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Dáil Éireann debate -
Thursday, 21 May 2020

Vol. 993 No. 4

Covid-19 (Health): Statements

I welcome the Minister for Health to the House.

Before we begin, may I make a point of order?

I am seeking clarification regarding the health advice this House was given which has led to the Minister for Health refusing to attend a second session of the Dáil, and the serious implications this raises for businesses and workers all over the State. It is concerning that the Dáil debate he has refused to attend concerns the situation of meat factories, which appear to be operating to very different standards than those that were laid down before this House. It is ironic that in this very controlled environment, politicians are being protected from attending for more than two hours-----

-----while, at the same time-----

I ask the Deputy to yield for a moment.

-----the workers we are going to be discussing are in very cramped conditions for multiple hours.

The Deputy is making a statement, not a point of order.

The point of order I am raising is an urgent request for the Acting Chairman to make a ruling as to whether the guidelines that have been issued by the public health authorities imply that Ministers cannot fulfil their constitutional duties before this House by being here and answering questions on behalf of very vulnerable and concerned workers right across the State.

I have the Deputy's point.

I am also asking the Acting Chairman to ask the Business Committee to meet again to reconsider our business.

I have the Deputy's point and I understand he feels strongly on the matter. I completely understand that he wishes to represent his constituents on the concerns he has as, I am sure, do other Deputies.

It has already been raised in the House. The matter was dealt with already. The Business Committee, of which I am not a member, may address it if it chooses to do so, but it is not a matter for the Chair to make a ruling regarding the interpretation of health advice that has been provided to the Oireachtas authorities.

With respect, surely when this House is getting different health advice than other workplaces that raises serious concerns.

Deputy Carthy is making political statements. He is running down the clock unnecessarily-----

Can I make a point?

-----and it is unnecessary for him to continue to persist.

I think these are really genuine concerns that many workers are asking about today. It would be remiss-----

-----if this House did not address them in a substantial manner.

If the Deputy would like, I can read from the Ceann Comhairle's position on this issue, but it has already been entered into the official record today. We would be going over it again and I think that is unnecessary.

Can I ask-----

Can I ask one question? The letter we received from the Minister's private secretary states that it would be against public health advice for the Minister to attend an additional session beyond the currently scheduled health session.

Please, Deputy Carthy, please.

Imagine if one of the workers-----

I am sorry Deputy Carthy-----

-----in one of the aforementioned factories-----

I ask Deputy Carthy to take a seat. The Deputy is being unruly. Will he please take a seat-----

-----sent that letter to his or her boss. He or she would be thrown out on his or her ear with immediate effect, and that is the unfairness at the heart of this.

May I reply to the Deputy?

I ask the Minister to be very brief.

I will be brief. I am not going to stand in this House and have any slur made against my name.

I abide, as I expect all of us to do in our workplace, by the public health advice that is given. The public health advice given to the Business Committee, and commissioned, I believe, by the Oireachtas, pertains to how we do our business in a safe manner. Should that public health advice change or should the Oireachtas adopt a different position----

Should it be different for other workplaces?

I am more than happy to be here. I am abiding by the public health advice and I suggest Deputy Carthy do the same.

Can I ask the Minister-----

By the way, I am here and Deputy Carthy can ask me any questions he wishes.

-----does that advice apply to other workplaces, because according to the HSE-----

I ask Deputy Carthy to take his seat.

-----that advice has not been conveyed to other employers?


Switch off his microphone. I ask the Deputy to take his seat. He is very fortuitous because the clock has not started on his time, which I do not think is appropriate. The matter has been dealt with already. The Deputy does not like the answer. He has to accept though that is the position that has been adopted by the Business Committee in interpreting health advice provided to the House. I am not going to interpret that for the Deputy, it is there in front of him to interpret for himself.

We have a two-hour session with the Minister for Health, ten minutes of which has been allocated to Deputy Carthy's party. Presumably, Deputy Ward wants to get in as well. The clock starts now and it is questions and answers. I ask that time be left for the Minister to respond, if the Deputy wants a response. I am sorry, the Minister for Health is starting with his opening statement.

I welcome this opportunity to be in this House again regarding Covid-19 and our national response to it. I am sure Deputy Carthy would like to stay and ask me some questions on the topic, although he is leaving the Chamber now.

First and most important, I wish to express my sympathy to the family and friends of those that have been lost to this disease since I was last in this House. I think of them today and every day, and I know all of us in this House, across parties and groupings, do.

On Monday, we initiated phase 1 of our Roadmap to Reopen Society and Business. We moved ahead on the basis of the clear public health advice that we received. We did so knowing increased movement carries increased risk. Our message remains stay at home, but we have eased some restrictions to allow more outlets and public spaces to open. We were able to make that progress and move to phase 1 of the roadmap because of the actions of the people of Ireland. As a country, we faced the reality that this highly infectious disease was among us and we responded to the threat from it. We understood how quickly it can spread and how lethal it can be. We heeded the advice and the evidence. We learned what works and we set about doing it as a country together. Our efforts and our sacrifices have pushed Covid-19 back but it is certainly and sadly not gone away. If we do not stay smart it will come forward again in a resurgence. The progress made is contingent on our actions.

I am pleased to once again report to the House that our modelling shows the R rate remains stable at around 0.5. Work by Professor Philip Nolan’s team shows it is between 0.45 and 0.63. This means that for four weeks in a row, this number has remained significantly below 1. Four weeks ago, our case numbers were in the region of 400 to 800 every day. This week – for four days in a row - our cases numbers have been below 100. This day last month, 774 people were in hospitals across our country with Covid-19.

Today, 367 people are in hospital with coronavirus. On 21 April, 132 people were in ICU. Today, that number is 49. Our recovery rate has reached 87.1% and I am pleased to confirm that 258 people have been discharged from intensive care. We think of all of them. Yesterday, I spoke to Tom, a wonderful man from Waterford who was discharged after spending 66 days in hospital. He and his brother ended up in ICU and, thankfully, both have now been discharged. I am sure Deputy Butler knows them. We send our best wishes to them and to all those 258 people who are now getting their lives back on track.

Many people have become sick with this virus and many have lost their lives. Let us never forget that and let us never forget them. However, we have shown as a country that we can suppress the spread of this virus with the right measures. Whether we are at home, at work or outside our homes for some essential reason, we need to keep washing our hands properly, covering our coughs and sneezes, respecting the important two-metre rule, staying away from crowds and heeding the new and important guidance on face coverings in certain places. We must take it one step at a time. We are only in phase 1. Let us go forward and not risk going backwards.

I wish to update the House on certain important matters. We know Covid-19 is going to be with us for some time. This has consequences for every section of society and the health service is no different. We all accept the need for and wish to see the recommencement of the delivery of non-Covid health services. However, we all wish for that to be done in a manner that is safe and effective for patients and staff. The HSE has now developed a clinical roadmap for the delivery of non-Covid services in a Covid environment in order to enable the safe and clinically appropriate reopening of services. The roadmap outlines eight key principles that will be used to guide the reintroduction of all non-Covid services. Those principles are equity, safety, based on need, long-term population benefit, clear and effective communication to patients, ensuring all healthcare staff are engaged and consulted, risk benefit analysis, and public health principles of pandemic management. I am sure Deputies and the public know that getting back to normal will not mean going back to the way our health services were before coronavirus. It needs to be understood that although we have this clinical roadmap, we will have to remain flexible and capable of responding to any changes in the behaviour of the virus. The HSE intends to publish its plan for non-Covid health services in a Covid environment within two weeks.

On the issue of nursing homes, throughout the response to the pandemic there has been particular focus on the challenges in the nursing home sector. The sector has been and remains an absolute priority for me. All of the evidence indicates that we will continue to live with this virus and its impact for a long time to come. I believe it is critical that we now take the opportunity to examine how things have evolved in nursing homes in Ireland and the measures we have adopted so far and to consider international experiences. What are other countries doing? Are there things they are doing better than us? Are there things we can learn from them or vice versa? We need to look at the approaches in other countries, identify examples of best practice and ensure we put them in place here.

We must continue to plan appropriately to meet the ongoing challenges of Covid-19 into the foreseeable future. It is not just about getting on top of the nursing home situation today, although there has been good progress in that regard. It must be about ensuring we maintain that vigilance. Today, I announce the establishment of a Covid-19 nursing home expert panel to examine and advise on these matters. It is a crucial aspect of good planning and a recommendation of the National Public Health Emergency Team, NPHET. It will support Ireland’s navigation through the Covid-19 landscape and ensure the best possible safeguards are in place to protect the many people who call nursing homes their home. The panel will have four members, a public health expert who will chair the group, a geriatrician, a senior nurse and a public interest representative. I expect the group to do its work by the end of June such that we can share it with the House as we prepare for the weeks and months ahead.

I advise the House that I intend to update the Government tomorrow on further measures we intend to take in respect of travel, protecting our country and ensuring measures are in place at airports and ports. All travellers who come through an airport or port, regardless of nationality, must fill out a passenger locator form. They are asked to self-isolate for two weeks and provide the State with the address at which they will so do. This is the land of céad míle fáilte. We love welcoming people to our country, but now is not the time for non-essential travel.

I will now address the matter of clusters of Covid-19 among employees of meat factories, as I stated I would.

I am informed by the Health Protection Surveillance Centre, HPSC, that as of 16 May there were 16 outbreaks in meat factories associated with 828 cases. The HSE established a national outbreak control team and specific guidance has been issued to all meat factories. I understand that the Health and Safety Authority, HSA, also has an ability to inspect meat factories and all workplaces to ensure their compliance with the back-to-work protocols in place for Covid 19. Yesterday, I had the opportunity to speak with the chairperson of the HSE’s national outbreak control team, Dr. Mai Mannix. I thank Dr. Mannix and her team for their work. Preliminary estimates from the team indicate that so far between 55% and 60% of employees in meat factories who have been diagnosed with Covid-19 have now recovered, thankfully, and have returned to work. We wish all of them well. NPHET will consider the issue of meat factories further at its meeting tomorrow. I will await any advice or recommendations from NPHET and will share same with the public and this House. Let me be very clear that if employees are unwell or have any symptoms of this virus, they must not go to work and should contact their GP to seek advice and a test. If people cannot self-isolate, measures can be put in place to ensure that they can do so. We are using our facility at Citywest in this regard.

Last week in this House, Deputy Naughton expressed concerns in relation to how test results were being relayed to employers. The Chief Medical Officer, CMO, has clearly highlighted the importance of patient confidentiality and I very much share that view. The HSE has now made it clear that this practice is not to continue pending engagement with the Data Protection Commissioner and any other relevant regulator or authority. I have also written to the HSE seeking more information and a report on this matter. There is no part of our country and no age group that has been untouched by this disease. It is important to say that because sometimes people think this is a virus that visits others, people in a certain age group or with a certain condition. We know that some people are more vulnerable to a bad outcome from this virus but the latest figures that I want to share with the House show that out of the total number of Covid-19 cases in Ireland, in 16,064 or 58.6% there was no health underlying condition. In other words, 58% of the people who got Covid-19 did not have an underlying condition and were not otherwise ill. Despite the power of this virus and the suffering it has caused across the world, this country has gone to great lengths together and we have managed to contain it. As our circumstances change and our society and economy reopen, we must stay focused on what we have learned and continue to practise it every day. It is in all of our hands. We all need to make sure we do everything we can to successfully move from phase 1 to phase 2 and to find that sweet spot where we can safely live alongside this virus. We need to stay with the evidence and the clear public health advice that we have been given. We ask everyone in this country to stick with us, stay at home, stay safe and protect each other.

I will be sharing time with Deputies Donnelly, Butler and Murnane O'Connor. I thank the Minister. I will take five minutes, three of which I will use to ask questions, leaving two minutes for the Minister to respond. My focus will be on the mental health, disability and intellectual disability sectors. I pay tribute to all of the front-line staff working in these sectors as well as to families and carers. I also sympathise with and offer my condolences to those families who have lost loved ones since I spoke here last week.

Last week, I raised the dire warnings issued by the WHO and the UN about a looming mental health crisis and what is sometimes referred to as the third and fourth wave of a pandemic. On 23 April, I secured agreement from the Minister for the establishment of a high-level mental health task force that would include experts and patient representatives. The establishment of such a task force is essential. It is critically important to bring together experts and patient representatives who can take an overarching view of what we need in terms of mental health in dealing with the Covid crisis and the other issues in mental health over the next year, including the lack of a director of mental health. I ask the Minister to provide an update on the establishment of the mental health task force. In terms of any mental health task force, a programme for Government or anything else connected with mental health, the publication of the refreshed A Vision for Change is essential. I appreciate that it may not be normal practice for a Government in the current situation to publish a Government policy document but there is broad agreement across the House that it should be published and I ask that this be done.

Many people with disabilities, both physical and intellectual, may be cocooning for the next year or more until a vaccine is found. Day services, respite care and community supports have all effectively come to an end. Parents and family members are exhausted. I can hear the stress in the voices of the people ringing my office.

Patients are also becoming distressed due to the break in routine. If there are underlying conditions, how is the education of those with intellectual disabilities going to continue in the next year or so? What supports will be put in place in terms of minimising the community and social isolation they are going to experience for quite a time? There is also the economic impact for people with physical or intellectual disabilities who have been in the workforce. Much good progress has been made in that area but it is going to slip back. There will be regression in rehabilitation because the supports cannot be kept up to the previous level as a result of prolonged cocooning.

A cross-departmental strategy needs to be put in place because the issue is going to affect education, economic well-being, social well-being and mental health well-being, as well as physical supports. Perhaps some sort national plan needs to be put place and I would ask the Minister to comment on that.

There are more than 1,500 young people with a physical disability in nursing homes or congregated settings but these are not appropriate settings and their families are very concerned to have them in those settings. A policy needs to be put in place in regard to housing and health to get those people back into the community, so they can be taken care of and take care of themselves.

I thank Deputy Browne for raising these matters. It is timely because, yesterday, I spent much of the day meeting, at the request of Deputy Shortall, the Disability Action Coalition, Disability Federation of Ireland and the National Federation of Voluntary Service Providers, which work with and represent people with intellectual disabilities and their service providers. They have done an incredible job in terms of both managing Covid and managing or limiting the spread of infection through their facilities. I had an opportunity to pay tribute to them and their staff, who have really stepped up to the plate. They told me about a new way of working with the HSE. It is unprecedented that they are working in such close partnership and there is a big eagerness on their part not to go backwards and to keep that relationship going. I also got that very strongly from Dr. Cathal Morgan of the HSE.

On the issue of disability and education, I share the Deputy's view that many children and others are out of school settings and other educational settings for a significant period, and perhaps they have not had access to health services or educational services. As the Taoiseach indicated, the Minister, Deputy McHugh, and I are doing some work on supports we might be able to put in place over the summer for that group. I will come back to Deputy Browne very shortly, once the Minister, Deputy McHugh, and I have bottomed that out.

With regard to the issue of isolation, I was very impressed by the use of technology by these organisations in terms of ensuring that even if the person could not go directly into a house, they were still having their Zoom classes or the like, which is something we need to keep up. However, we also need to look at how we can restore the in-reach visits in a safe manner.

When I referenced the non-Covid care plan that the HSE is due to publish within two weeks, I am very clear that it is not just a non-Covid care plan for the hospitals but that it also has to be a non-Covid care plan for communities. Dr. Colm Henry and Anne O'Connor, the chief operations officer of the HSE, are leading on that and I expect some of the answers to the Deputy's questions on how we safely resume those services to feature in it.

With regard to A Vision for Change, it is ready go to Government and it is my view that the new Government should own and embrace that policy. I am open to a discussion across parties in that regard, maybe at a level above my pay grade.

On the issue of the task force, I am looking for clarity in regard to whether the Oireachtas wishes to establish it or whether the Deputy wishes to see a task force established within my Department.

Within the Department.

Okay. I will certainly undertake to do that and will revert to the Deputy next week.

We heard from health officials on Tuesday that we could be dealing with Covid for years to come. In a Covid world, this is going to have a dramatic impact on our healthcare system and reduce the number of patients who can be seen. As the Secretary General said, it will cost more and take longer to do less. Hospital bed occupancy will drop from near 100% to 80%, which is the equivalent of losing about 2,000 public beds. The plan was to go from 10,000 beds to 12,600 over five years under Sláintecare. Instead, we are going from 10,000 to 8,000 in about two months. Radiologists tell me they will be able to scan about half the number of patients, so a sick child in need of an MRI who has already been told they will have to wait two years, in this world, will actually end up waiting four years. Outpatients' consultants have said they can see about half the number of people in any given session. Before Covid arrived, we had the longest waiting times in Europe to see these consultants.

In the new world if they can see half the number of patients in the same time, the waiting times would double. The pain, suffering and loss of life at this level of reduced capacity is almost unfathomable. We could be looking at a level of loss of life many times more than we already see, tragically, from Covid-19. Opportunities such as telemedicine have been referenced when I have raised this issue with the HSE but based on the scale of the challenge we need a root-and-branch review of how we will deal with this to ensure that not only does capacity not decrease by 20% to 50% but actually increases to deal with the lists. To this end, has a task force been set up? If so, has there been any progress? If not, is that something the Minister will consider doing as a matter of urgency?

The short answer is that, yes, it is something I consider doing as a matter of urgency but there is work under way in respect of it. The Deputy is entirely correct. Our clinical experts believe we are going to need to keep bed occupancy in our public health service at approximately 80% to 85%. That is what it should normally be but we know that this has not been the norm in Ireland. We need to keep it at approximately 80% to 85% as long as we are living alongside Covid. Let us be honest, we would all like to keep it there going forward. The Secretary General said here in the Chamber at the Special Committee on Covid-19 Response the other day that we cannot go back to the situation with people being left on trolleys. This is not because the trolleys are undesirable, although they are, but because of the infection control issues that arise. There are real challenges.

One of the discussion points we are going to have to have is about how we look at the extra capacity we have put into the public health service and how we look at partnering and utilising private bed occupancy. By the way, even if we park ideology there are different ways in which we can we can arrive at that. There is a review built into the private hospital agreement at the end of May to run for 30 days and there will be a discussion for the current or new Government in this regard.

With regard to outpatients, I genuinely think there is a huge opportunity for reform in the context of measures such as virtual clinics. We know that in Ireland many people go to outpatient clinics who would, if they were in other countries, see allied healthcare professionals in primary care centres. Much of what the Sláintecare report includes that we have temporarily set up for Covid needs to become the new norm. The short answer is the executive director of the Sláintecare office in the Department of Health is analysing where we are at with regard to the delivery of Sláintecare, what good has happened in Covid-19 that we want to bank and keep and what other things perhaps have fallen behind or are new challenges. The board of the HSE is also considering these issues from a strategic point of view and I expect both pieces of work to be completed over the summer months.

The prospect of a second wave of coronavirus infection throughout Europe is no longer a distant theory. I understand that we are also making our plans here. It is imperative that nursing homes, residential homes and care homes be given much higher status when these plans are being drawn up. I welcome what the Minister announced in his opening speech, that there will be a nursing home expert panel. I have a question on the make up of that panel. The Minister stated that the chair would be a public health expert and that there would also be a geriatrician, a senior nurse and a public interest representative involved. May I assume this will mean that somebody from Nursing Homes Ireland or from that area of expertise would be on the panel? We have noted that Nursing Homes Ireland was not represented on NPHET.

On Tuesday, at the meeting of the Special Committee on Covid-19 Response, I questioned Dr. Colm Henry on the resumption of cancer screening services, which is a huge concern. I was disappointed with his answer because he said it is far too early to say when the screening programme will be back up and running and that the screening services will be focused on symptomatic patients in the short term. The Minister has also given us information that a clinical roadmap will be put in place for non-Covid care in a Covid environment. May I assume that the resumption of cancer screening services, particularly BreastCheck and CervicalCheck, will be included in that roadmap?

I thank Deputy Butler. On the nursing homes, I have informed Nursing Homes Ireland of this expert panel and we will certainly have an opportunity for it to input. There will be many stakeholders from which the expert panel will need to hear. I do not intend to have people from representative bodies on it but it is important that there is a way for those bodies to have an input.

When we look at other countries the world over, we put a lot of measures in place in Ireland for nursing homes that other countries did not but, equally, we know we have seen a very difficult situation in nursing homes.

I want to know if there are more things we can do here based on best international experience. I want to bring those experts together. We are not just going to have to deal with Covid for a couple of days or a couple more weeks now. We may well have to go through a winter period and maybe beyond that. What do we need to do and learn in that regard? It is about doing a comprehensive but quick piece of work that is back to us by the end of June so that we can plan.

On screening services, I absolutely get the importance of this. The HSE is currently developing capacity planning for the ongoing delivery of Covid-19 and non-Covid care services side by side. They will obviously examine the issue of screening as part of their non-Covid care plan. I want to be in a position to recommence our population screening programmes as soon as possible. It has to be safe for patients and staff. None of us disagrees on that. As we all appreciate, screening can involve tests and examinations which present particular challenges for the staff running the programmes in terms of physical distancing issues. There are a lot of challenges there but there will be a lot of challenges in many sectors. We need to plan and know how we are going to recommence it. I make the point, though, that I think Dr. Henry was making in respect of symptomatic patients. Nobody needs to wait for screening. If you are symptomatic today, go forward. That is not in any way to demean the value of our screening programmes but I urge those who are symptomatic today to contact their GP. I expect with the framework document the HSE will publish within two weeks that it will outline its plans in respect of screening.

I want to ask about information. How much is being spent on information campaigns during the coronavirus crisis? I have to ask if the message is actually getting through. Anyone who passed the canal earlier this week would have seen that it was like a bank holiday weekend. I was contacted last night by a worker on a construction site who said social distancing was not being applied at all. Front-line workers are telling me people are not going to hospitals for fear of the virus. Why is this? Why do people believe our hospitals are somehow unsafe? The suspension of smear tests and other diagnostics have sent the message that if someone has a symptom, he or she is not safe to be tested. There are people at home desperately afraid to contact their GP. Why is this? It is not right. The message should be that anyone who needs healthcare should get it, not because of how much money they have in their wallet or whatever. It is about getting the service. Is it because compared to other countries we have incredibly high rates of the virus among our healthcare workers? We have to get the message through that our staff are protected and our hospitals are safe. Every mistake we make now, we pay for in lost lives and years of repercussions.

I want to ask why there is not a public campaign regarding an illness associated with the coronavirus in children called Kawasaki disease, which can be triggered by Covid-19 in under fives and can be fatal. There are already 100 cases of it in New York and the Italian doctors reported a 30-fold increase in cases. I know lots of things can change in the pandemic but doctors and nurses are aware of this rare disease and there is little information on it. Why? The public needs to know what to look out for so they can get treatment if they need it. This is of huge concern to me. On people with disabilities, as the Minister knows, a few months back there was a 1% decrease in funding for children with disabilities across the board. That has to be reversed. Children with disabilities need to have the funding and we need to make sure that we resource the most vulnerable children in our society.

I want to ask the Minister about smear testing, not specifically about screening but about women who are symptomatic and who have come forward. I have been contacted by a number of them in the past week. They did as the Minister has previously advised. They were symptomatic, they were concerned and they went to their GPs. Their GPs are telling them now that the labs are not accepting the smear tests. I fully appreciate this was not the Minister's intention when he gave the advice but they are being told that the labs are not accepting the smears. In some instances, the GPs are taking the test and saying they will hang onto it until such stage as they can send it forward, while others are telling women they appreciate they are symptomatic but there is nothing they can do because the labs are not accepting the smears. I ask the Minister please to investigate this because as we have discussed before, some 21,000 screening tests are going to be missed. There has to be a catch-up programme but in the intervening time there has to be help for these women.

We have 41 days left on the private hospital deal. Where do things stand at the moment? It is an extraordinary deal. I do not necessarily think it is going to represent great value for money in the outturn but I fully understand why the capacity was needed.

Will the Minister indicate how many surgeries or procedures have been carried out in private hospitals, broken down by specialty? I have asked for this previously. It is important that we see this information.

I received figures on the average occupancy of these private hospitals. According to the information I have, the Bon Secours Hospital in Limerick was occupied for an average of 1% since the deal was signed. I put it to the Minister that there are people on trolleys in University Hospital Limerick. That cannot be allowed to continue when there is spare capacity just down the road. Will the Minister outline the information he has on that matter?

I welcome confirmation that advice will be forthcoming with regard to air and sea ports. That guidance and advice will be very welcome. NPHET has recommended, however, that passenger locator forms are filled out. I am not sure how diligently this is being attended to. My information from people working in the airport is that it is a little hit and miss. We are aware that people do not have to fill out these forms. Has the Minister been apprised of how many people are filling out these forms? Is he aware if the follow-up phone calls, as mentioned by NPHET, are taking place? How many such phone calls have been made? Is the information communicated to his office or to the HSE?

Will the Minister consider working with managers in local authorities to source and supply mobile homes for self-isolation for preventative accommodation for members of the Traveller community? I ask this because we have just been made aware that there is a very high rate of infection, with one in every four Travellers tested being Covid-19 positive. These people urgently need accommodation to self-isolate if required. They want to do the right thing - and the Minister is aware that they have said this publicly - but they cannot do so without assistance. I ask that he work with the Minister for Housing, Planning and Local Government and with local authorities to ensure this assistance is provided.

Money is still owed to nurses in Mayo, Galway, Sligo, Letterkenny, Limerick and the south east. This is money the Minister has agreed to pay to them. In addition, the expert group on pay for nurse managers, which is due to report at the end of the month, has not even held its first meeting. It is all very well to stand here at 8 p.m to give them a round of applause, which is very much appreciated, but those nurses went on strike and won the money that is now withheld from them. It is not fair and it is not tenable. We have already spoken about the upstairs-downstairs attitude that sometimes exists. Members of this House received a pay increase. I did not accept mine and I think many, most or all of my colleagues did not accept theirs. Our pay increase came as a matter of course. The nurses won this money. Will the Minister please ensure it is paid to them without delay?

There are quite a few questions from the Deputy, as always, which is good. I might respond in writing to some of them. I have a list of the breakdown for inpatient discharges, day cases, diagnostics and total outpatient figures relating to the private hospitals. If I was to read it out, it would take up all of the time so I will send it to the Deputy.

I have an open mind regarding how we proceed with the utilisation of private hospitals beyond the current timeframe of the existing agreement. I recognise, as does the Deputy, there will be a need to use that new capacity. The question is what that arrangement and agreement would look like at a point in time where the pandemic is in a different place to the one we feared. I will write to Deputy O'Reilly on that.

Without getting ahead of the discussions I hope to have with Government colleagues tomorrow, at the moment the passenger locator form is on an administrative basis. A person is asked to fill it out. I do not have the figures with me for how many people fill it out but I can get them from the Department of Justice and Equality-----

If the Minister asks nicely.

I will ask nicely. I am sure the Deputy does so too. I am of the view that it should be on a legal footing. Government is working on that and I hope to have news for Deputy O'Reilly in respect of it shortly. We are also keeping our Northern Ireland colleagues informed of our plans in that regard and we had a quad group meeting recently with the Deputy First Minister, the Secretary of State for Northern Ireland, the Tánaiste and my counterpart in the North.

I will absolutely take away the issue relating to the Traveller community and work with the Minister for Housing, Planning and Local Development and his Department on it. I will come back to the Deputy for more detail on that.

The Deputy raised the issue of symptomatic cancer patients. I will certainly talk to those involved with the HSE's national cancer control programme today or tomorrow on that, and I will revert to the Deputy tomorrow.

With regard to the enhanced nursing practice measure, the numbers are going up. We need to get everybody paid. The HSE has told me that there has been a situation where some people have been out of payroll offices and so on. I will keep in close contact with the INMO on this. We need to get to that point.

It is money owing to them. They won it, it was agreed to, and the money has been allocated and should be paid over.

I will ask a brief question and the Minister's response will allow me to ask any further questions I may need to. Last week we had a brief discussion about Pieta House and the additional services that will be provided during and post Covid-19. Will the Minister clarify whether the 300 hours that he stated will be provided for therapy for high-risk clients are per month or per quarter?

According to my note, it is 300 hours per quarter. The funding is being provided to fund an additional 300 hours for high-risk clients and the quarterly review will ensure that any client who commences a programme of support can have reasonable assurance of its completion. The cashflow supports are also contingent on a continuation between the HSE and Pieta House. I will confirm that in writing to the Deputy but that is my understanding.

Last week the Minister stated there was additional funding of more than €343,000 to provide 300 hours of therapy per quarter for high-risk clients. I also have a written response from the Minister that reiterates that. This works out at €1,146 per hour for therapy sessions. The average cost of a psychotherapy session is in the region of €70 to €120 per hour. If, for example, 300 sessions were charged at the higher end of the average - €120 per hour - that would cost the State €36,000. The State is paying Pieta House more than €343,000 to provide the same service. That is a difference of €307,000 per quarter.

I have also received information from some self-employed therapists who have contacted me and other members of my party and who counsel clients for Pieta House. They charge them only €24 per hour, yet the State is funding Pieta House to the tune of €1,146 per hour. The Government, as the Minister said, has already invested heavily in Pieta House, to the tune of €2.03 million per year, and Pieta House has also availed of the wage subsidy scheme. Despite this, several staff were let go and others have been offered redundancy.

Will the Minister inform the House exactly where this funding is being directed? Is any of the additional funding being used to pay for the redundancies? Does the Minister think we are getting value for money at €1,146 per therapy session when it would cost the State €120 per hour, or €24 per hour if a self-employed therapist at Pieta House was hired? The State should provide such services and not rely on a charity to do so. Pieta House provides an essential service but it is essential only due to the lack of investment in mental health by this and previous Governments.

I thank the Deputy and note his sincere and strong interest in the issue of mental health. I could outline, although I do not have the time now, what we are doing to beef up the public mental health services but I agree with the Deputy that Pieta House does a really good job. It is very well regarded by people throughout our country, as was seen in recent weeks in terms of how people responded to the fundraising call from Pieta House.

My understanding is that the HSE and Pieta House have formally agreed to that additional funding, as the Deputy rightly noted, of €114,608 per month, or €343,824 per quarter, and that will be provided once the current Government staffing cost schemes, which Pieta House has availed of, have ceased. It is to help keep staff. The HSE has also committed to providing cashflow support on a monthly basis, 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 anybody who commences a programme can complete it.

As I said when we spoke last week, the cashflow support is contingent on the continuation of that engagement between the HSE and Pieta House on a more sustainable funding model for the organisation. Work has been ongoing between the HSE and Pieta for some time on how to ensure that the funding will be sustainable into the future. That ongoing engagement is required in return for the cashflow support.

I wish to raise two issues with the Minister. First, the sadness and devastation of suicide has touched our community in Dundalk this week, with the death of a young man I knew. I express my sincere sympathies to his family and friends. Unfortunately, it is a situation that has been endured by families in Louth and throughout the country for many years. The message needs to be that suicide leaves nothing but pain and unanswerable questions. Often, it is a permanent solution to a temporary problem.

The pressure people are feeling is being exacerbated by this pandemic. I want to let people know there is help out there for them. To families who are worried about a loved one, they should engage with the person concerned, ask how he or she is feeling, ask if he or she feels like ending his or her life and contact the appropriate services immediately. Sometimes, the last people one wants to talk to when one is going through a bad time are those one loves the most. However, there are services available and there are people who care, such as Pieta House, which was mentioned earlier, SOSAD Ireland in Louth and the Samaritans. These organisations step into the breach, like many other NGOs, when State services are lacking. We need to make sure people make contact and tell how they feel or that people tell these organisations they are worried about a loved one. They will help.

I echo the calls that have been made by Deputy Ward for a special sitting of the Dáil to focus on mental health and for the reconvening of the Committee on Future of Mental Health Care. The WHO has said that Covid-19 could cause a global mental health crisis so I want to ask the Minister if there are immediate plans for a strategy to deal with the short term as people head into the tenth week of lockdown.

The second issue I want to raise is Dealgan House nursing home in Dundalk. I acknowledge the correspondence Louth Deputies have received from the Minister's Department following my questions here two weeks ago and I acknowledge the correspondence from his office in recent days but core issues remain. I acknowledge the news that the Health Information and Quality Authority, HIQA, will carry out an inspection at Dealgan House in the near future and is talking to families there. Can the Minister clarify if this inspection report will be used as the basis for deciding if and when the RCSI Hospital Group will hand operational control back to the owners of the nursing home? That is the immediate concern. We still do not have knowledge of how and under what circumstances the RCSI Hospital Group will step back from Dealgan House. I would like the Minister to directly address this. This needs to be decided upon and communicated to families who still have loved ones in Dealgan House. They need to know whose call it is for the RCSI Hospital Group to end its involvement.

There are constant concerns about a second wave of the virus coming as we unlock and families with loved ones in Dealgan House, as well as in every other nursing home in the State, need reassurance that any and all measures are in place to ensure people in residential settings will be protected into the future. We need to know there is a foolproof contact infrastructure in place for all staff or for anybody with worries. The families demand an inquiry into what happened at Dealgan House. Can the Minister state today whether a preliminary process can be put in place to gather testimony from families and staff and whether an inquiry can be established? Families feel strongly about this. We need to ensure it happens and that we do not have other scenarios like Dealgan House in the future.

I offer my sincere sympathy to the Deputy for the loss his community is feeling because of people losing their lives to suicide. The Deputy is entirely right to put on the record of this House that it is okay not to feel okay and that there are supports available. I direct people to for a range of good information and supports.

I am in favour of the suggestion of a special sitting of the Dáil on mental health. It is not a matter for me but it is a good idea and it is a matter for the Business Committee.

On Dealgan House, I have heard some of the stories through the public forum of families and they are heartbreaking situations. My thoughts are with them all. I understand HIQA is to carry out an inspection and that will form the basis for any further actions that may be required.

I will write to the Deputy and other Louth Deputies on the RCSI Hospital Group and its ongoing involvement as well as on making a patient advocacy service available for people in the community.

I welcome the Minister and I acknowledge the tremendous work being done by him, his Department, the HSE, nursing home owners and employees and everybody in the country. I also welcome the Minister's commitment to set up an international best practice assessment of how matters have evolved in our nursing homes. This assessment will examine: the fact that 54% of all deaths from Covid-19 in Ireland have taken place in nursing homes; the measures we have adopted so far, some of which have worked and some have not; and will consider international experience on approaches and identify any further best practices. Given the fact that this virus will more than likely return, it is important and proper that the Minister has limited the time for which this committee will sit. It will only sit until the end of June or July so that it will have real proposals to work on.

The committee needs to consider not only what will happen in the future but also what happened in the past. I represent the constituency of Louth, where Dealgan House Nursing Home is located. Sadly, a large number of people died there. I acknowledge the question Deputy Ó Murchú asked in this regard but I have a different one: why did the HSE go there in the first place? I am not asking when it is going to leave. It can leave only when it knows exactly what happened in the nursing home, what the problems were and how they are being addressed. It can leave only if it is absolutely satisfied all the people who live there, and their families, are safe and well. We need to get to the bottom of that.

I am not referring to Dealgan House Nursing Home disrespectfully because it got an exemplary report from HIQA at the last public inspection. The last set of published data on all nursing homes shows that only 123 of the 581 nursing homes in Ireland were fully compliant with all regulations. That is an absolutely unacceptable number. As regards governance and management, 32% of the nursing homes, public and private, exhibited non-compliance. Regarding infection control, 18% of the small, limited number that were examined – 251, I believe – were non-compliant. Therefore, there are important issues to be addressed.

We do not want to apportion blame but get to the facts so families who have lost loved ones can have closure. Closure is the most important thing for families. One of the big problems they face is that they do not get to say goodbye to their loved ones. That creates great trauma for them. Nursing homes and hospitals have different configurations of buildings and different arrangements but it should be possible for every single family to say goodbye, in the appropriate and proper place, to their loved one. This, above all, is crying out to be addressed. Friends and relatives of bereaved families see a beautiful ceremony but it is a sad one. That it may be attended by fewer than ten people causes great emotional distress for the families and their relatives and friends. We can act only according to the best possible advice, and I acknowledge death is cruel at any time, but death is exceptionally cruel when families must endure what is happening now. I am not blaming anybody but just believe we need to have the best possible advice, given in the best possible way, to end this. I understand the reason for limiting the number who may attend a funeral to ten. I am not disagreeing with the guideline and I would only work with and support public health advice on any of these matters, but it needs to be determined whether there are ways in which people could participate at a distance. People love to be with their families, loved ones and friends at a time like this. I hope we can do more on this.

We must look to the future. We need to move away from the nursing homes model. It represents a failure right around the world. Covid-19 is rampant and affects most people who are over a certain age and in nursing homes, but it is a fact that home care is under-supported and undervalued. Having people live in their homes must be our priority, along with the provision of services to their homes, notwithstanding the existence of Covid. Preparing staff to provide this service must be a top priority. If we cannot visit people in their homes, the community setting should be the next priority. I refer to where people can live in small bungalow-type accommodation in which they can be looked after. There are examples in this country. The system should be in place to support home care. There should be a deal for people in home care in addition to those who must go to nursing homes, which I accept has to happen.

I appreciate that the Minister will be happy to reply to these points. We need to examine the role of HIQA. It has not just an inspection regime - in fact, I think it may not have enough inspectors - but also retraining and upskilling programmes. It is all very well to talk about inspecting a nursing home if there are problems in it but we need to make sure staff are trained to the highest possible degree. There needs to be greater interaction between the HSE and private nursing homes on upskilling and helping everybody to get through these difficult times.

At the end of the day, we need to make sure the staff needed in nursing homes are there. The level of dependency - high, medium or low - of residents in nursing homes determines the ratio of doctors to residents. Occupational therapy and speech therapy services must also be provided. It is not good enough to have residents warehoused as, unfortunately, they can be in many respects. They pay high fees and in many cases get very little other activities for that money.

I acknowledge that Deputy O'Dowd has been working on nursing home issues, if I may call them that, since long before I was a Member of this House. He has championed the rights of older people, so I take very seriously what he has to say about the matter. He is right. At the end of this pandemic, or when a new Government is formed, there will be a big job of work for this Oireachtas to do in moving forward with a new model of care for our older people. We have all been saying for years that we want people to be able to grow old in dignity in their own homes. This House, however, has never passed legislation to make that happen. Regardless of which parties have been in government, that has never happened. There is no statutory home care scheme. Incidentally, we have a scheme nearly ready and a new Government, whoever the Minister for Health may be, should be in a position to bring that forward quite quickly. A statutory home care scheme is key.

The second issue, without getting into the ownership model, whether it be public or private - Deputy O'Dowd referred to both - is the connectivity between a nursing home and the health services, as he rightly says. The idea cannot be that because someone has gone into a nursing home, our responsibility of care to him or her lessens. There are serious lessons for Ireland and the world in that regard.

The idea of the expert review panel is to look at what we have done in Ireland and how it has gone, what is in place that we need to keep given that this pandemic is not over and we need to continue to shield and protect vulnerable people and what other countries have done and whether we can learn anything from them. The idea is that the leading geriatrician, leading public health expert, senior nurse and public interest representative will come back to us by the end of June, feed that information back into NPHET and share it with this House. That will be very useful.

Deputy O'Dowd has been in touch with me about Dealgan House Nursing Home. I will await the outcome of the HIQA report. As I said to Deputy Ó Murchú, in my role I need to be careful not to pre-empt what I will do on foot of receiving such documents, but I take the matter seriously. Deputy O'Dowd is also right about the issue of people wanting closure. I took the opportunity to FaceTime some staff and residents in nursing homes around the country the other day and noted the connection and the bond between staff and nursing home residents. They are like a second family so many of the staff are grieving as well, and I acknowledge that.

On the issue of saying goodbye, the Taoiseach met some religious leaders recently to discuss how we can safely get church and religious services, including funerals, back up and running. That meeting was very useful. The Irish Hospice Foundation also wrote to me yesterday and I intend to meet its representatives next week. People are grieving and hurting as a result of Covid and non-Covid deaths and we need to look at how we can do better in that regard.

I will reflect on the Deputy's comments on HIQA and come back to him.

When will we have our detailed roadmap for the reopening of medical services? We have a roadmap that specifies when social services and businesses will reopen. For example, we know that on 20 July people can go to the hairdresser's but we do not know when they can, for example, get a cervical check or breast check. The HSE website simply states:

Breast screening is paused until further notice. It will begin again when it is safe to do so.

In other words, there is no indication or prediction as to when that will happen. That is what people see. We are encouraging people to present to a hospital if they are sick. We are telling them that this is the time to go back, yet health professionals do not know when their services should be offered again. If the health professionals do not know, the patients will have even less of an idea when they should be there. It is therefore important that we provide clarity in the same way that clarity was provided to businesses.

For example, I have been contacted by several occupational therapists, including people who do a mixture of public and private occupational speech therapy for children. They are prepared now to reopen with appropriate precautions but they are unclear on where their services fit in to a reopening roadmap. I am looking for a roadmap to avoid uncertainty and anxiety for them and their patients. Can the Minister tell me for a start if he can map the reopening of the various detailed medical services onto the existing roadmap or if there is a plan to do that?

I thank Deputy Smyth for raising this matter. We know that roughly from the middle of March until 12 May the position was that all non-essential health services were effectively paused. Then, on 12 May, the National Public Health Emergency Team said that from a public health point of view the team believed it was appropriate to lift the pause and replace it with a recommendation on appropriate clinical and operational clinical decision-making. Since then, the HSE, led by Mr. Paul Reid, has been working on trying to put in place a safe non-covid care plan. Those responsible in the HSE are doing good work. I met Paul Reid to discuss this matter either yesterday or the day before. It is their intention within two weeks to publish the framework for non-covid care in Ireland. I outlined on the record of the House earlier the eight key principles that they would use as a guide. I will not eat into Deputy Smyth's time by going through those now but I am happy to send Deputy Smyth a note on that. Within two weeks I expect the HSE to outline to people how the executive intends in a safe manner to recommence non-covid health services in the community and in hospitals.

I thank the Minister for that answer. It will be within two weeks.

We are all aware that there are profound implications for mental health from the pandemic. Yet, as far as I know, A Vision for Change is 14 years old and requires to be updated. I know there have been reports from people like Catherine Day on trying to improve mental health strategy. Can the Minister outline to the House where we are on getting an updated mental health strategy and whether the document is likely to be published?

That is a really important question. We have all probably met with Mental Health Reform and other organisations on this. We need a new vision for change, absolutely. My colleague, the Minister of State with responsibility for mental health services, has been working on this and there is now a draft new version of A Vision for Change. It was considered by a Cabinet committee. It is ready to go to Government. However, there is a longstanding position on not bringing forward new policies. There has been a view expressed in this House in recent weeks, to which I am sympathetic, that despite the political interregnum political leaders are happy for me to bring it forward. I cannot give a commitment on behalf of the Government but I am happy to engage with parties. The general view is that we allow the new Government to bring forward the policy - we all hope there is one of these soon. A new A Vision for Change document is ready to go. It is simply a matter of when we bring it to Cabinet and whether it is brought by the outgoing Government or the incoming Government in a few weeks' time.

Is the Minister saying it will be in the next few weeks?

Yes. I was going to be funny and say that Deputy Smyth could answer that, but I will not because it is a serious matter. It is ready to go to Government. There is a longstanding principle that I would not bring forward a new policy after an election but it could be brought by a new Minister for Health during his or her first or second week in the job.

I want to move on to scenario planning. In general, the simple way of planning for things is that we look at what is likely to happen based on what has happened in the past. Things continue on and they go along a line. However, because this is a novel coronavirus and we do not know exactly what path the disease will take, there are several different possibilities that have profound implications across different sectors of society. It covers everything from whether a double-decker bus carries 17, 35 or 50 people to how many people will be able to go into a waiting room for a medical service. We have many different possible outcomes. Different amounts of money will have to be borrowed and different quantities of services will be available. It is actually a time when we need scenario planning. Will the Minister consider asking for some proper scenario planning to be carried out? I do not know whether that should be by econometricians or someone else.

I absolutely will do so. I discussed this with the chairperson of the HSE and the chief executive. I am conscious and clear about the fact that NPHET advises the Government from a public health point of view on the Covid-19 pandemic. The running of the health service falls to the HSE. I have had good discussions with the HSE on non-covid planning. I see Deputy Kelly nodding in agreement. Deputy Smyth is right. As I was saying earlier, we probably need to keep our capacity at 80% to 85% bed occupancy in our public health service. That has serious implications in terms of how we prepare for a winter surge. We also need to look at outpatient clinics. Will we be doing more of them virtually? I imagine we will be.

We also need to look to see if this is an opportunity to move some of the outpatient clinics. For years we have been talking about bringing people from outpatient departments to the community, so could the new community assessment hubs or primary care centres be used in that regard? Could we have allied healthcare professionals leading that? I assure Deputies that this work is under way and being led by Dr. Colm Henry, the chief clinical officer of the Health Service Executive. I expect we will be able to talk about it in detail in a fortnight.

I suppose I can ask about it at a meeting of the Covid-19 committee. I want to speak to international travel within Europe. Every country has its own roadmap and part of that is reopening international travel, and every country is coming up with different rules. There is a lack of symmetry or reciprocity in this. A person may be quarantined on arriving in a country but would not be quarantined on returning home, which makes no sense. Will the Minister update us on efforts to co-ordinate the strategy across Europe?

Certainly, on a North, South, east and west basis this is a matter I have discussed with my counterpart in Northern Ireland and I know the Taoiseach has spoken publicly about his discussions with the British Prime Minister. At a European level, there is no doubt this is discussed at various ministerial European Union Councils and the like. We must acknowledge that different countries are in very different places. For example, I know Germany is considering the idea of having a so-called travel bubble with a couple of other countries that are in a similar position with the virus.

The Irish position is that we expect people, whether Irish or not, to self-isolate for 14 days. This applies to anybody coming to the country, including returning Irish people. We also expect people to fill out a passenger locator form, indicating a name, phone number and where the person intends to stay for those 14 days. These processes are being administrated and a good job is being done by the border management unit. We must look at how to regulate for that and I hope to be in a position to update the Government on that tomorrow, or if not then next week, on how we can move forward in that regard. I would be happy to brief the Deputy after that.

I thank the Minister.

I have a number of questions across a range of different topics, as the Minister might appreciate. We all know we got new advice here this week. I will not relay the entire story again but the advice means I have a stopwatch in front of me to measure the length of time I am in the Chamber so I do not go beyond two hours. I broke the rule last week as I was here for questions to the Minister and the Taoiseach. This was new to all of us and we did not know the advice. We thought with a break after two hours, we could come back. When did the Minister first become aware of this rule relating to workplace settings? We cannot have one rule for here and one for somewhere else. The advice is that if one goes beyond two hours in a workplace setting within 24 hours, a close contact is created and this clearly creates risk. When did the Minister first become aware of this?

I became aware of it this week, I believe. I have heard this mentioned during the day and I have heard people asking the Taoiseach to clarify the matter etc. I am open to correction from the authorities in the Oireachtas but my understanding is that the Oireachtas brought in a public health expert. I heard Deputy O'Reilly describe the person as an independent public health expert.

There was an assessment of this workplace and guidance was to be provided not just to Deputies, Senators and Ministers but everybody who works in this place to whom we owe a duty of care. That includes our staff and everybody else. It was the view in the advice, and I am only going along with that not as a Minister but as a Deputy in my workplace. It is the Oireachtas public health advice from an independent expert brought in by the service.

The advice has been endorsed by the Chief Medical Officer.

It is endorsed by the National Public Health Emergency Team, NPHET. Page 4 of the National Interim Guidelines for Public Health management of contacts of cases of Covid-19 seems to be updated to reflect this. We need clarity where there is confusion. The Minister only became aware of the advice this week and perhaps nobody else asked the question. This is NPHET's advice. There cannot be two conflicting rules. I referenced George Orwell earlier and I will not do so again.

The Minister only found out about the advice this week and it is from NPHET, although it has come a circuitous route, with the Oireachtas getting advice from another individual. How is it that this was socialised to everybody else only this week?

Was risk not being created across all communities by the fact that this had not been socialised beforehand? How are people meant to operate in shops and factories? People can only spend two hours in the same space within 24 hours. Otherwise, they will create close contacts, and if anyone gets infected, everyone will have to isolate for 14 days. Take my local shop as an example. It did not have a clue about this. If anyone working there got infected, the shop would have to close. Viability is the key issue. If NPHET was aware of this situation, why was the public health information not socialised before now? It has huge ramifications.

Who initiated the request for advice following concerns about Oireachtas sittings? I accept the public health advice - that is not the issue. Who initiated the conversation between the Oireachtas and the Department of Health regarding the first sitting of the Special Committee on Covid-19 Response and people's concerns?

I truthfully do not know. I am sure we can find out.

The Minister might do so.

I will indeed. To be clear, I am aware of the 15 minutes within 2 m in terms of close contact and I am aware of the two hours in terms of close contact. It is a question of how long one must leave an area before coming back.

It is two hours within 24 hours.

I first became aware this week that one needs to have a 24-hour period. I am a Member of this House and I want it to be able to do its business. I am one of the few people who is here answering questions every single week along with the Taoiseach and a couple of others. I am sure there are ways we can get this right. I am a receiver of the advice-----

It is broader than this House.

-----rather than a maker of it. I am sure the Ceann Comhairle and the House's authorities can clarify, but my understanding is that the Oireachtas made a decision to seek public health advice in terms of how it conducts its business. The Oireachtas is sharing that public health advice with Members.

Okay, but will the Minister answer my question?

One is not less of a Member upon becoming a Minister-----

I respect that.

-----in terms of one's own health.

Regarding other workplaces, I heard the deputy chief medical officer speaking about this matter yesterday. It is about carrying out a risk-based assessment of any workplace and a variety of factors can obtain, for example, the safety of a location, how long to spend in a room and the like, but I am sure there can be more clarification. I hope that a way forward can be found. I believed the Covid committee was coming up with innovative ways of ensuring that it could do its business. Doing that business is crucial. Parliaments all around the world are doing their business.

With respect, my question did not focus on what happened in here. Rather, I am worried about the people in my local shop. How are they meant to carry out a risk assessment? It would mean having many more employees and would make the business unviable.

I will ask the Minister the question again because he did not answer it. Why was this public health information not socialised - put out there - across the country previously? Why did it appear all of a sudden this week? Deputy Harris is the Minister for Health. Tell everyone in this country who owns a shop, including pharmacists, how they are meant to operate in these conditions. They will have to get assessments done. For many, how they will do that is questionable. Who is professional enough to do it? It is not viable. How are shops, other retail outlets and the people who produce our food, including meat factories, meant to operate under these guidelines? I do not buy the idea that every area is different. Rooms have a certain square footage and we are expecting people working on checkouts to spend six or eight hours together in the same environment.

Either this advice on risk was known and not mentioned or it is new. The Minister found out about it last week. The whole country is depending on what he will say. We need to know why this was not socialised. Is it new advice? If it already existed and people were not informed, then a risk of which they were not informed was created.

I doubt the whole country is waiting to hear what I will say on this, but I will be clear. On 27 March, workplace protection and improvement guidance was issued by the National Standards Authority of Ireland, NSAI, for all workplaces that were open. The NSAI is the body from which people and businesses around the country are taking their advice. Guidance has been issued for many different sectors. For example, guidance has been issued by the national outbreak control team in respect of meat factories and by HIQA in respect of nursing homes. It has been the case, and is the case the world over, that different settings have different guidance.

There has been a debate since the start of this pandemic as to whether the Oireachtas should fulfil its duties by having Members work from home using virtual technology. There have been good ways of using committee rooms and video links.

My understanding is that the Oireachtas asked for the piece of public health advice and I am following it. That is my understanding of how it surfaced.

That is not the question I asked.

It is the answer to the question. The answer to the question of why did this become socialised this week is the Oireachtas asked somebody to come in and assess our workplace, and not just for the Deputy and me, but for our staff and the staff who work here-----

Why does it not apply to meat factories, shops or pharmacies?

We will talk about that as well.

The Minister without interruption please.

I am following the public health advice in this workplace and so, too, are Deputies for their staff. Everybody has to follow the public health advice in their workplace. There is a HSA in place that can go in and inspect workplaces. Between Monday and Tuesday of this week it carried out 190 inspections of workplaces. Every workplace has to operate in a safe way. We need to lead by example. I also think we need to find a way forward regarding this. The Oireachtas needs to be able to do its business. It cannot be beyond us to ensure that can happen.

The Minister keeps answering a question he was not asked. I have asked it a number of times, but the Minister is refusing to answer the question.

The Deputy knows the answer.

I ask the Minister to allow me to finish. I have only a certain amount of time. The Minister is refusing to answer the question.

In regard to all of the other sectors across Ireland, what are they meant to do now? I am speaking about the meat factories, pharmacists and other sectors that exist to serve us and are doing a fantastic job across the country providing food and medicine, etc. If we apply to them the rules being applied here today they will not be able to operate. They are not viable in many cases.

I will ask the question one last time. Why did this advice arrive all of a sudden this week? If NPHET knew this to be the situation for an area like this and an organisation like the Dáil, how come similar advice was not given to all the other sectors? Surely, this advice will have to issue to all sectors across the country. Based on viability and what is happening in here, why has this not happened already?

Deputy Kelly is blaming NPHET for everything. The Oireachtas asked someone to come in here and give advice. It had nothing to do with NPHET.

That is not the question the Minister was asked.

Deputy Kelly is obsessed with blaming people. He will be blaming NPHET for Covid-19 next.

That is unfair and the Minister should withdraw that remark.

Okay, I withdraw it. NPHET did not do this. There is guidance in place. The pharmacists and other people are putting different protections in place. Some people are putting up perspex, some people are wearing face masks, some businesses are not allowed to open and others are only open for takeaways.

In regard to the people working in Dunnes Stores and Aldi, what are they meant to do?

Some people are coming to sealed rooms and they are working in different ways. I am very grateful to doctors for giving us advice on how to protect our health. I am very grateful for doctors around the country putting guidance in place for different sectors as to how people should protect their workplaces. It should be remembered that as of today, most workplaces cannot open such is the risk of this virus.

Tell that to the Dunnes Stores and Aldi workers.

The next speaker is Deputy Shortall. The Deputy has ten minutes.

By way of clarification, the Oireachtas did not ask someone to come in on Monday. It was written advice that was given that is completely new advice. Previously a consultant on workplace health and safety was asked to come in and gave the original advice that we have been operating to up to this week. The other was just a particular medical person who was asked.

I have four questions. I read in today's edition of The Irish Times that the Health Information and Quality Authority, HIQA, has said that immediate action is needed to mitigate the risk of infection spreading throughout our public hospitals. I want to bring a matter to the Minister's attention, although I understand he has already received a letter about it. This is about the packed waiting room at Beaumont Hospital last weekend, where large numbers of people were sitting side-by-side, many of them waiting there up to 12 hours. Photographs of the situation have been sent to the Minister. I hope he can respond to us about that high-risk situation. My concern is that that high-risk situation is being repeated every day and every night in emergency department waiting rooms throughout the country. What guidance is being given to public hospitals in terms of the safe management of people waiting for services in emergency departments? This is an urgent issue. On the one hand hospitals are providing services to Covid patients and on the other hand the non-Covid patients would seem to be placed at risk as a result of the failure to segregate and provide sufficient space for social distancing. If that situation was to arise in a shop the numbers would be reduced drastically. There would be control on the numbers but there does not appear to be any control on the numbers in emergency department waiting rooms and we need a response on that urgently.

My second question concerns private hospitals.

We have been told by the Minister for a number of weeks that there would be a roadmap and that there is unused capacity that needs to be brought into use for non-Covid conditions. That needs to happen quickly. I read the briefing we got from the HSE the other day. We are still talking about two weeks before that is finalised and the services are up and running. There are empty beds in hospitals. We are paying quite a lot for them and they should be brought into use as soon as possible. For example, we have talked before about the advisability of having elective-only hospitals. If we look at the Sports Surgery Clinic in Santry as an example, why are we not using it to its maximum capacity and putting large numbers of people through it for hip and knee procedures and all the other orthopaedic work that needs to be done? I do not see why there is a need for a delay in ramping that up. It is really important that we use that capacity to the absolute maximum and I hope the Minister will retain it for the foreseeable future. It is really important that he does so.

Regarding Covid services in public hospitals, there is a single list. When people come in with Covid, they are not asked whether they have health insurance, and that is absolutely right. All patients are being treated for Covid in public hospitals. By the same token, all patients should be treated for non-Covid conditions in private or public hospitals where there is spare capacity. There should be no question about that and we should be embedding that principle into our health services generally.

My next question relates to home care services. There are indications of delays in home care provision in terms of, say, somebody being discharged from hospital and needing home supports, as well as delays in testing before the home care service is put in place. Equally, where a person in receipt of home care has suspected Covid, there are delays in getting the test and delays in getting a new team of carers into that situation. Another concern is that at the beginning of this pandemic, a lot of families were nervous about home care workers coming in and asked for the service to be suspended. Now, several weeks down the road, those families cannot cope any longer and want the service reinstated, and there seems to be delays with that. Some action is needed there fairly quickly.

My fourth question is how we identify high-risk groups and respond to them appropriately. There is a stand-out example of delays in responding. It was early days and all of that kind of thing and it happened in other countries, but there undoubtedly were delays in identifying and responding to the high-risk situation that people in nursing homes were in. There were tragic results because of that. There are a whole lot other high-risk situations. People in direct provision - the Minister is just getting to that now - and Travellers are examples. There are also meat packers and construction workers who are living and working in very high-risk situations. There is no point in coming along a week or two after the event when there is an outbreak or several clusters. Is there a system in place to identify those high-risk groups and is there a hit squad to ensure there is a speedy response to outbreaks in those circumstances?

Just to say at the outset, the Deputy raised the question last week of the over-70s being able to participate in tennis, golf and so on. We were able to clarify that this is the case.

I have not yet seen the letter from Beaumont Hospital to which the Deputy referred, but I will make sure I see it straight after this and I will respond to the Deputy and to the letter. It is important to say that one of the reasons we are reading today about the HIQA report on acute hospital infection prevention and control preparedness - I thank the authority for publishing it and the transparent way it went about it, so that there is no need for freedom of information requests and so on - is that it was requested by NPHET in recognition of the fact that we cannot talk about everybody else having to manage infection control and not get on top of it in our health service. It will help to surface the challenges we are going to need to face.

HIQA points in the report to the progress that has been made, particularly during the Covid-19 period, to expand the infection prevention and control capacity and capability in acute hospitals, and this is no doubt an assistance in our efforts. However, it also identifies common challenges across hospitals in relation to access to PPE, which will become a bigger issue as we commence more services, testing kits and consumables. It draws particular attention to the need for additional supports for the UL hospital group and the South/South West hospital group. My Department is now working with the HSE on the implementation of practical measures to address each of the risks. In fact, I wrote back only today asking to receive an update on that next week in terms of how we are getting on with the implementation of each of those recommendations.

I also intend to pursue it at my weekly meeting with the HSE next week.

Waiting rooms are at a very basic level.

They are, and I want to see this matter relating to Beaumont Hospital addressed as well because, as the Deputy stated, we have spare capacity across the health service. That is a rarity, but we need to be able to address this issue.

Regarding private hospitals, I share the Deputy Shortall's view that we are going to need to retain all the capacity we can. Where I think there is room for debate, although I think I am close enough to Deputy's view on this, is how to best use that capacity and what arrangements and agreements we come to in that regard. It is complex to switch back on non-Covid-19 care. I am not being smart in saying this, people get that. It is complex to switch this back on from a safety point of view and also from the perspective of clinical prioritisation. Earlier, for the purposes of transparency, I placed on the record the eight key principles the HSE is applying in deciding the priority and order of resumptions. I expect the work by Dr. Colm Henry and Anne O'Connor within a fortnight and for it to be very helpful in guiding what non-Covid-19 care will look like for the next three months or so, and what that will mean in the context of using the extra capacity of the private hospitals.

I will come back to the Deputy on home care. I was not familiar with testing delays there. Regarding the reinstatement of services, that is a fair point. People might believe they need their service back after being nervous. I will try to get a sense of the numbers in that regard. We can debate another day the nursing homes and how Ireland responded. The Deputy makes a fair point, however. This is a challenge the world over. We have tried to suppress Covid-19 in the community and we have largely done that thanks to people's efforts. Then we see clusters and outbreaks in different sectors, some of which are more predictable than others. Tomorrow, the HSE is due to bring a testing strategy paper to NPHET regarding how it tends to target - and the Deputy has often raised this with me - the extra testing resources it now has at particularly vulnerable sectors or groups of people.

I thank the Minister for those answers. I also asked him about the mechanism for identifying those groups and responding, and that is an important point. If we look back over the past week, for example, there were about 86 new cases the other night. If that was based on a positive rate of 3% or less, that means that fewer than 3,000 tests were performed. The numbers are getting very low now, so there should be vast capacity. There should not be any reason for not ensuring there is full testing and repeat testing in those high-risk settings. I find it hard to understand why we are not using that capacity. We are only using a fraction of the capacity for which we have been waiting for several weeks. The capacity is there but there seems to be a problem availing of it. That does not make sense.

I have discussed this with the Chief Medical Officer and he said it is a short-term challenge. As we begin to resume non-Covid-19 care, we are going to see a significant need to increase testing, and regular testing, among certain cohorts of people. That could include hospital staff and patients going into hospitals----

Why are we not doing that now?

There is advice from the European Centre for Disease Prevention and Control, ECDC. The testing strategy paper tomorrow - and genuinely tomorrow - at NPHET is to finalise that deployment. The HSE is bringing the paper to NPHET tomorrow. Even ECDC guidance out this week, I think - and which was shared with the Covid-19 committee - refers to the frequency of testing that may be required in long-term residential care settings. When we map that out, it is possible to see how we quickly get through capacity. I expect news on that issue in the coming days.

I am sharing time with Deputy Paul Murphy. I have two questions for the Minister. The first concerns testing of front-line healthcare workers. Healthcare workers across the world have suffered a terrible toll in fighting this pandemic. In Britain, 200 NHS workers - doctors, nurses, care assistants and auxiliary staff - have died. It has been a terrible toll. In Ireland, more than a quarter of front-line workers have contracted the virus. That is 25% and that has also taken a huge toll.

It takes three days for a front-line worker to be tested and for the result to come back. Does the Minister envisage a time when the period relating to testing front-line workers will be much shorter? It has to be under 24 hours. I offer the example of a nurse who does a shift, finishes work and is then tested for Covid-19.

Does the Minister envisage that nurse having to work his or her next shift, which may be the next day, without having received a test result? It seems impossible that this could be allowed.

I thank the Deputy for raising this matter. I would appreciate his privately conveying to me any examples he has of such situations. Although what he stated is correct, the HSE in its plan has given a commitment that, starting from Monday, 18 May, it will take an average of one or two days from a swab being taken for test results to be received. The overwhelming majority of people should be receiving results much more quickly than was previously the case. That is certainly the feedback I have received from people, including GPs, this week. I am sure the Deputy will be able to point me to examples of where it is not the case and I would welcome him doing so. The process turnaround times have significantly improved. The advice for anybody with symptoms is to self-isolate until the test results are forthcoming in order that he or she will not accidentally spread the virus. That would be my advice to anybody who fears they may have contracted the virus.

My next question is not in respect of Covid. Last year, the Minister made an announcement regarding access to Spinraza for those living with spinal muscular atrophy. Unfortunately, the response I received yesterday to a parliamentary question indicates that fewer than half of the applicants approved for Spinraza have received it. Glen McHugh Farrelly, one of those applicants, is 19 years old and a student at Maynooth University. He is frustrated by the process. He thought he was going to get Spinraza at this time last year and would be able to move on with his life. However, 18 of the applicants have not received the drug. The Minister knows as well as I do that time is of the utmost essence in the context of this drug and the condition. Can he give any assurance to those 18 people and their families that they will be able to access this drug as soon as possible?

I know the Deputy has been advocating on behalf of this group of patients for a considerable period and I thank him for his work in that regard. What he has stated is correct. My officials and I have met several Deputies, including him, in respect of this matter, and I have met several of the patients awaiting this drug and their families. I am disappointed that some are still waiting for it. Rather than giving false hope or false commitments, I will arrange to meet the Deputy via videoconference or telephone early next week and I will speak to the CEO of Children's Health Ireland in the meantime to try to get timelines. I will revert to the Deputy on the matter.

In a response I received yesterday to a parliamentary question I tabled regarding my repeated requests for a breakdown of expenditure under the agreement with the private hospitals to be published, the Minister claimed this information is commercially sensitive and, therefore, will not be published. I have written to the Ceann Comhairle under Standing Order 44A to complain that the Minister has not answered the question and ask that he request that the Minister does so. I have a very simple question for the Minister. Has he at least seen the breakdown of costs for April provided by the private hospitals?

I have not yet seen that breakdown of costs. I expect to be briefed on the matter by the Secretary General or another senior official of my Department as part of the review process we intend to undertake as per the agreement. That is due to commence at the end of this month. It is a review process of 30 days. I have not yet seen the breakdown of costs but I intend to be briefed on it.

We have a situation whereby the State has now paid €112.4 million, as I understand it, to the private hospitals owned by, among others, Denis O'Brien, Larry Goodman, etc. We know from reports that the State is paying up to four times as much per bed as is paid in the United Kingdom. We are now finding out that, two weeks after the figures were to be provided by the private hospitals, the Minister has not looked at those figures. We are expected to be okay with that and with the fact that he has repeated in writing that he is refusing to publish the figures on the grounds of commercial sensitivity. As a result of this, the public will not get to see them.

The public is asked to pay the bill for this, which is substantial, but does not have oversight. This makes a joke of the idea of the open books model which was touted by the Government. The sum of €115 million per month is more than the entire debt write down for Siteserv, with which it was claimed there was no problem at the time but which then required an inquiry. If the Government, the State and private hospitals have nothing to hide here in terms of the deal then I do not understand why these figures are not published. This is an arrangement between the State and all of the private hospitals. The only way we can understand why we are paying what look like - although we do not have the full information - extremely high fees per bed is to publish the accounts. The public is paying for this and has a right to see the receipts and to know what is happening in our health service.

The Minister has said in the past that in retrospect, the Comptroller and Auditor General will be able to look at this but the idea that behind closed doors an accountant will look over costs is simply not acceptable. We are talking about €500 million of public money, potentially, by the time this is finished, or something close to that. Again, I ask the Minister to look at the costs. I also ask him to intervene to, at the very least, allow Deputies to view the figures but they should really be published. The public has a right to know.

I must say that I find the comparison with Siteserv a little grotesque when one remembers what we were trying to do here. We were trying to make sure that we had ventilators and rooms for Irish people who might be struggling to breathe and fighting for their lives during a pandemic in which we could have seen 39,000 of our citizens die at this stage. I will never, ever regret making sure that we did everything we possibly, humanly could to obtain access to every single bed, ventilator, nurse, doctor and healthcare professional possible in this pandemic. If that allows Deputy Paul Murphy to score points or play politics, that is okay. There are important questions that he should ask as a Deputy on these matters and I have no difficulty with that. I fully respect his right to do so but trying to elide everything in a big conspiracy theory involving Siteserv is beneath him.

The HSE received information on this on Friday which is currently being analysed. The Deputy will have to pardon me but the information was only received by the HSE last Friday and this is Thursday, in the middle of a pandemic. The Deputy will have to pardon me for not yet analysing information that must go to the HSE, to an accountant and then be relayed to me. The information sought is in line with the heads of terms for the arrangements, which I laid before the Houses of the Oireachtas on 16 April. It includes the management accounts of the hospitals for the six months prior to the arrangement and the information as set out in schedule 2 of the heads of terms. The information is being verified by a firm of accountants on behalf of the HSE, which is the appropriate thing to do. Of course there is commercially-sensitive information therein and most people in this country will understand that, but it is intended to publish summary financial information regarding the arrangement in due course. There will obviously be recourse to the Comptroller and Auditor General, the Committee of Public Accounts and there will be lots of scrutiny but obtaining this capacity was number one, two and three in terms of our priorities and making sure that we had access to as many beds as possible for a surge which, thankfully, has not yet come but which may come in the future.

I welcome the opportunity to participate in today's debate. I offer my sincere condolences to the families and friends of those who have died over the past week due to Covid-19. The number of deaths is decreasing, which is to be welcomed but the sorrow and grief of those who have lost loved ones to this terrible virus is as painful as at any other time. I would also like to take this opportunity to offer those who are currently fighting Covid my full support and I wish them well during this very difficult time. I also want to take this opportunity to thank the incredible healthcare workers throughout the country, and particularly in County Louth, for the amazing personal sacrifices they have made to keep us all safe.

As the Minister knows, more than 20 residents of the Dealgan nursing home in my constituency have died from Covid-19 since the beginning of April. As I have said previously in this House, I am not interested in a blame game but lessons must be learned and admissions must be made regarding how certain aspects of the Covid-19 outbreak were handled by those in power.

In order to ensure the same mistakes never happen again, it is vital to spell out how certain areas and sectors were overlooked, abandoned and left to fend for themselves for far too long, until it was too late to stop the virus from taking hold. Nursing and residential homes are the most obvious victims of this neglect. It was known from the very start of the Covid-19 outbreak, from what happened in other countries, that the elderly and those with underlying medical conditions were most at risk from this virus, yet nursing and residential homes ranked near the bottom of this list when it came to Ireland's preparations for the outbreak here.

I have a real concern that the management of nursing homes will be made scapegoats and blamed for the high number of deaths that occurred in these settings. Management and staff always have a responsibility for what happens on their watch but the tragedy that happened in so many nursing and residential homes could have been greatly reduced had they been given assistance from the top, as was needed from the very start. It is utterly unacceptable that immediate support was not made available when it emerged that only seven of the 24 nursing staff were available to work in Dealgan House Nursing Home due to staff contracting the virus or being suspected of having the virus. If coming to the aid of nursing homes had been treated as a national emergency, then replacement of staff, provision of PPE and regular testing would have occurred as a priority at the start.

The record is very clear that this did not happen. The result is a huge number of casualties, loss of life and utter devastation for families. All that the families are looking for is answers. They do not want to hear excuses or admissions from those in power regarding the failure to protect their loved ones. The only way lessons will be learned is by ensuring the same neglect of the most vulnerable in our society never happens again.

Does the Minister accept that the Government's failure to act early enough in safeguarding nursing and residential homes contributed to the devastating outcome that befell those homes? Can he confirm that he is planning to set up a public inquiry into what went wrong in nursing homes like Dealgan House Nursing Home in Dundalk?

I thank Deputy Fitzpatrick for raising this important matter. In regard to Dealgan House Nursing Home, I very much welcome the fact HIQA is due to carry out an inspection in regard to Dealgan and I will be guided by the outcome of that, as I am sure the health service will be. HIQA is the regulator and has the ability to go into any nursing home and inspect it, and it is right and proper that it is going to do that.

I join with the Deputy in paying tribute to staff. An impression has been given, not by the Deputy but by some, that suggests every nursing home failed to prepare. My experience, from very detailed engagement with nursing home owners and staff, is that people have worked extremely hard. This is a very infectious virus. It is hard to keep it out of the Deputy's home and mine, and even harder to keep it out of a home where many people live together, in particular people who are vulnerable. That is not a reason we should not try to rise to the challenge. The world over, this has been a real challenge. Some countries have not tested in nursing homes and some do not record deaths in nursing homes. Painful as it is, we put everything out there for people to see, so we can learn and can do better, which is very important.

I am sure there are learnings and there must be learnings, but I do not accept that Ireland acted slowly in this regard. If one looks at the interval between Ireland having its first case and making the recommendation around visitor restrictions, in this country it was 14 days; in South Korea, it was 47; in Belgium, 36; in Sweden, 61; in Spain, 41; in France, 47; in Norway, 16; in Canada, 46; in Germany, 48; in Australia, 53; in the Netherlands, 22; and in New Zealand, 23. Therefore, we moved very quickly in terms of putting visitor restrictions in place and also providing personal protective equipment to what are for-profit, private businesses, and it was right and proper that we did that. There was also a funding scheme, HIQA protocols, testing of asymptomatic residents, testing of staff and a plan was put in place in that regard.

There is absolutely a need to make sure we look around the world and check if there are more things we can do. That is why I have announced today, on the basis of a NPHET recommendation, that we will set up an expert review panel, with a geriatrician, a public health expert, a senior nurse and a public interest representative. The panel will look at what we have done in Ireland, what has gone well, what we can do more of, what we need to do more of, what other countries have done and what learnings there are. The panel is to report back by the end of June. I will be happy to share that with the Deputy then.

I want to raise another important issue regarding the recent handling of the Covid-19 outbreak, that is, the "do not resuscitate" order. Most families are totally unprepared when confronted with the discussion around a "do not resuscitate" order when a loved one becomes gravely ill.

I am aware the HSE guidelines place an obligation on healthcare providers to consult with patients where possible or, alternatively, with family members regarding the issue of "do not resuscitate" orders. However, the reality is that many families are too overwhelmed when they are faced with this situation to be able to make a fully informed decision on the spur of the moment. I know for a fact that many families who have been in this heartbreaking and terrible situation could not fully grasp what they were being asked and were 100% dependent on the information given to them by those caring for their loved ones. They are now left with questions as to whether they did enough to save their loved ones and the answer, of course, is that they did. Any of us can only act on the information we are given. My concern is that patients and families are not significantly informed on the matter until it lands at their door.

A HIQA report from a number of years back referred to the fact that "do not resuscitate" orders were written on the medical charts of patients in some nursing homes without the consent or knowledge of the next of kin. This is an unbelievably serious matter and the only response to this is more openness and public debate on the issue. I am aware that many families were put in impossible situations in recent weeks, with a feeling of being kept in the dark and feeling overwhelmed about what they were confronted with regarding their loved ones who became gravely ill. In many cases, sadly, they died. I stress that I am not singling out any specific nursing home. However, the area of "do not resuscitate" orders needs urgent attention.

I have nothing but respect and admiration for the heroic healthcare workers who have been standing in the firing line in recent months to help save the lives of others. They are true heroes. I want to put on record my praise and gratitude to them in the strongest possible way. However, as a society we cannot allow the situation to continue whereby families feel totally overwhelmed when confronted with issues such as "do not resuscitate" orders. In some cases, they believe that doctors are making judgments on whether their loved one should receive additional medical care not based on clinical considerations but on quality of life and other non-medical considerations.

The lack of a proper public consultation on these issues before the Covid-19 outbreak has placed us in this impossible situation. It has caused huge heartbreak and even despair for many families. The answer required is not an uncontrolled discussion on medical ethics but one that openly embraces the view of those who have been left out of the debate and sidelined in recent years. I call on the Minister to address this as a matter of urgency.

I thank Deputy Fitzpatrick for raising an important and very sensitive matter. These are major decisions that we take as individuals and sometimes take in consultation with our families. I can only imagine how difficult it is for people at a time of huge grief. I will reflect on what the Deputy has said and will respond to him in writing. I hear very clearly his call in this regard and I will consider the HIQA documentation he has referenced and will reply to him in writing.

What percentage of residents in nursing homes and residential homes suspected of contracting Covid-19 between February and May 2020 were admitted to hospital for treatment? I know the percentage of residents from such homes admitted to hospital during a typical flu season is quite low. We all know that Covid-19 poses a much more serious health risk than a flu and I would have thought the percentage of residents being admitted to hospital should be considerably higher. There are many distraught families who have lost loved ones in nursing homes and residential settings who are looking for answers. I would like an answer on the exact percentage of residents admitted to hospital for treatment of suspected Covid-19 or after testing positive between February and May 2020. Will the Minister indicate this percentage? If he needs time I ask him to give a commitment to place the precise figures on the public record as soon as possible.

I thank the Deputy and I am sure the Minister will respond directly to him.

Healthcare workers have been heroes since the outbreak of the coronavirus throughout the country. During recent weeks, essential front-line healthcare workers from various parts of my constituency and beyond have contacted me to express their concerns about the fact they have no time to do homework with their children. They are worried that come September, when schools reopen, their children will have fallen behind. The parents of some children were home full time to offer them support and home educate them but these were not. Many healthcare workers work 12-hour shifts and have little time with their children. Some were even forced to isolate from their children when at home to prevent the potential spread of the virus within their homes. What provisions are in place for the children of these healthcare workers?

I propose that they should be given additional support in tandem with the July provision scheme already being rolled out for children with additional needs. These schemes should be run simultaneously in primary schools across the country.

I would like to concentrate in my second question on coronavirus testing and the need to get tests carried out quickly with same-day or next-day results. I have had all too many calls with people waiting for days and weeks to get results so they can get cancer treatment or other urgent procedures done. The State has sent samples to Germany to speed up results. This whole process came at a great cost as a PC-12 aircraft had to be acquired by the Air Corps. No one would argue with that until now we find out that if a small bit of investment was made, labs in Ireland could have given us thousands of same-day or next-morning results at a fraction of the cost. I refer to excellently run companies like Animal Health Laboratories Limited in Bandon which is giving same-day or next-morning results for the HSE on a small scale. With a little support it could turn out thousands of results weekly, saving the State millions of euro and saving lives. Can the Department of Health look deeper at companies like Animal Health to carry out tests in this country, thus creating badly-needed employment and saving the State significant costs and probably saving lives?

I join with the Deputy in paying tribute to healthcare workers across the country. The point he makes is a very interesting one, that they have been at work when many of us have been staying at home, and the Deputy raises their concern in respect of their children and their children's education. The Deputy will understand that it is a matter for my colleague, the Minister for Education and Skills, but I will certainly raise the matter with him and ask that he or I respond to the Deputy directly. I thank the Deputy for bringing it to my attention.

On the issue of testing, I hope people are beginning to see an improvement in the turnaround time. Job number one was trying to ramp up capacity so that we have capacity to do up to 15,000 tests a day or 100,000 tests a week from this week. Job number two, which is equally important, is the turnaround times. I am very pleased that the HSE has now outlined how it intends to provide an average of one to two days of a turnaround time from swab to result. I am certainly getting feedback of an improvement in turnaround times but I will keep a very close eye on it. On lab capacity, that is a matter for the HSE but I would be happy to take examples the Deputy has given me and ask the HSE to respond. I would point out that we are now using 41 labs, which is a very significant lab capacity. That has grown from just using one lab in UCD and has been built up right across the country. If there is potential to do more, I would be very happy to hear about that from the Deputy.

When will the Minister employ a pain consultant for children with chronic pain? We have a family in Limerick where one of the parents and two of the children were diagnosed with Ehlers-Danlos syndrome. Patches for pain alone cost €130 for one child and this is not covered under the medical card scheme. These children are in chronic pain. The pain gets so bad that the child falls unconscious. Some 16 times in the last eight months there has been an ambulance transfer to the accident and emergency department. With no dedicated pain consultant assigned to under 12s, the HSE has directed them to rheumatology, which is not effective as they say they are not trained in this syndrome. The public are on waiting lists for rheumatology of two and a half to three years. They have been promised a consultant from Belfast but this has not materialised. A waiting list for physiotherapy is up to two years currently and there are 5,300 signatures to a petition looking for a pain consultant. This mother is distraught and has been up all night with her children crying. It is not satisfactory and I need the Minister's help.

I thank the Deputy for raising this important matter. I do not have the information to hand but from my memory, I understand that there was a pain consultant working within Children's Health Ireland, I think in Crumlin, who left the position for a variety of reasons. I wish the consultant well and understand this person was very highly regarded by patients and families who are really feeling that loss. The last time I checked I understand the HSE was in the process of trying to recruit a replacement. On foot of the Deputy's query, I will take the individual details of the cases he has referenced and ask the HSE to respond to him directly. I will also find out where they are at in terms of recruitment of a new, full-time consultant. In the interim the HSE was trying to put together a multidisciplinary team, which sounds similar to what the Deputy was saying, but I understand that is not the same as what the families want and need. I will revert to the Deputy directly and will ask the HSE to come back on the specific cases.

A company in west Limerick has made great inroads into producing a complete process for temperature monitoring of staff. This company operates to ISO and ICE standards and Food and Drug Administration, FDA, guidelines. It has tested the process in many situations and it is now at the highest standard. The issue for the company is that it is competing with other companies that have brought in equipment from countries such as China. These do not have the same approval as Irish companies and using their methods does not have back-up for temperature screening. This is not a level playing field and is not reliable. We have been told that this virus originated in China and now we promote businesses from China to come here to supply temperature monitoring equipment. We have companies in Ireland, including in Limerick, that produce this equipment to the highest standards, including the HSE standard. We should be looking here before any equipment is brought in from China. China has given us enough. It is time that we looked after our own companies to fix the problem.

The first thing we do when sourcing any equipment is to try to source it from wherever we can. I am very pleased that we were able to secure some international supply chains to get access to personal protective equipment and so on. The Deputy's general point is on the importance of trying to support indigenous industry. This issue has been raised by a number of Deputies in the House. I have spoken to the Minister for Business, Enterprise and Innovation about how we can work together to support Irish businesses in this area and I intend to do so again. We are, however, very grateful to international partners for providing us with that equipment at a time when we could not source it in other places.

Some taxis are open for business with health guidelines and for multiple passengers. Driving instructors and testers would have a maximum of eight people in their vehicle daily. There needs to be some easing of restrictions in this regard. One solution could be for instructors to use only their own cars, which are Road Safety Authority, RSA, compliant, and for regulations to be put in place that all instructors abide by the hygiene standards laid down by the RSA. Many instructors' cars have antibacterial seat covers and cars can be sanitised if necessary after every lesson. Machines for sanitising vehicles in a ten-minute cycle cost between €400 and €500. Maybe an incentive could be used to fund or partially fund this cost. Instructors could also operate a dual control system while wearing masks and gloves. They have the use of a hand-held thermometer. They are being told, however, that there can be no driving lessons or testing until social distancing restrictions no longer apply. It is mandatory for a student studying to be a paramedic to hold a C1 driving licence. That licence has now been deferred for 12 months due to Covid-19 but it is mandatory to hold a full car licence for paramedic training. A person who does not hold a full licence cannot take up a paramedic training course in college and this course cannot be deferred. Once again, it is front-line workers who are affected. We need to ease some of the restrictions in that area.

I thank Deputy O'Donoghue for highlighting this issue. My Department provides public health advice and other line Departments interact. I will certainly bring the issue raised to the attention of the Minister for Transport, Tourism and Sport and ask that his Department respond directly to the Deputy.

I thank the Minister for his responses to the questions I raised when we last met. I have some specific questions on nursing homes and all residential centres that have now been tested. Have all the tests come back? If not, why not and what is the reason for the delay?

I believe they have but truthfully I would need to-----

Perhaps the Minister will confirm it in writing.

I will confirm that in writing so as not to mislead the Deputy.

The Minister referred to 41 laboratories. Are we now using all our laboratory capacity in Ireland or is further capacity available?

I believe we now have enough laboratories on board to deliver 100,000 tests per week. There are 41 laboratories being used across the country, mainly hospital laboratories, as well as some academic laboratories and private laboratories. I will get a breakdown of those for the Deputy.

Will the Minister confirm in writing that we have sufficient capacity in Ireland?

Will we, therefore, stop using German laboratories?

The Minister might confirm that.

I want to zero in on nursing homes. Again, for the record, I do not believe they were prioritised. My office has checked when it came to our attention from Europe that there were serious problems in nursing homes. It was way back in early March. We did not learn from other countries but perhaps we will learn now.

I turn to private hospitals and preface my remarks by saying I am an absolute advocate for public medicine. However, the manner in which the arrangement with private hospitals has been carried out has not been fair or equitable. The Minister did not lay the contracts before us. He laid the heads of agreement but the rest is commercially sensitive and we cannot see it. I am in receipt of quite a lot of correspondence telling me the hospitals in Galway are at 15% to 20% capacity. We are paying €115 million per month. We have major waiting lists and our two private hospitals in Galway city are at 15% to 20% capacity. The hospital itself - I must be wrong about this figure but it is what I have been told - was at 30% to 40% capacity as of 15 May. The Minister has stood in the Chamber and told us he had to make such arrangements, and certainly I welcomed the narrative at the time that we were taking over the private hospitals to deal with a pandemic. However, we are not utilising them.

On top of that, I was talking to somebody yesterday about Merlin Park Hospital in Galway, which has a state-of-the-art rehab service. It has a gym and all types of therapists but it is now lying idle because, under this deal, the Government transferred the patients from that wonderful facility to a private hospital. It took the therapists and patients into the private hospital to allow them to get up to 15% or 20% capacity. It sent the nurses into the public system and left the system empty at Merlin Park, and that is to mention only one service. None of the way this has been done makes sense to me. Surely anybody with a bit of sense would know that when the terms and the heads of agreement were signed, it should have allowed for change. Will the Minister please give us a copy of the contract so that we can see what we are dealing with? Will he state we can change this so that we can bring capacity up to 100%?

I have two letters to hand, one from someone who has been on a waiting list for some time but is not being taken for treatment and another from a person who has been diagnosed with cancer of the uterus. The latter has got her diagnosis but there is no surgery because a memo two weeks ago stated there would be no surgery until September. There are many other examples while our hospitals are empty. Furthermore, there is a complete lack of equity and fairness in respect of how consultants are being treated. Private ones can see no private patients, whereas other consultants on mixed contracts can see private patients in public hospitals.

I do not expect the Minister to agree with me but surely he will admit we have a serious problem on our hands in the way this is being carried out.

We will not have the nursing home debate because we do not agree on that and it would take up time. We will get to debate it one day.

There is vacant capacity in the private hospitals but, to be clear, we do not want to get the capacity in our health service to 100%-----

It is at 15% to 20%. Will the Minister please deal with the figures?

Let me agree with the Deputy on this point. I want us to see greater utilisation of that capacity but, as Dr. Colm Henry of the HSE has said, we have to do it in a safe manner. Even in the case of surgeries the Deputy talks about wanting to be recommenced, it is not just a matter of flicking a switch. We will have to look at how we can provide it safely and how we can bring people back into our health service safely-----

How does the Minister stand over Merlin Park Hospital being left empty?

I will have to find out from Saolta why it decided to move patients. Presumably, it was a clinically appropriate decision to do that but I will check that out. A review at the end of May is built in to the agreement and I am very open to the idea of looking at how we can use the hospital. I will write to the Deputy on the matter.

I am sharing my time with Deputy Harkin. We have reached a stage on our roadmap where we can have a McDonald's but we cannot have a cancer screening. Is that satisfactory to Deputy Harris, as Minister for Health?

I know why the Deputy makes that point but I certainly would not be in any way flippant in respect of this. The decision to suspend cancer screening was taken by clinicians on public health grounds. I do not have responsibility for McDonald's but I do have responsibility for the safety of people in our health service, of its staff and of the women and men of Ireland who use it. The decision is in line with the advice not just in the Republic of Ireland but in Scotland, Wales, Northern Ireland and New Zealand.

I have yet to find another country that has turned back on its screening programme. I want to turn it back on but I want to do so in a safe way and I will be led by clinical advice. Within two weeks, we will have the non-Covid-19 care plan from the HSE, led by clinicians, which will determine when it is safe and how they intend to recommence screening.

In normal times the Minister would not have responsibility for McDonald's but given the extraordinary powers this House gave him, it seems he has in his regulations a responsibility for everything. I urge him to look at what the priorities are because sometimes the priorities do not seem to make sense to ordinary people across this land.

My priority with Covid-19 is to keep as many people in this country alive as possible. Through the incredible efforts of the Irish people, we have saved an awful lot of lives. My ongoing priority is to manage the virus to a point that we do not see a second wave and that we continue to see the virus suppressed while we try to live alongside it. That will be a difficult and delicate balance. My priority at that point is to begin to safely turn back on non-Covid-19 services. In his role as a Member of this House and as Chairman of the Special Committee on Covid-19 Response, the Deputy will see how challenging that will be. We will have to run our health service in a very different way. There will be opportunities in that but there will be challenges too.

I thank the Minister for coming in to answer our questions. I was listening earlier when he spoke of the HSE plans for non-Covid treatment. He said such treatment had to be safe and clinically effective but did not say it had to be timely. The Minister also said there would be a plan within two weeks but unless intervention is timely, it is not effective. I am not being political about this. I was about to say it is only the Minister and I in the Chamber but there are still only a few of us here. I am really concerned that we are watching a slow car crash in front of our eyes. Many people are suffering unnecessarily and many will die because of but not of Covid.

While I am not putting the responsibility for that on the Minister's shoulders, one of his areas of responsibility is the contract with the private hospitals. I heard the Minister say he had an open mind on the contract and that he will look at it again. I ask him to do so because I have had so much correspondence about it. For example, a gynaecologist in a private hospital in my constituency contacted me. Many of her patients need life-saving, urgent interventions and she cannot perform any of them. I have also been contacted about the local podiatry service for diabetics. To paraphrase what I have been told, unless patients are in danger of needing amputation, they cannot have their toenails seen to. That is the bottom line. Those are the kinds of circumstances we need to act on speedily. I await the Minister's response. I have spoken to him about this before in this House and while I do not say we should cancel the contract, we should review it, change it and get it to work more efficiently.

We have a two-hour time limit here. If any of us spends more than two hours in the Chamber and it transpires that someone here has Covid, we have to self-isolate for 14 days. That is the recommendation that has been given. We are socially distanced here and we use hand sanitiser entering and leaving the Chamber. Can the Minister make the detail of the relevant risk assessment available to Members?

I am open to correction but I believe the risk assessment was done by the Houses of the Oireachtas Commission. I did not carry it out but I hope the Houses of the Oireachtas Commission will make it available to Members if it has not already done so.

The point the Deputy made about deaths because of but not of Covid-19 is a serious and accurate one. This will be a major challenge for all of us. While I am growing in optimism that we will get through this Covid-19 pandemic, I am not ignoring the awful loss of life and pain it has caused. Our next big challenge will be secondary morbidity and there is a huge body of work we need to do on that.

On the private hospitals, we effectively took them over for a purpose. If that purpose changes, we have to be big and brave enough to change as well. I have an open mind on that. There is a structured review process to go through that will involve more than my Department. It will involve the Department of Public Expenditure and Reform and others. It will start at the end of this month and run until the end of June. I will approach that with an open mind. However, we will need extra capacity. How we use that capacity is a discussion we should have.

For the information of Deputy Harkin, the document she seeks is available.

Sitting suspended at 4.20 p.m. and resumed at 4.40 p.m.