way? We should be able to get through lots of the backlog by scheduling that properly. Even in the awful event that there might be a second wave, it should still be possible to balance that. In that regard, given the way the people have co-operated on this huge addition in capacity, has the Minister given consideration to potentially not going back on that, that is, to keeping all of that capacity within the public service and jumping a couple of steps ahead in the implementation of Sláintecare? Has he given considerations to or had discussions on that? I really think he needs to do that.

I welcome the fact that the Minister will meet disability service providers within the next few days. While the funding being made available on an emergency basis is welcome, there is a limit on it of €100,000 per organisation. The National Council for the Blind of Ireland, NCBI, for example, is losing approximately €3 million through not being able to fundraise. It is a huge organisation that caters for approximately 8,000 people. It does not make sense and is not fair to have that kind of cap for some of those very large organisations. Will the Minister revisit that issue?

On the opening up of some sporting facilities from next week, Tennis Ireland is advising that people aged over 70 may not play tennis and there are many over 70s who cannot wait to get back onto the tennis court. Can the Minister clarify the guidance on that? The same applies to other sports such as golf. It would be helpful to have clarification on that.

Childcare is a major issue. The collapse of the scheme was absolutely predictable. Lots of people said from the start that it would never work, that childcare workers could not be sent into people's homes without all of the necessary regulations, safeguards and protection. My colleague, Deputy Whitmore, talked about the possibility of using public buildings. We have a network of schools in every area of the country, spacious buildings, covered by insurance, with play areas and all that kind of thing. Has the Minister given consideration to bringing together all of the interests there, including teachers' unions, childcare workers, SNAs and other interests, to see whether something can be done in schools? That is happening in the UK, for example. All children of front-line workers and children with special needs are being cared for in schools. What consideration, if any, has been given to that? Would the Minister consider bringing those representatives together while of course following the advice of the Chief Medical Officer?

Deputy Shortall is right about the partnership approach. There are things we need to do as a Government, a State and a health service. There are things people are doing very well. We desperately want to get what we are doing right. The Deputy acknowledges that. People are trying to do everything humanly possible to get our testing and tracing to where it needs to be. The commitments given by the HSE today were significant in that regard. I welcome the Deputy's comments on the Covid-19 committee to the effect that it will not become a party political group but is more focused on trying to get the information, get the answers and apply that focus..

The Deputy is correct that the more data that can be shared open source, the better. I have no difficulty with that and will talk to Paul Reid in advance of his attendance at the committee to see how much can be achieve on that.

On testing, the Deputy will be interested to know that following a request from NPHET, the HSE and the Health Protection Surveillance Centre will proceed with plans to undertake a population zero prevalence study. It is intended to submit an application to the national Covid-19 research ethics committee later this week and, subject to ethics approval and completion of a clinical validation of a suitable antibody test, the aim is to start a zero prevalence study in the next four weeks. That could be of potential assistance.

The Deputy's comments on PPE make sense. We must secure whatever we can because speed is of the essence but considering the virus will be with us longer, and how we do things will change, we will need a big supply of PPE now and for the foreseeable future. I will speak to the Minister, Deputy Humphreys, to see how we can pull together the HSE and some of her agencies to see how we can support the economy in trying to benefit from that.

I have no intention of us at least temporarily owning private hospitals and having a situation whereby the taxpayers pay for them and not for public work. It just does not make any sense. There are issues around continuity of care from a medical ethics perspective but aside from continuity of care, I understand there will be a single list but I will write to the Deputy on this.

On capacity generally, Laura McGahey, leader of the Sláintecare office is analysing where Sláintecare stands - in a good sense - and what lessons can be learned out of the HSE board. We will consider capacity as part of that.

I take on board the Deputy's point about the limitations of the funding scheme for disability services. I will return to her on that.

On opening up for the over 70s, I heard the same as her about tennis and it did sound rather peculiar. I will seek the advice of NPHET on how cocooning - which again, is a phrase I do not like using - may evolve as we move forward in the plan.

On childcare and schools, the reopening of both will be key. I will be happy to meet Deputy Whitmore or to get the Minister, Katherine Zappone, to engage with her to see if it is possible to bring stakeholders together.

Could we have the guidance on the Tennis Ireland directions by Monday? Can we have them in the next couple of days so people are clear about them?

I understand that as of now, NPHET's advice for the current phase is that those over 70 years should stay at home with the exception of exercise. The Deputy's question is whether that exercise be expanded to understand participating in some sports. I will ask that the Chief Medical Officer to comment on that as part of any decision that we will make tomorrow.

For clarity, I was not suggesting that the schools should reopen; I was saying that school buildings could be opened to use them for childcare.

I know the Deputy did not say that. I was just trying to make the point that the reopening of schools, crèches and childcare will be a massive body of work which we will have to get right over the summer months.

I am sharing time with Deputy Paul Murphy. I wish to press the Minister on the issue of public and private healthcare. Given that Covid-19 will be with us for the foreseeable future, any consideration of a return to the two-tier system is untenable. The Government needs to make up its mind. Fianna Fáil seems to be somewhat sitting on the fence and even hinting that we should go back to the two-tier system sooner rather than later. I want to push in the exact opposite direction and it should not be for a few months. We need Covid-19 care, Covid-19 surge capacity and to deal with the waiting list crisis and non-Covid-19 care. The only way that can be done is to integrate all healthcare capacity, public and private, into a single system. We need to grasp that nettle now and take the private hospitals fully into public ownership, not on the basis of paying huge sums in rent to billionaires who own them but taking them over fully. Will the Minister respond?

I must be very careful on the floor of the House as I am conscious that we are in an agreement between the Private Hospital Association and the HSE on the use of private hospitals for, in the first instance, a three-month period, which, from memory, runs to the end of June, with the opportunity to extend for a further month and then the opportunity after that of extending on a month-by-month basis with the agreement of both sides. We are not doing it to provide profit for anyone; it is being done on an open cost basis and will be subject to scrutiny by the Comptroller and Auditor General and the Committee of Public Accounts and so on. There is a clear understanding in the agreement that at the end of this month, there is a 30 day review period. I intend that the Department and HSE will use that time to review the arrangement, and there have been many suggestions and comments, and then to arrive at an informed viewpoint to engage with the Department of Public Expenditure and Reform and revert to the Government and the Oireachtas.

It is not my intention to take over the ownership of the private hospitals through this arrangement. It is my intention to try to keep the capacity at the level we require for the Covid-19 pandemic. The question Deputy Shortall asked about the future beyond that is in my view a question for the Sláintecare work being led by Laura McGahey.

I think we need to go further now. There was never a justification for a two-tier system. There has been a general acknowledgement with Sláintecare that that is the case. Now that we have the private healthcare capacity in our hands, why on earth would we go back? It does not make any sense. There is a problem with this contract because it is essentially rent to people who are making profit from health, whatever way one puts it. Why not take it directly under public control? That is the only way we can establish how much additional capacity we need but we certainly need significant additional ICU capacity generally and staffing levels across the healthcare system. Unless we have a single integrated system I do not see how we can even do that. The Minister also needs to respond to the INMO's demands in terms of pay parity for nurses with other healthcare workers, a big recruitment campaign and paying them the awards they were granted as a result of the industrial action. I would like to hear the Minister's response on that.

I have a final brief question although the Minister might not have time to answer. For a long time I have been asking about blood plasma therapy. There are trials going on and 500 people have signed up to donate plasma but the plasmapheresis machines in St. James's Hospital are currently sitting idle. I know that from somebody who went there and was told that by the staff. The results from blood plasma therapy are very good. If there are people who are willing to donate, why are we not collecting the plasma?

I will revert to the Deputy in writing on the plasma issue. On the enhanced nurse contract, I am pleased that the number of nurses on it now is 4,500 compared with 3,200 last month but I want us to ensure that every nurse who wants that enhanced nurse contract can get it quickly. I have been clear to the HSE in that regard.

Regarding nurses or other staff working in private hospitals, my understanding from the agreement is that they remain employees of that entity. I want to be clear on that. I want to create a universal health service. I want to create the Sláintecare health service but the reality is that we do not own the private hospitals. We have the use of those buildings for a period of time by agreement with the private hospital owners.

I know the Deputy would like to go further but I just want to put the factual position on the record of the House.

I have a very simple question and I would like a clear answer to it. According to the agreement with the private hospitals, last week they were to produce a full cost statement detailing the costs for the month of April. I asked last week if that would be published but I did not receive a response to that question. Will the Minister make this detailed breakdown of costs available to Deputies and the public? He has said, including today, that the model is an open book but, for that to mean anything, will he open the books for the public so that we can see exactly what we are paying for and try to get to the bottom of why we are paying four times as much per bed as the NHS is paying in its similar agreement with private hospitals?

I thank Deputy Murphy. I have written back to the Deputy on some of the questions he has asked in this regard. If I have not answered all of them, I am more than happy to; my office will come back to him as well.

Regarding the full cost statement, my understanding is that all of these will be analysed by independent firms of accountants who will give a view then in respect of ensuring that it is a cost book approach. The Committee of Public Accounts and the Comptroller and Auditor General are obviously welcome to have a role also. Whether the full cost statement will be published, I truthfully will have to liaise with my Department. I could imagine that there may well be information commercially sensitive to one entity in it but I will certainly have a conversation with the Department officials and revert to the Deputy.

This is the fourth time I have raised this question and got various answers but on the essence of publishing the information about the costs so we can establish why we are paying so much for the private hospitals, I am not getting an answer. I raised it once with the Taoiseach and three times with the Minister and, repeatedly, the phrase "open book" is used to explain it but I do not understand what "open book" means if the books are not actually open for people to be able to read them. I got a response yesterday from the Minister for Finance who refused to publish the final agreements with the individual private hospitals saying only that it could be considered but it may be "commercially sensitive". This is an issue of transparency when hundreds of millions of euro are being handed over to the private hospitals, including owners like Denis O'Brien and Larry Goodman.

We need the final agreements and the breakdown of costs to be published or this could prove to be another scandal in the making. I asked repeatedly if we are making payments, whether fees, interest or otherwise, to Denis O'Brien's Ragazza special purpose vehicle or other companies like the Goodman Group - companies which are registered in Luxembourg specifically to avoid paying tax on profits. The letter I received this morning from the Minister's office says that rent and interest that is a proper operating expense will be paid "regardless of who the ultimate beneficiary is". I read that as an admission that some of this money is going to companies in Luxembourg that are set up to avoid paying tax. Can the Minister confirm whether that is the case, and if so, how much is being paid? Will he publish the full cost breakdown in order that we can see for ourselves?

Respectfully, not everything can be a scandal. What we are trying to do here is make sure we have enough capacity in the Irish health service to deal with a wave that, thank God, has not arrived so far. I am very grateful for the fact that a number of privately owned hospitals reached a not-for-profit open-book cost-only arrangement with the State. There are a number of safeguards put into the agreement, including independent accountant's oversight. The normal scrutiny that applies to the spending of taxpayers' money applies here in relation to the role of the Comptroller and Auditor General and the most powerful and only constitutionally named committee of this House, that is, the Committee of Public Accounts. I have no doubt that Members such as the Deputy will ensure that oversight is exercised to the full extent.

I was clear in my letter to the Deputy that where fees or interest payments relate to the ongoing functioning of the hospital, they will be included in the costs, but intra-company payments are excluded and the rent and interest payments apply to pre-existing arrangements. Any rent or interest payment relating to the ongoing functioning of the hospital is to be paid under the agreement but intra-company arrangements will not. I am happy to continue considering the issue of the full cost statement. We have to be conscious of commercial sensitivity, which is a legitimate issue for any business.

I will quickly ask a separate question. Has the Minister considered the request by the Irish Council for Civil Liberties not to expand the Garda powers beyond 18 May? Rather than using these restrictions on civil liberties, the Garda should rely on the things that have an overwhelming impact, such as education, persuasion, etc.

The legislation passed by this House, which allows me to set regulations, is very clear in the statutory consultation process that I need to undergo, including liaising with people like the Chief Medical Officer and other relevant Ministers before making a decision to extend, renew or alter regulations. I will be going through that process. I share the Deputy's view that the people of this country have been incredible in their response. We are always of the view that regulations are something for the Garda to have in the exceptional and very rare circumstances in which it may need them and I think that is the way it has policed them.

I have been watching the handling of the Covid-19 infections within the meat industry over the last number of weeks. It gives me no pleasure to say that I am very seriously concerned by the manner in which this particular infection is being managed. I have a genuine fear that if the reopening of the economy continues next week, we could be looking at the resurgence of this virus. We have a serious problem within our meat plants, which should come as no surprise because this is a global problem that has sadly been replicated here in Ireland. Our response to this can at best be described as lethargic. There are now clusters of infection surrounding meat plants where the levels of infection within the plants themselves is up to one third or in some instances half of the workforce. This seriously brings into question the Covid protection measures implemented in these plants. Despite this, the Minister for Agriculture, Food and the Marine assured me here in the Dáil just two weeks ago that he was satisfied from the feedback from his officials in the meat plants that everything was being done to minimise the spread of this infection. What surprises me is that even though we had a problem in nursing homes because of delayed actions, the same was allowed to happen within our meat industry. Why did it take six weeks after the first infections in plants for screening of all staff to take place?

Why has it taken up to two weeks to return test results to some meat plant employees if there was no backlog with testing? Why were staff not instructed to self-isolate in the interim while awaiting those test results? Instead they returned to work the very next day into meat plants where public health doctors were concerned enough about the scale of infection to order testing of every employee. Because of this failure to self-isolate staff members who potentially showed no sign of infection, they could have been spreading the infection asymptomatically. This has resulted in a situation where the negative results issued to employees are worthless, as they could have become infected in the interim period by employees who were asymptomatically positive while awaiting test results. We have serious lessons to learn from the manner in which testing and the delivery of results have taken place in the meat plants.

This is also the case in nursing homes, where staff have been waiting up to three weeks for results. As these delays have seriously undermined the value of the screening process, will the Minister ensure that all residents and staff members are re-tested immediately and the results issued in a timely manner? This also needs to be done in meat plants and staff instructed to self-isolate until they have received a clear result.

The Deputy may have corresponded with me but I would very much welcome the details of those nursing homes. I will revert to him directly about that. I am holding twice weekly meetings with Nursing Homes Ireland and the HSE's national director leading on this with the specific aim of identifying any difficulties - be they in terms of PPE, testing and the like. I would be very happy to engage with the Deputy on that. Regarding when nursing home residents and staff and indeed many priority groups will be re-tested and the schedule for that, NPHET has asked the HSE to put in place a testing plan in that regard. I want to go back to nursing homes next week and be able to outline to them when they can expect further testing. I know a number of them are eager to do the testing themselves, which will further streamline the process rather than requiring the National Ambulance Service to go there, but I will engage directly with the Deputy about nursing homes.

I thank the Deputy for raising the issue of meat factories. As the Deputy knows, food production was deemed an essential service. It was also decided that where essential work cannot be carried out other than in a workplace setting such as in a meat plant, employers are required to have protocols in place for the protection of their employees. These protocols have been put in place. Examples could include things like protecting employee safety through the reduction of throughput rates at plants, the extension of operating hours and other safeguards such as the checking of temperatures of people entering plants, the provision of additional PPE, the use of Perspex screens and the provision of additional facilities to support physical distancing measures. Where cases of Covid-19 do arise, employers engage with the HSE. Typically, a local outbreak control team is set up. On foot of a number of clusters arising in meat plants, a national outbreak control team was established on Thursday, 7 May with further meetings planned. This group will oversee and co-ordinate the approach to Covid-19 outbreaks in meat plants in Ireland and as part of its output, it will issue guidance documents to all meat processing facilities.

The Deputy raises a very serious point. Approximately 250 veterinary and technical staff in the Department of Agriculture, Food and the Marine are involved in supervising and regulating the operations of 56 slaughter plants and a large number of meat processing plants. I know that the Minister for Agriculture, Food and the Marine, Deputy Creed, has had ongoing engagement with Meat Industry Ireland and that he met with it on 5 May. He acknowledged the efforts made to date but emphasised that the meat industry should proactively take any additional measures necessary to continue to mitigate the risk of Covid-19 for all workers. Regardless of whether it is an essential business or one that may open in the future, it has a very clear responsibility in terms of public health. Regardless of who is involved, what business he or she owns or how important it is deemed to be by society, NPHET and others issue public health guidance and it is the expectation that this guidance needs to be followed. The measures announced by the Minister for Business, Enterprise and Innovation the other day are very clear regarding the enforcement that can be taken if those measures are not in place.

The only conclusion I can come to is that the delays I have outlined to the Minister are being used to wallpaper over the gross system failures, particularly in contact tracing. We have been informed as public representatives by the HSE that people are being given results within a day of their return from the laboratory and those who are positive are being contacted directly by a health professional.

This is not happening and negative results are being long-fingered for days and possibly weeks. In fact, the system is so bad that employers are being directly provided with a list of test results and they are the ones informing employees as to whether they are positive or negative for Covid-19. Will the Minister now confirm that medical data are being shared with employers before employees and explain to me why this is happening? Can I also say to the Minister that, if he thinks the initial communication of test results is bad, the follow-up contact tracing is, at best, intermittent and from my experience is failing fundamentally.

We need to be clear and honest about this pandemic. There is no doubt that there are always areas in which we must continue to improve but the difference between this Government and others in different jurisdictions is that, when the challenge gets difficult, we do not walk away. In many countries, one would not get a test for Covid-19 unless one was in a hospital setting. Many countries are not doing community testing or recording what we are recording. We are proactively seeking to find this virus in every possible scenario we can, including the community at large, and we have had success in that regard in the suppression of the virus so far. We are also now identifying areas of particular challenge and difficulty such as nursing homes and we have seen progress made as a result of the significant effort in testing made by many staff in the HSE, HIQA and other places. The Deputy is right to highlight certain workplace environments.

We will have the capacity to do 100,000 tests a week from next week. That will ensure that there is capacity to test people who are symptomatic, to test their close contacts and also then to target testing at other groups who might be vulnerable to the spread of the virus.

The Deputy is right about the need to tighten further turnaround times. The issue was the challenge of capacity and it is now the challenge of turnaround times. The HSE made clear comments about that today, with a target of completing end-to-end referral to contact tracing in less than three days in 90% of positive cases from next week, acknowledging that there will always be some cases, the remaining 10%, which will be more complex in terms of contact tracing and management. The HSE also outlined a target from swab to result of two days which, of course, will account for the majority of people who receive a negative result, which is currently approximately 97% of tests.

I do not have any information about the issue of patients' details going to their employers but I would be very happy to receive it and revert to the Deputy.

I will give that information to the Minister.

What we have here is playing with figures. The Minister has said that 90% of those who are positive would be contacted within three days. I have outlined to him a fundamental problem with the negative results which is leading to a situation whereby people are not self-isolating and there is contamination and people being infected as a result. The system is not working. I am not attributing blame, but to keep to the agricultural theme, the reality is that Deputies are now being fed organic fertiliser. As long as this happens and we are not being given the truth public confidence in the management of this pandemic will be seriously undermined. After such heroic efforts by every citizen in this State to stop the spread of the virus, we cannot allow, under any circumstance, a second wave of infection. The Government cannot ask people to continue to make such efforts if the truth about the consistent delays in contact tracing and informing people of their results are being hidden from them.

I see that time is up. I am not sure that, in my time in this House, there has been a time when there was a greater level of engagement between Deputies. I take questions for two hours a week, every week, on the floor of the Dáil, along with a range of other Government Ministers and the Taoiseach. A special committee dedicated to the issue will meet next Tuesday. A range of briefings has been provided, delivered by the HSE leadership, the Taoiseach, the Chief Medical Officer and others. There has certainly been an effort always to answer questions and exchange honestly.

I would like to take any details that Deputy Denis Naughten has and revert to him.

Deputy Denis Naughten raised the point that information in respect of test results was going to employers before it went to those who had been tested. That would be fundamental concern to the public and needs to be addressed.

As Deputy Denis Naughten has made that comment on the record of the House, I have asked him to provide the details.

It has happened in a number of instances across the country.

I do not have that detail so I do not intend to comment.

I am frustrated, like Deputy Denis Naughten. We ask lots of questions in question time but we are not getting the answers. As for the briefings, the one yesterday evening was a total waste of time.

When can we expect smear test cancer services and other essential health tests to resume?

Having arranged additional capacity for Covid-19 care in the private hospitals, are the Minister and his Department putting together plans to resume operations in them? There are ideological issues coming up about treating all patients together, but people who pay their insurance and are waiting for treatments need answers.

Mental health services in Tipperary are still non-existent while we wait for the Jigsaw service to be set up. Mental health, disability and early intervention services have all been cancelled and there is no idea of when these essential care services will resume for so many families. Mental health is a huge issue. I heard of a case recently where a suicide, unfortunately, was put down as a Covid-19 death. There is a lot of trick of the loop going on here. Deputy Naughten called it "organic manure". I would call it something that starts with "b" and something else starting with "s", but I do not want to say that in the House. It is just not on.

It is time to stop the spin and give us the answers. We are seeing the love letters being exchanged between Dr. Holohan and senior officials in the HSE. The Minister can smile if he likes but they are not really love letters, as has been exposed today. They are litreacha, not Litreacha um Thoghcháin, going from different Departments to different officials, and showing a jealous kind of questioning of who is who and what is what. We need to put accountability back on the floor of this House. The Ceann Comhairle intervened when Deputy Naughten spoke about workers' test results going to the meat factory owners. I would not be surprised at anything that has happened in the meat factories, because they own their workers.

I have several questions about testing arrangements for Covid-19. In one case I know of, an 80 year old in Clonmel in my constituency, had to get a 75 year old to take him for testing in Kilkenny in spite of the fact we have a test centre in Clonmel - provided by the GAA club I support, Moyle Rovers, which is of some fame - that is empty and not working. What is going on? Can we have some transparency about the number of tests being done in that GAA club, and in the centre in Nenagh? Where are the answers to the questions we are asking? My office is waiting more than three weeks for replies from the Department and the HSE to our queries about facilities and funding in Tipperary.

What is happening with St. Brigid's Hospital? It is a lovely facility, formerly a district hospital, in which many people from Carrick-on Suir were born and where they lost loved ones, who were waked there before we had funeral parlours. The building has been taken over as a Covid-19 centre but it is empty. The lights are off and it is in total darkness. Beds are being removed to be put into Cashel. The Minister and I visited one day and we saw a pristine, empty hospital. People in Carrick-on-Suir and surrounding areas in west Waterford, south Kilkenny and all over Tipperary funded the three hospice beds that are there and other facilities. We need answers but I cannot get them from the HSE. I cannot get telephone calls returned or emails replied to. Where are the answers?

Unfortunately, the usual issues regarding the HSE, which many other Deputies and I raise on this floor day in and day out, are still there. They may have gone down in the pecking order but they are still there. The cardiac care service in the south east is non-existent. There are still problems with dentistry, orthodontics, speech and language services, and the waiting lists are a mile long in the public system. How long will it be before those services are resumed and will we have chaos again?

Worst of all is what has happened in nursing homes. I will not repeat what I said to the Taoiseach earlier in that regard. Those people were thrown to the wolves and blocked and blackguarded. What happened when a response had to be given? The usual suspects from HIQA were sent in, which had to hire in experts from other areas, for a form-filling and paper-ticking exercise.

The Minister must feel for the people with intellectual disabilities, children with autism, and their parents and families. We have some excellent centres in Tipperary, many of them voluntary and community-run, but now the people they serve have no outlet. There is nobody to look after them. Parents are getting no break from their children and the children are getting no break from their family. Those breaks are badly needed because many of them require 24-7 care in the home. I see many young adults who are pure frustrated by the current situation. Younger children are frustrated, too, but it is easier to control them because they are smaller. I am talking about young men and young women who are big and strong. It is desperate for them that they cannot get access to services, not even the trip on the bus with the other young people who are brought to school by the excellent bus drivers and staff who care for them. That service is badly needed and it must be put back in place in some semblance of a way in order to keep those families sane who are under enormous pressure. I cannot quantify the pressure they are under.

The over 70s have put their shoulders to the wheel but they have been locked up for long enough. They are asking questions, as we all are. We want less of the spin on RTE every evening, on "Six-One" and the "Nine O'Clock News", and more honesty. The last thing people want is to have the Taoiseach saying something on "Six-One" and then his spin machine is outspun - and he has a fair machine - by Dr. Holohan saying something else. That is divisive. The Minister rightly praised, as did every speaker, the front-line staff and all the citizens of the State for what they have done, but they need to be seeing one message, and it has to be an honest, direct and fair message.

I begin by asking about the actions and interventions that have been taken regarding nursing home staff shortages.

A number of staff were out of nursing homes due to testing for Covid-19, waiting for results and all of the rest. I sent an email to the Minister's office on 17 April about one nursing home that was at crisis point and I am very disappointed that I received no response whatsoever. I had to email six different individuals in Laois-Offaly HSE, and only after emailing them for a second time did I finally get a response. The delay in terms of our nursing homes are unacceptable and appalling. I have spoken directly to managers of nursing homes. They feel they have been neglected. I urge the Minister to take urgent action to try to address this crisis. I would be grateful for a written response to my questions.

My second issue is hospitals. The staff in our hospitals have played a fantastic and commendable role during this pandemic. It is at times like these that we realise just how important and crucial our hospital services are. Tullamore and Portlaoise hospitals are located in my constituency of Laois-Offaly. Uncertainty still hangs over Portlaoise hospital. It is unable to develop services and recruit staff because of the uncertainty in regard to its future. I appeal to the Minister to put that to bed for once and for all because my constituency needs this hospital. We need to ensure that at no time is any service downgraded. I appeal to the Minister to provide some certainty to the hospital.

My third issue concerns meat factories. I was contacted by constituents in Edenderry who informed me that 60 workers in the Rosderra Irish Meats plant have now been confirmed as having Covid-19. I wish the workers a speedy recovery and a return to full health, but there is major concern about this in the town. What protocols have been put in place? The Minister answered some of my questions in his response to Deputy Naughton but I want to stress the important of resolving and getting to grips with this issue because there is huge concern about clusters of Covid-19.

I will start with Deputy Nolan's questions. She is absolutely right to highlight the issue in regard to meat factories, as was Deputy Mattie McGrath. I have outlined on the record of this House the protocols in place and the national outbreak team that is overseeing this issue. The regulation and management of meat factories resides with the Minister for Agriculture, Food and the Marine, Deputy Creed, rather than with me, but I take very seriously the points made by Deputies Nolan and Mattie McGrath. I will revert to them in writing in regard to the specific protocols and safeguards in place and the work that is under way. I will also revert to Deputy Nolan in writing, as requested, in regard to the nursing home issue and Portlaoise hospital.

I thank Deputy Mattie McGrath for raising a range of very serious issues. I wish to note, however, that the only reason we have suspended any service is to save lives. Nobody wants to suspend a disability or screening service. We suspended services to make sure that more people did not die of Covid-19 in our country. The only motivation for suspending services was public health. The Deputy is correct that we now need to put in place a plan to safely reintroduce some services in a manner which recognises that this virus is not going away and we will have to work out a way of living alongside it while keeping staff, residents, patients and citizens who use services safe.

I have outlined the processes that have been put in place for screening services. A plan is being devised to determine how we can try to provide some supports to children with disabilities. I thank the Deputy for raising this very serious issue. Many children with disabilities have not had a school or health intervention for many months. We cannot just tell children we will see them in September. That would be an entirely inappropriate, offensive and irresponsible approach. I am working with colleagues in the Department of Education and Skills to see what we can do for them over the summer months. It will have to be done in a safe way involving physical distancing. There are things we need to do to support that.

I have a note to hand on St. Brigid's that I will not have time to read out. My understanding is that admissions will recommence when there is a demand and I wish to provide the Deputy with that assurance. I am sure the Deputy did not mean to say that those aged over 70 are locked up. Nobody is being locked up. We are giving people over the age of 70 the very best medical advice to keep them safe. I know it has been really tough for them and we are eager to see that situation improve.

On Jigsaw in Tipperary, I had a meeting with Jigsaw. In the interim period while its services cannot be provided locally it has moved a lot of services online to try to provide some degree of support to young people in Tipperary. The website has a lot of help for young people in Tipperary.

Deputy Thomas Pringle is sharing time with Deputy Michael McNamara.

I am going to ask some questions and then hand over to Deputy McNamara, with five minutes per session. I said this earlier to the Taoiseach, but it has to be said again. Regarding testing and the testing regime, we are getting fed a load of BS, as has been mentioned by other Members across the board. I think we are because I know of cases - and I have not looked for these - in the nursing homes tested on the very first day the nursing home blitz was done, when the Army went into nursing homes and did the testing, and yet people still have not got results. I know of at least 20 people, from one nursing home, who have not got results.

Those cases may be within the 10%, and perhaps that is why this has occurred. If that is the case, it is very worrying because that is a big number. That is the problem we have. I attend the HSE briefings and meetings. We hear all of the stuff where we are told that 15,000 tests a day are being done, that there is huge capacity and we can do 15,000 tests a day. There are not 15,000 tests a day being done, however. Why does the HSE just not tell us what is happening, instead of feeding us lines all the time that there is great progress and that everything is being done? We know it is not.

Sometimes, as politicians, we only ever hear about the bad stuff because that is what we end up having to deal with. In social welfare, for instance, we do not hear about the 90% of people who get payments in time, but we always get the people who do not get them. Perhaps we do have a skewed view, therefore, on how things are working because we only ever hear about the trouble. It is worrying for me, however, when there is no acknowledgement of it and that is very difficult.

That was one of the things I wanted to ask about, but I really want to talk about another matter. I know the Minister is in a difficult situation during this crisis, but we are going to have another crisis coming up very quickly regarding our hospitals as they start to reopen and deliver services. Outpatient clinics, and similar services, are only going to be fit to see about a third of the people they were seeing prior to this crisis. Our waiting lists are just going to get longer and longer. Right away, therefore, we must have discussions about seeing people on Saturdays, working from 7 a.m. or 8 a.m. to 8 p.m. or something like that. We will not get the level of appointments we had prior to this situation, but it is going to be a major and serious problem to stop our waiting lists going through the roof. Will the money be made available and will hospitals be able to take those actions so as to be able to deal with waiting lists in future?

As Deputy Pringle said, and this is not a problem, sometimes we only hear the bad as politicians. That is a good thing that we get to bring the challenges and things not going well to the floor of this House. I respect that fully. I can tell Deputy Pringle that we are publishing testing figures every week concerning how many tests are completed. The Deputy is not just hearing that from the HSE or people like me. I heard the president of the Irish College of General Practitioners, ICGP, Dr. Mary Favier, in the national media the other day saying that things were better than they were the previous week and they will be better this week than last week.

They do need to continue to improve, however, and I am very clear on that. Testing and tracing is in a better place now than it was a few weeks ago, but it is not yet where we need it to be. We need to improve and build on it further. I went to visit a contact tracing centre yesterday to see the plans. A fair bit of what is involved is automation. If we know at the moment that 97% of people who get a test result are getting a negative result, and if one of us then has a test and it is negative, I would be happy to receive that result by text message-----

If we got a result, that would be something.

-----to free up the time of a public health doctor to talk to someone who gets a positive result. I am confident things are moving in the right direction but I am in no way complacent or cocky about it. This is going to be an area that will require the scrutiny of this House, the Covid-19 committee and the likes. That will be a very constructive role. Deputy Pringle has also raised a very pertinent issue concerning our hospital services. I am conscious I am talking about the future. At some point, this House is going to elect a Government and some of these questions will fall to that Government.

My own view of the world, for what it is worth, is that we are going to need to look at new ways of doing things in the health service. It is no longer a case of it being nice if we did things in a new way. It is going to be essential. Deputy Pringle is entirely right. Things we have been talking about for years, such as telemedicine, are now happening. We need that to continue happening. I also refer to the idea that all outpatients, as the Deputy referred to, need to go to the hospital, when some might be able to be seen in community assessment hubs or primary care centres. I agree fully with the Deputy on that. It is a big body of work.

It will fall to me currently but, principally, to the new Government and committees that scrutinise the work of that Government in terms of how we make Sláintecare happen in that regard. The advantage is we have a blueprint from Sláintecare in terms of how some of these things should be brought about. I am happy to keep in touch with the Deputy on it.

I wish to return to a matter which was previously raised with the Minister, which is nurses. Obviously, we owe everybody in the front line a huge debt of gratitude, including nurses. We all have stood and applauded them, but nurses cannot live on applause alone. None of us can, although applause for politicians is rare and, maybe, deservedly so. Will the Minister set a deadline by which he will use his legal powers to force through the pay agreements that were entered into, if they are not already implemented by a certain point?

We have talked a lot about mental health today. Will the Minister have a representative of psychiatrists, who are the people responsible for the delivery of mental health services according to the system in Ireland, appointed to NPHET, so that they can participate in the decision-making that it undertakes?

The Minister talked about a new way of doing medicine. The deal that was done with the private hospitals, and the effective takeover of the private hospitals, is not something that I would dare to criticise because nobody at the time knew what we were facing. Thankfully, our hospitals have not been as overwhelmed as we feared and those private hospitals have not been working to capacity or anything like it. I believe the Minister gave figures for the Bon Secours in Cork. Will he confirm that 142 beds are being used in the hospital at present out of its 300-bed capacity and that it is the hospital which is being most used? All the others are working at even lower capacity.

Is it the case that the doctors who work in those hospitals can no longer carry out any work for private patients, even on a pro bono basis? Is it the case, for example, that they are no longer able to have a colposcopy, which is a testing procedure for cervical cancer, carried out in respect of an ongoing patient if they have not signed the new contract? If so, that would be, we will all agree, very worrying.

Finally, I understand NPHET is looking at a proposal to carry out non-elective work in those private hospitals now because there is capacity in them but that there is an anticipated budget of €115 million per month. The budget for all of that work last year in the national planning framework, NPF, was €75 million as opposed to €115 million for a month. There may be many reasons for that increase but it looks like it could be a very bad deal for the Exchequer at a time its returns are plummeting. There are many questions there but I would appreciate answers to at least some of them.

I will do my very best. First, I congratulate the Deputy on his election as chair of the Special Committee on Covid-19 Response-----

I thank the Minister.

-----and look forward to any co-operation my Department can provide him with in discharging his duties. It will be an important role.

I gave figures earlier regarding the enhanced nurse contract. When I was last asked about this in this House last month, just over 3,000 staff nurses had been appointed to the new scale. That was up from 700 in February. I believe the number is approximately 4,500 now. I expect a significant further increase on that in the next week or so when I get updated figures. At that stage, I will make a decision as to whether I need to issue a direction to the HSE. I am not detecting an unwillingness in the HSE to do this at all. Basically, I will give the Deputy an answer on that within a week.

On the private hospital issue, the Deputy rightly acknowledged the reasons it was done. Obviously, a review period is built in from the end of this month to the end of June where I must decide in consultation with Government colleagues, and particularly the Minister for Public Expenditure and Reform, whether it makes sense to renew the contracted and whether it is needed. We will consider all of these issues. We will use that review period to the fullest in terms of value for money for the taxpayer but also, obviously, the needs of the public health service. Of course, if we are to be paying for the use of the private hospitals, we would all agree that we want them used for public patients.

I do not have the figure for the number of vacant beds. I only have the percentages I outlined earlier which I am happy to send to the Deputy in writing. I will also correspond with the Deputy, specifically about psychiatry, which he raised. We have a psychiatrist, Dr. Hillery, on the medical leaders' forum but the issue of having a psychiatrist on NPHET is something I will discuss with the Chief Medical Officer, and on which I will revert to the Deputy.

Sitting suspended at 4.15 p.m. and resumed at 4.42 p.m.