Covid-19 (Health): Statements

We move now to statements and questions and answers with the Minister for Health, Deputy Simon Harris. The Ministers has ten minutes for his opening statement.

I very much welcome this opportunity to once again update this House on the Covid-19 disease and our national response to it. First and most important, I wish to express my sympathy to the family and friends of those who have been lost to this disease since I was last in this House. It is important to say that each private loss is also a loss to our country, and we offer our deep and sincere condolences to all those impacted.

I am pleased today to be able to report some good news to the Dáil. The modelling data, compiled by Professor Philip Nolan and his team, confirms Ireland’s reproduction number is now between 0.4 and 0.5 this week. It suggests a stable transition where we have kept this virus under control while moving to the first phase of reopening our society. This, and other key indicators, give grounds for cautious optimism. The modelling also shows the key measures of severity. The number of people in hospital and intensive care has also remained stable through the last week.

We have seen one to two admissions a day to intensive care units and ten to 15 admissions a day to hospital.

It seems at this stage that despite some more businesses opening, and more people moving, we, the Irish people, have managed to keep control of this virus so far. That is down to the people of Ireland. It is down to their incredible efforts and their incredible self-discipline. People have adapted their behaviour to the realities this virus brings. They have kept their distance, they have washed their hands, and they have adopted the public health advice. They have worked with us to try to find a safe way of living alongside the virus. That is really what the next number of weeks have to be about, namely, while the virus is here, how can we safely live alongside it? We are very grateful to the Irish people for all they have done, all they are doing, and all they are sacrificing.

All of our efforts now, our entire national effort, must be to keep the reproduction number below one, and to keep cases low so that we can keep this virus as weak as possible. Once that reproduction number remains below one, this virus is continuing to be suppressed. The understandable temptation might be to think the battle is won and we can drop our guard at last. That would be an extremely dangerous position to adopt because unfortunately this is certainly not the case. The more we open up our society and economy, which is what we want to do, the more the obligation falls on each and every one of us as an individual to continue to keep ourselves and others safe by following the public health advice that has been shown to date to work.

We are all rightly concerned about the possibility of a second wave of Covid-19 in our country. We have to be clear about who is in control of that possibility. It is not someone else. It is us. This disease cannot come forward on its own. It can only move through being transmitted by people. It is our actions that will decide the behaviour of this disease. We have kept it at bay and we can continue to do that if we stay focused and continue to push home our advantage, as we move to reopen our society and our economy. We hope to move forward, but we will continue to be led by the data on the behaviour of this disease and our capacity to respond to it, and by the public health advice that has brought us this far. Cabinet will decide towards the end of next week if we can move forward to phase 2, based on public health advice.

I know there has been significant debate, and rightly so, in this Chamber regarding nursing homes and long-term residential care facilities. I want to assure this House that the Department of Health, the HSE, HIQA, nursing home operators, and front-line staff have all worked tirelessly to help stem the spread of this virus and protect our most vulnerable. People will seek to apportion blame but we should not forget that the villain here is the virus.

Over the past number of weeks, I have made contact with residents of nursing homes across the country using FaceTime in order to talk directly to them. They are full of steel, resolve and determination, but they also spoke of loneliness. When we took the decision to introduce visitor restrictions we did so with a heavy heart, knowing the impact this would have on people in nursing homes, and on their friends and families. I am pleased to report the health service is examining the issue of easing some visitor restrictions and assessing whether we can allow visitors to meet members of their families outside. I am not suggesting that we can return to normal with visiting, and I do not wish to raise any false hope, but I want residents in nursing homes today, and their families, to know we are looking at this and we are hoping to be in a position to make progress on it shortly. There has to be a safe way of bringing about some level of visiting, and I have seen very innovative ways of doing this in other countries as well.

I also want to update the House on the outbreaks in nursing homes. As we know, we have experienced a significant number of outbreaks in nursing homes. Today I can confirm outbreaks have been stemmed in 29 of those. This means there have been no new cases of Covid-19 in those clusters more than over 28 days. I want to thank nursing home owners and staff for their heroic efforts in the face of great challenge. I am also pleased to see there has not been a new outbreak in a nursing home in over a week, according to the chief clinical officer of the HSE today.

The protection of those in our nursing homes continues to be my priority. As I mentioned earlier, we have established a Covid-19 nursing home expert panel, following the recommendation of the National Public Health Emergency Team. Until now the actions we have taken in relation to our nursing homes have been designed to assist the sector to prevent and control outbreaks of Covid-19. We recognise this virus may well be with us for months and perhaps years to come. We must, therefore, continue to plan how to best protect residents and staff in our nursing homes into the future, asking how can we do better, what are our current measures like and are they effective, what are other countries doing and can we learn from them, and what is best international practice. That planning will be undertaken by the Covid-19 nursing home expert panel.

I am really pleased Professor Cecily Kelleher agreed to chair this for me, and I met with her yesterday. The expert panel will assess, as I have said, the measures already taken, both nationally and internationally, as well as emerging responses to what is still a new virus, to ensure we are doing everything we can in our nursing homes to prepare for and respond to the ongoing threat of this disease in the months to come.

I very much look forward to the first report and the recommendations from Professor Kelleher, due at the end of next month.

We talk a great deal about older people, and rightly so, but on the other side of the age spectrum I am concerned about the impact this pandemic is having on our children. Childhood is a time of joy, innocence and exploration. This pandemic has deprived them of time with their friends and of school time, and that is bound to have an impact. Summer is here and, while it will not be a normal summer, we must look at ways to help our children resume some form of normality. I hear from children right across the country and from their parents. This is a very tough time for our kids and I am not sure we are talking enough about the impact of this pandemic on children. I am pleased to tell the House that NPHET is currently examining the matter of how we provide more guidance and assistance for children and their families, and it hopes to be in a position to make some decisions on this next week.

On the matter of travel, from tomorrow it will be mandatory for passengers from overseas, irrespective of nationality, to complete a Covid-19 public health passenger locator form on their arrival in our country. We have put this measure into law because this form is very important in our overall public health response to this disease. The form facilitates follow-up checks to make sure that people are staying where they said they would stay and it allows us to do more accurate and faster contact tracing in the event of a confirmed imported case. It is really important, as we continue to suppress the virus here, that if there is an imported case we can move very quickly to contact trace and isolate. We will require all passengers, with exceptions such as for aircraft crew, to complete this form. The regulations will be further reviewed by me on 18 June. If they must be continued, they will be kept under very regular review so that they will only be in force for as long as they are necessary.

The introduction of this measure, along with the public health advice for self-isolation for 14 days and, I must say contrary to what I heard on the airwaves this morning, the continuing public health recommendation against non-essential travel off the island of Ireland are to ensure that we can continue to protect the progress that we have made against this disease. I will continue to take my travel advice from public health experts.

It is tempting to look only to the future and to wish to leave behind the sacrifices and the hardship of these last months as quickly as possible. It is very understandable but we must guard against moving too soon or too fast. We must remain patient and be vigilant but there are signs for cautious optimism. If we continue to practice the behaviours that we know will keep ourselves and others safe, we will keep saving lives, we will weaken the virus and we will strengthen our position in being able to take more measures and more moves forward in terms of our roadmap, hopefully by the end of next week.

I thank the Minister. We now have 15-minute slots for Fianna Fáil and Sinn Féin and ten minutes for all other parties and groupings.

I will share time and will take the first five minutes.

Yesterday, hundreds of pages of correspondence between Nursing Homes Ireland and the State were released. They paint a very dark picture of staff having to use painter's overalls and goggles from local schools to protect themselves; of four-week delays in testing; and of no voice on NPHET or even on the subgroup looking at nursing homes. The Minister said to me recently that HIQA was its voice. I put that to HIQA yesterday at the Special Committee on Covid-19 Response. HIQA said it was not the voice of nursing homes on those groups.

The correspondence is damning when it comes to patients being transferred from hospitals to nursing homes. It began in early March. It began before there was guidance in place for the testing of those patients, before there was guidance in place for nursing homes on how to care for those patients, and before nursing homes had the PPE needed to care for those patients.

When some nursing homes refused, the HSE wrote to them on 6 March. Here is one of the things it concluded. It concluded that there were no grounds for greater concerns about discharges from hospitals at that time, as every possible risk assessment and medical assessment necessary would have been carried out before the patient was confirmed suitable for discharge. That was before any guidance was issued.

The guidance was issued four days later, on 10 March, and it was sobering. Patients from hospitals that have Covid patients, but where Covid has not spread around the hospital, were not tested and were not isolated. Regarding patients from hospitals where there were Covid patients and Covid was spreading through the hospital, if those patients were asymptomatic, they were not tested. If they were not a close contact of a Covid patient, they were not even isolated.

If they were in a hospital where there were Covid patients and where Covid was spreading, and they were a close contact of one of those Covid patients, they were not tested; they were just isolated for a few days. The representatives of nursing homes asked for stricter measures and said that the guidance contained "no practical guidance to nursing homes on how to reduce the risk of transmission" or to inform regarding the procedures to care for residents or staff who may present with symptoms. No information was provided with regard to accessing PPE. The nursing homes were screaming for help. On the same day of that guidance, NPHET actually advised that the visitor restrictions that nursing homes themselves had put in place were unnecessary. That is where NPHET was.

A week later the Minister launched the Government's 60-page action plan, which mentions nursing homes once. The only mention of nursing homes was that they were somewhere that patients should be discharged to. That was it. As of today, 884 women and men have lost their lives in nursing homes due to Covid. It is over half the total number of fatalities. Does the Minister accept that the transfer of non-tested and non-isolated patients from hospitals with Covid in them most likely contributed to those clusters happening in nursing homes? Will he commit to finding out how many of those outbreaks in the nursing homes were likely to have come from the patients who were transferred?

I watched much of the committee hearing yesterday. It was disappointing that officials from the Department of Health were not invited to a committee hearing on nursing homes. Their ears must have been burning but they were not in a position to speak. Nor were representatives of the HSE invited to give an opening statement setting out what it has been doing. However, be that as it may.

Action 4 of the national action plan on Covid, caring for people who are at risk or vulnerable, is all about protecting older and more vulnerable people. There was engagement with the nursing home sector as far back as 19 February, when the head of the HSE met representatives of Nursing Homes Ireland. His note of that meeting specifically refers to his conversation about preparedness for Covid.

I am very conscious that the transfer of patients from one setting to another is done on the basis of clinical guidance and a clinical viewpoint. It would be done on the basis of a doctor deciding that it would be appropriate to transfer somebody. It is true to say that our position on testing evolved throughout the crisis. Ireland is probably one of the only countries to have decided to test all residents and staff in nursing homes regardless of symptoms. I do not accept - because I do not yet have the evidence to accept - that the clusters were caused by the transfer of patients from acute hospital settings. I am not sure that the timeline shows that either. I very much accept the point the Deputy made that this is something that should be established. I hope that the expert review panel, chaired by a public health expert with a geriatrician and a senior nurse on it, could also look at the overall issue of admissions and transfers, and discharges from hospitals. The Deputy raised a fair point in that regard.

I first raise the issue of home support services. In recent days older people in County Wexford received a letter stating if they did not wish to restart their home support service by 8 June 2020, their service will cease and they will be placed on the waiting list for home support services - in other words, use it or lose it by 8 June. Many elderly people are concerned and have contacted me about this. They have had to rearrange their home situation, often having to move into the home of a son or daughter because the normal care cannot look after them. This letter is totally inappropriate at this stage. It is basically telling older people they will have to move home and reuse this service or they will lose it. Based on the most recent figures, almost 900 people in Wexford are on the waiting list. Bizarrely in Carlow-Kilkenny there is nobody. The fear in Wexford of being put to the back of the list is very real.

I have a second question. I was contacted by a healthcare worker this morning. She was in contact with asymptomatic but Covid-positive patients. She has been waiting 14 days for her test results. I ask the Minister to comment on this and ensure healthcare workers are not waiting for 14 days for test results. She has been out of action for that length of time.

I have a final comment. There is now effectively cross-party support for the publication of the refreshed Vision for Change. Can that please be published?

I will follow up on the issue relating to the healthcare worker.

On home care, I am not familiar with the letter but I share the Deputy's view that this is a very nervous time for lots of people, including people deciding whether or not to resume these services and so on at a time when they are cocooning and that there should be a degree of flexibility and discretion shown. We are eager that people feel comfortable to resume home care again and to have vital supports back in their home but I understand that different people will think differently on that. I will pursue it with the HSE and the Deputy might provide me with the correspondence.

On A Vision for Change, my hope, if not expectation, is that a new Government will be formed in June. I would like to see it bring A Vision for Change to the Government in its first weeks. The document is ready but traditionally new policy initiatives are not taken to Government, that they need to be owned by the new Government. It is something with which the new Government should hit the ground running. It has been through Cabinet committee. My colleague, the Minister of State, Jim Daly, has put much work into it and it is ready. We should aspire to have it published in June. If a new Government is not formed in June, I can introduce it on behalf of the current Government. We should commit to publishing it then.

I now call on Sinn Féin. Apologies, I call Deputy Calleary. I hope he forgives me.

I would not like to steal Deputy O'Reilly's thunder.

There is a significant difference between himself and Deputy Donnelly.

I acknowledge the 1,615 people who have passed away. While this has been a very significant week, we can never forget these people or their families. I also acknowledge the vast work done across the country but today I focus on my own county, Mayo, with the work done by health workers, carers, home helps, family carers and other professionals, which has been immense and under hugely challenging circumstances. There are specific difficulties which I have spoken to the Minister about. I would like his reviews. There are difficulties in Mayo University Hospital in particular. Staff have contacted me and other public representatives on the continuing, up to last week, cross-over of staff between Covid and non-Covid units. Staff are moving between units, traversing through one unit to get to the other. Second, they have raised the inadequate physical space in the hospital between the Covid unit and the non-Covid unit which makes this crossing over between units inevitable. Third, they have raised the absence of an isolation unit in Mayo University Hospital and also the district hospitals in Ballina, Belmullet and Swinford. Are there plans, as we catch our breath from what may only be the first wave, to invest in capital facilities in hospitals across Mayo and the rest of the country, looking at the lessons learned in recent months and putting investment in place to ensure that these hospitals are ready for what may be an ongoing Covid situation?

What are the testing levels of staff at Mayo University Hospital as well as all district hospitals and health facilities across Mayo? Some weeks ago, great effort was put in. Has that continued? Has it been updated? What percentage of staff at Mayo University Hospital were tested?

Finally, there is the matter of derogation. An issue has arisen across the country where HSE occupational health may advise someone who is defined as a close contact not to work but their line manager can ask or derogate them to work. What are the rules around that policy?

I thank Deputy Calleary for raising the issue and join him in acknowledging the passing of many of our citizens from Covid-19. I often feel somewhat uneasy when we speak about progress in statistics and figures but we are not talking about them in a vacuum. This is a virus that has caused a lot of tragedy to an awful lot of people and we think of them. I thank Deputy Calleary for raising the matters on Mayo hospital. He was in direct contact with me on these issues. I am advised by Saolta hospital group that appropriate control measures are in place in Mayo University Hospital for Covid-19. As is the case across hospitals, Mayo University Hospital has adjusted how care is delivered to patients as well as continuously implementing updated national advice. Actions taken include streaming patients into Covid and non-Covid pathways. This did require some physical changes to the hospital, including a new entrance. Where possible, patients are treated in single rooms. However, given the infrastructure of the hospital, it is not always possible to provide single rooms for patients, which was the point the Deputy made about isolation facilities.

Patients who attend the hospital through the emergency department are also separated into suspect and non-suspect Covid-19 patients. Suspected Covid-19 patients who attend the emergency department are tested in rapid turnaround time. While every effort is made to ensure patients are streamed separately, occasionally it will happen that a person in a designated non-Covid space will turn out to be positive, but he or she may not have shown any symptoms. Patients who develop symptoms consistent with Covid-19 on a ward are tested rapidly and transferred to a Covid-19 ward if diagnosed positive. The hospital has separated its clinical staff into teams to minimise contact and to reduce the risk of healthcare worker and patient infection. Again, that is all based on the national guidance provided at that time.

Saolta has provided executive microbiology and infectious disease input into the management of Covid-19 in Mayo, but in light of the serious issues Deputy Calleary raises I will now ask the CEO of the HSE for a report on the matters he raised with me, and that report to include information on the testing levels of staff. My understanding is that the national public health emergency team is likely to broaden the case definition for testing at its meeting tomorrow. It is certainly something under consideration. I will also ask specifically about the supports for the district hospitals in Ballina, Swinford and across Mayo, and for a view on the derogation. I will get the Deputy a written report from the CEO.

The entire country is living in very difficult times. Our sympathies and condolences must go to the bereaved families who have suffered tragic losses in recent months due to the Covid-19 crisis. We must all acknowledge that there has been a tremendous national effort by everybody involved across the country. We also acknowledge the very dedicated work by all the front-line staff, especially but not just in the health service. I refer to those people who work in supermarkets and shops and who look after people getting food and allow them to go about their daily business. They are all putting themselves at risk by being out there, but I know that most employers have good arrangements in place to ensure social distancing.

The Minister might be happy to hear me say this: it is impossible to get every decision 100% correct during a pandemic. That must be acknowledged. Some of the issues that did arise showed up previous shortcomings, such as the treatment of nursing homes. For years, they have tried to be involved with national committees but the Minister refused several times to agree to that. Other issues that came to light relate to the promises to process 5,000 and 10,000 tests in the next week. We have long heard the over-promising of testing. Private hospitals have not been used to their full capacity. The National Treatment Purchase Fund must be stepped up to pick up a lot of the slack because there will be a lot of people on waiting lists.

People might agree or disagree with it, but I am happy to hear there are differences of opinion among the members of the national public health emergency team, their advisory committees, the Government and the Department of Health. I would be very worried if everyone was sitting there mute and they were all yes-men and yes-women. I am pleased there are differences of opinion because we would not have got to where we are unless people had teased out their various points of view. I do not have a question for the Minister.

Apologies to Deputy Brendan Smith.

Acting Chairman, I was supposed to have two and a half minutes. The Minister read out a reply to Deputy Calleary.

The Minister reads lots.

He could have sent it to the Deputy. The Minister got as much time, as the clock was stopped. I am not blaming the Minister but the system is a farce.

I am sorry. A 15-minute slot was allocated to Deputy Smith's party. It is not up to the Chair to police the slot.

The Minister took up as much time as the Opposition.

The Minister could have emailed his reply to Deputy Calleary. It is totally unfair. It is not acceptable. I will raise the matter with the Ceann Comhairle.

Deputy Smith should please do so and he will set him straight as well.

I am sharing time with Teachta Buckley and Teachta Quinlivan. I will have seven minutes and they will have four minutes each.

I thank the Minister for his response to the question we discussed on cancer screening. I have sent the names to him. I have a very brief question on the national children's hospital. After much discussion, construction has restarted. I would have thought the hospital would be a priority project. As I often say to my daughter, it is the thing that she is going to be paying for out of her pension, but we do want to see it built nonetheless. My information is that work has not restarted. Perhaps the Minister would comment on that. Will there be an additional cost for the delay and, if so, how much will the additional cost be per day, per hour or per week?

I apologise to Deputy Brendan Smith that he did not get his question in but it is hard to answer the many questions from various parties in 15 minutes. I do not make the rules.

I thank Deputy O'Reilly for raising those screening matters. I will come back to her directly on the cases she has raised with me.

The Office of Government Procurement, OGP, has been considering how to support a co-ordinated approach to the resumption of public sector construction projects. This has resulted in the publication of notes providing guidance, which are available on the its website. The National Paediatric Hospital Development Board, NPHDB, has statutory responsibility for the delivery of the national children's hospital. Health and safety on the construction site, including workforce health and safety, is the responsibility of the main contractor. Construction-related work on the site of the hospital stopped on 31 March due to the restrictions. Health and safety is a priority for everyone working on the new hospital and the reopening of the construction site needs to be carried out safely and in compliance with regulations, in the interests of the well-being of those working on the site, members of staff, visitors to St. James's Hospital and local residents. The NPHDB has been informed by the main contractor that it is currently updating the construction stage health and safety plan in preparation for the reopening of the site. A date for the resumption of construction works has yet to be finalised. When the site reopens, it is expected that work will resume on a phased basis to accommodate social distancing.

It is too early to fully assess the impact of health and safety requirements associated with Covid-19 on the new national children's hospital. Unlike others in this Chamber, I do not think we should pick figures out of the air at random and throw them out there. We need to see the impact of the safety measures.

The sooner it starts the better. We are going to pay for it. I wish to quote a text message I received from a cousin of mine, shortly after her father passed away in a nursing home:

Is it the case that nursing homes were hit so hard because patients, some already showing signs of Covid-19 were transferred out of hospital to free up beds? They were not only moved once – in some cases they were kept for 2 weeks in one home and transferred on. You can understand my alarm.

I received this message on 26 April. I indicated to my cousin that I would ask that question and I did. I asked HSE officials during a Zoom meeting. They said that the testing regime meant that nobody was transferred out until they had two negative test results. I asked the Minister about this in the Chamber at my next opportunity. I understand that work is ongoing and I appreciate that he has been talking to people in nursing homes. The reason I have quoted this text message to him is that I want to make it clear to him that families want answers.

Yesterday evidence was given by representatives of private nursing homes. The same issues exist in both public and the private homes. It seems that there was no plan. Mr. Tadhg Daly said: "The point we have been continuously making is that given the vulnerability of the age profile and the complexity of care of older persons, there should have been a national plan". He maintains that these people were categorised as low risk. On 10 March, a request was made to the HSE and the Department of Health for all patients to be tested, risk assessed and medically assessed. I cannot tell my cousin whether this was done, but I know what she believes. We have spoken about this several times.

Many of those families felt somewhat vindicated by what was said here yesterday. They had been told that this could not have happened, or had been shown graphs to show that it could not have happened that way. These families cannot be dismissed. They are real people. This family wants to know how this virus got into the nursing home when they could not visit their father. They had to wait outside. They observed all of the rules and they believe the staff did their best and followed best practice. However, on 10 March, when the nursing home sector was looking for guidance and assurance that people would be tested, it was not forthcoming. I note that there are now more than 400 delayed discharges in the acute hospital sector. There is a possibility that those people will be transferred en masse. Can the Minister make a commitment that in the event of this happening, this testing will be carried out?

I thank the Deputy. I extend my sympathies to her cousin on her loss and I thank the Deputy for sharing the text message. I can only imagine what a traumatic time this must be. I understand what the Deputy is saying and I do not want to show a graph or a chart or be cold in my response. These are valid questions. However, I note that the first cluster in a nursing home occurred on 16 March. The first case in Ireland was 29 February.

People are now looking back to January and February as though there was a knowledge and understanding of this virus when perhaps there simply was not one here or in many other places. I heard the Minister of State, Jim Daly, say there should have been a plan, but there was and there is. There is a national plan, for starters, but on top of that national standards for infection prevention and control of antimicrobial stewardship for nursing homes were published and adopted in September 2018 that every nursing home in the country is meant to adhere to. There was a meeting with Paul Reid, the HSE CEO, on Covid preparedness on 19 February and a meeting with the Minister of State on 28 February-----

Mr. Reid described the meeting on 19 February as "informal". He stated that Covid was not discussed. It is on the record of the House.

It is not my understanding that Covid was not discussed. In fact, that is the opposite to my understanding from my conversations with the CEO, which is that Covid was discussed.

Can I request that the Minister find that out definitively?

Absolutely. The Deputy can indeed. Interim guidance on transfer between care facilities was circulated to NHI on 10 March and there was an agreement to provide PPE on 12 March. I do not wish to use the Deputy's time going through all of this but I reject her assertion. Some 400 pages of correspondence show there was an awful lot of contact between incredible people in the HSE, the Department and nursing homes.

Yesterday, Peter Hughes of the Psychiatric Nurses Association, representing workers on the front line of our mental health services, called for an end to lip service and idle promises. As general secretary of the largest representative organisation for mental health workers, he is surely well placed to make such an appraisal of the past few years of the Government's and the political establishment's approach to the system. I join his call.

This crisis has highlighted not just the gaps in our services, which are plain to see for anyone who cared, but also the failure of the outgoing Government to do anything meaningful about them. It is generous to say the Government did the bare minimum during the austerity years but the damage done in the wake of that austerity is simply not good enough. For years, the Government has misled the House, the public and campaigners for mental health funding with delays, retractions and re-announcements. The costs have been far greater than the money needed to boost services or the false economy of savings on our vital health services. Mental health represented just 6% of planned health funding before this crisis. Unfortunately, I do not have enough time to go through all the issues but I will ask three brief questions.

We need to publish the refresher report on the A Vision for Change strategy. This is something the Government has talked about for almost five years, and it has used it as a smokescreen for an in-depth public assessment of the system, as would be done by a full, permanent mental health committee. The previous Government wound up the temporary Joint Committee on Future of Mental Health Care in 2018 and has ignored its recommendations. I ask the Minister to publish the report now. It was carried out under his time and reflects the reality of the services under his time, and he must take ownership of that. He must also ensure that any Government negotiations deal properly with mental health and that the public can be informed to scrutinise adequately any proposed Government on mental health. The Minister has the report and told me he would leave it to the next Government. I ask him to publish it now. There is cross-party agreement on the matter.

I also want to raise the effect of Covid-19 on our mental health services. Mental health staff must be provided with adequate PPE and safe and secure working conditions to protect themselves and those in their care. Social distancing presents serious issues in an overstretched, understaffed and overcrowded system. This cannot be done effectively and safely with the problems the system has faced due to years of neglect. The Mental Health Commission has expressed grave concerns about the delays in testing in the mental health settings, and it was only one month ago that all mental health staff were required to be tested, despite working with many high-risk and vulnerable people in crowded conditions.

Finally, I raise the problem of precarious work conditions for mental health professionals in the community and voluntary sector. Those organisations have been fantastic and much needed bodies for people who cannot access public services that, in too many cases, do not exist in their communities. Mental healthcare is not a charity. It is the right of the people and the duty of the State and the public service. We must protect the vital workers in these organisations and ensure that the expertise is not lost to fundraising difficulties or reorganisation during the crisis, as seen by Pieta House.

Any new Government needs to take mental health seriously, fund it properly and heed Peter Hughes's words. I have asked all parties to join together to form an Oireachtas mental health forum to support the permanent mental health committee. This is vital.

I wish to raise with the Minister for Health the issue of contract cleaners across the State but especially in hospitals. Many of these cleaners work as front-line workers in hospitals and care facilities in the battle against Covid-19 and they were expecting a 40 cent pay rise at the beginning of March, which would have brought their hourly rate of pay to just €11.20 per hour. According to SIPTU, which represents these workers, contract cleaning companies have reneged on this pay rise, which had previously been agreed on proposal. The decision to withhold this pay rise beggars belief. Contract cleaners who are putting their lives on the line while working in our hospitals are paid just €10.80 per hour. One of these workers has already lost his life due to Covid-19. Hundreds more are affected. SIPTU negotiated the 40 cent increase in good faith with employers. I understand that the Irish Contract Cleaning Association is now refusing to implement this pay increase. The Irish Contract Cleaning Association, which represents all the big cleaning companies in the State, needs to immediately honour the 40 cent per hour increase, backdated to March, and to apologise to those employees. The issue again highlights what happens when good public jobs are privatised. Cleaners employed directly by hospitals are paid at least €3.20 per hour more than those employed by private cleaning companies who also have no pension or sick pay entitlements.

I have spoken recently with a worker in University Hospital Limerick who told me that she worked 37 hours overtime last week at double pay, and yet the hospital does not hire staff. That 37 hours at double pay would hire two staff members. I put it to the Minister, but perhaps it is a question for the next Government, that there needs to be a major review of those privatised services when we come out of this Covid-19 emergency, with the aim of bringing them back under direct hospital contracts that would be better for workers and cheaper for taxpayers.

I have two questions for the Minister on separate issues. The trolley crisis at University Hospital Limerick, which I raised constantly with the Minister in the last Dáil, is coming back again. There are 29 people waiting on trolleys there today. What will the Minister do specifically about those people on trolleys? How will they practise physical distancing while they are waiting? In response to a parliamentary question tabled by my colleague, Deputy O'Reilly, on the issue of private hospitals, the Ministers said that Bon Secours Hospital Limerick, which is located at the old Barrington's Hospital site, had only 1% utilisation under the plan agreed with private hospitals. Will the Minister explain the reasons for that?

On the contract cleaners, and taking the point made by the Deputy, I join with him in sharing the view that cleaners have been on the front line and they have been keeping us all safe. I too would like to see that agreement honoured.

On the Bon Secours Hospital Limerick, they are the figures I gave to Deputy O'Reilly. The updated figures I have today show 30% of inpatient beds now being used in the Bon Secours Hospital Limerick. I will forward a refreshed table to Deputies Quinlivan and O'Reilly. I remain committed to the development projects at University Hospital Limerick and to getting them opened as soon as they are ready. I take on board the issues made to me in this House and in other fora by Deputies Quinlivan, Kelly, O'Donnell and Leddin that we cannot see a return to the overcrowding there.

I wish to be clear for the benefit of Deputy Buckley that the Government did not wind up any committee. The Government does not have the ability to do that. It is a matter for the Oireachtas to decide what committees to set up. I take seriously Deputy Buckley's work in the area of mental health. It is my intention that A Vision for Change will be published in June. If I am still in office I will do it in June and if not I hope the new Government will. We have provided additional funding to the €8 million with €1.1 million also allocated for online counselling services. The issues raised by Deputy Buckley on mental health are important. Peter Hughes has a degree of expertise in this and I thank him for the work of his members during the pandemic.

I thank the Minister, the Department of Health and all the people in the HSE, those in our nursing homes and all healthcare people who have worked so hard over the past three months in dealing with the issues.

My query to the Minister is about the taking charge of private hospitals, which was the right decision at the time, whereby we have access to more than 2,000 beds that were not in the public healthcare sector. I live less than half a mile from one of the biggest of those private hospitals, the Bon Secours Hospital Cork. There is a view, communicated to me through much correspondence, that there is underutilisation of many of these facilities.

I know that a decision is to be taken in the next few days about extending that beyond the end of June. Will the Minister clarify how we can make more efficient use of those facilities over the next four weeks? If we wish to retain all or some of those facilities after 30 June, can we put in place a process which will allow some people back into providing the care that they were providing? I have a case of an 11 year old boy with autism. It is an intellectual disability and he is non-verbal. He needs urgent care. He had a programme of care but that stopped because the consultant he was under did not sign the category A contract. Will the Minister provide some clarification on that? Will a decision be made on this matter in the next few days? If so, can we get an indication of how we can progress making more efficient use of those 2,000 beds?

I thank Deputy Colm Burke for raising this issue and for keeping in touch with me on these issues, particularly those in Cork.

The Deputy is correct that at a point in time we had to make sure we had access to every possible hospital bed in every possible setting for a wave or a surge which, thankfully, did not come in the way that it could have. That is thanks to the incredible efforts of the Irish people.

It is clear that we are going to require additional capacity for the foreseeable future, however. Even providing non-Covid care services is going to be much more difficult now. One will have to keep vacant beds in public hospitals. One cannot go back to having massive numbers of people on trolleys. Accordingly, we will have to keep some additional capacity. I have an open mind on how we arrange that. One could look to finesse or improve agreements in that regard. The Cabinet will consider this on Friday.

We have seen the relocation of a number of services from public hospitals to private. For example, with medical oncology services, there has been the relocation of day wards from St. Vincent's public to St. Vincent's private, Tullamore to the Hermitage, Waterford and Wexford to Whitfield and Kilkenny to Aut Even Hospital. Urgent surgical oncology services have moved from the Mater public to the Mater private, from Galway to the Galway Clinic, from St. James's to Blackrock and from Waterford to Whitfield. There are real benefits to non-Covid services which are now beginning to be ramped up.

This is the Deputy's point about how we make better use of that capacity now that we have the virus in a very different place to where it could have been.

I want to bring up the issue of bed capacity in University Hospital Limerick, UHL, in my constituency. As the Minister is aware, a 60-bed block there has been under construction since the start of the year. In addition to that, as part of a Covid response, another 48 beds have been earmarked for UHL which brings that up to 98 beds in total. Of the 48 additional beds, 14 are due to be completed and opened in June with 24 beds opened in July. In addition, another 24 beds are to be provided in Croom for completion in July as well. Will the Minister give an assurance that resources will be in place to ensure UHL can recruit the necessary staff in order that these units are open when completed? As the Minister will be well aware, Limerick and the mid-west region has a bed capacity issue outside of Covid. I am looking for a reassurance about resources. I know the buildings are under way which is great news for Limerick. However, will the resources be in place to ensure staff can be recruited and be in place when the 122 beds are completed at the units in UHL and Croom?

I found myself smiling because this must be the most famous 60-bed block in the country because it is raised so often and talked about so much in the House. I visited it quite a while ago. I am delighted to see it is progressing and nearing completion.

I am glad it is being accompanied by a further 62 beds, including 48 at UHL.

Exactly, and 24 in Croom. The short answer to the Deputy's question is "Yes". We will need all of the additional capacity we can get. I will give the Deputy a commitment that it is the intention of my Department to ensure those beds are fully funded and can open as quickly as possible. Of the 48, 24 are due to be ready to be opened in June and the other 24 in July. I will look into the opening of those in Croom.

I am talking about medical, nursing and ancillary staff.

Yes, we need to staff the beds so we can fully-----

Will the resources be made available?

Absolutely. Those beds are specifically being provided as part of our ongoing response to Covid and non-Covid care. There will be 98 potential extra beds plus the 24 in Croom, which is much-needed extra bed capacity in the mid-west.

Our thoughts are with the families and friends of the more than 1,600 people who have lost their lives due to Covid-19, and indeed all those who have recovered from it. I thank the people of Ireland for the work they have done to help effectively flatten the curve. I wish to bring the thoughts of many of my constituents to the Chamber. The 2 m rule has been mentioned already and I know that a meeting between the Chief Medical Officer and Cabinet is ongoing as I speak. It is something many people are beginning to articulate and while I understand that we will take the advice of the Chief Medical Officer, it is an issue that needs to be brought to the Dáil Chamber.

We have been dealing with Covid for a long time now but the health service is continuing to work away. I was coming back from the Dáil last Wednesday night and ended up in Sligo University Hospital. Everything is fine and despite what people say, politicians do have hearts. I thank the ambulance staff, the clinical nurse co-ordinators, the doctors and all the staff in Sligo University Hospital. The work they are doing is absolutely incredible. I was very proud and thankful for my experience late on Wednesday night. We are very fortunate to have such dedicated professional service staff who are doing tremendous work. I was asked to bring their thoughts to the Minister today, and I will be talking to him off the record as well. I again thank the staff at Sligo University Hospital and all the front-line staff around the country. I saw first hand the work they do. I ask the Minister to elaborate on the issue I raised.

First, I am very pleased that Deputy Feighan is okay. One cannot keep a good man down. I am pleased he is well and that he had a good experience in our health service. I join him in paying tribute to the staff in Sligo University Hospital, and the paramedics as well. I had the pleasure of visiting Sligo University Hospital some time last year. There are exciting plans in place in terms of capital redevelopment, as well as plans for the hospice facility in Sligo. It is a very well-run hospital but it is in need of significant extra capacity and that is something we are going to have to work on together in the weeks and months ahead.

On the 2 m rule versus a 1 m rule, as the Deputy rightly said, we will be guided by public health advice. It is very clear that if someone is 2 m away from me, there is a 99% chance that he or she has a degree of protection if I cough or sneeze. If that person is 1 m away, he or she will still have protection, but not as much. Let us be honest; there will be some sectors in which 2 m of distance will not be possible and we will have to look at how we can put other mitigating measures in place there. It would be hard to get one's hair cut from 2 m away, for example. We will have to look at those sectors in other ways, but the general public health advice is that our citizens should follow the 2 m rule as much as possible. It is the best way of disrupting transmission of the virus. Very interesting research is being done on this issue in the Mater Hospital, as was shown on RTÉ last night. It is very hard for the droplets to carry further than 2 m.

I thank the Minister for visiting Sligo University Hospital over a year ago. I look forward to going down with him next time, when we will go in the front door rather than through the emergency department.

I will be sharing time with Deputy Noonan. I want to talk to the Minister about Limerick. There is concern in my city and county at the rise in trolley numbers at University Hospital Limerick, UHL. While I acknowledge the Minister's response to my constituency colleague, Deputy Quinlivan, many people locally have questions about the spare capacity in Barrington's hospital and why it is not being used. I do not want to make a political issue of it, but I plead with the Minister to give this House and the public some cause for hope. In recent years, the issue of overcrowding has been very damaging for confidence in the health service in the mid-west and while people have been very understanding of hospital workers throughout this pandemic, we need optimism that the situation can be solved in both the short and long terms. If we continue to make progress in reducing the spread of Covid-19, does the Minister expect the trolley numbers in UHL to return to pre-Covid levels in the coming months?

I thank the Deputy for raising this important matter. I pay tribute to the staff in UHL, led by chief executive, Ms Colette Cowan, and clinical director, Dr. Gerry Burke, for the excellent work they do. It is a hospital, and a hospital group, that does not have adequate capacity relative to the size of the population, which will not come as news to anybody. I do not want to use up all the time but, as we have been discussing, there are now exciting and ambitious plans to try and grow that capacity. There will be a 60-bed ward block. I am looking at Deputy Kelly because he regularly raises this issue with me. There will be an additional 48 beds in UHL and 24 in Croom Hospital. I saw the latest figures for the Bon Secours Hospital in Limerick and it is true that there was only 2% inpatient occupancy in the week 11 May to 15 May. That increased to 30% in the week 18 May to 22 May. In light of Deputy Leddin raising the matter, I will specifically seek an update from the HSE on the utilisation of that capacity.

I do not want UHL to be allowed to go back to the significant overcrowding issue it had. That was not a fault of its own but rather of decades of failure to deliver additional bed capacity. I argue that we have put the plans for that capacity in place but we need it to come on stream as quickly as possible.

I call Deputy Noonan. Is he taking all ten minutes?

It is eight minutes now.

That is for both questions and answers.

I thank the Minister for his work. I highlight the issue of section 39 service providers to disability and intellectual disability service users. It is commendable how they have adapted so quickly to the changed set of circumstances and how they have managed to keep Covid-19 infection at bay but they are now facing a dual challenge of the cost incurred due to risk of infection coupled with a perfect storm of underfunding and a 1% efficiency cut imposed by the HSE. It is simply not feasible for section 39 providers to take hit after hit and be expected to provide the same high level of care that is, in many circumstances, beyond a basic social care model. Those providers need the support of the Minister and the Government to deal with the additional costs. Will section 39 providers be compensated for expenses incurred as a result of this pandemic, including the purchase of PPE, taking on agency staff and other costs?

Thanks to the collective efforts of front-line staff, all agencies, the Minister, the Government and the people of Ireland, we have managed to suppress the spread of the virus in the community. We have prevented the overwhelming of our healthcare system. We now face the new crisis of ever-growing waiting lists for non-Covid hospital appointments. Waiting lists were at a critical level in the public system for some time before the pandemic and that point is now also being reached in the private system. I seek the support of the Minister to design an element of flexibility within the arrangement between private hospitals, consultants and the HSE. Even at this stage as we, hopefully, exit the health phase of the crisis, we can offer an opportunity for consultants and private hospitals to again see their patients, to deal with non-Covid patients in the public system and to build capacity once again to reduce those waiting lists.

The Minister mentioned my constituency and Aut Even Hospital in Kilkenny which is running at between 33% and 36% bed capacity. Healthcare staff want to do their jobs and reduce the burden on services. We do not know if there will be a second wave of Covid-19 coupled with a winter flu later this year and we need to prepare for that.

Will he come to an arrangement to urgently allow a degree of flexibility for consultants to see their patients? There were, as I understand it, proposals around B and C contracts to build in that flexibility but they were denied at the time.

Will he provide the House with an update on the commencement of videofluoroscopy scans at Temple Street Hospital? Many families are awaiting vital scans for their children while Temple Street is awaiting clear direction from the HSE to recommence scans.

Is there a case to be made for the provision of PPE to allow an opportunity to family members and loved ones of patients in a hospice setting where there is no virus to pay a final visit and say goodbye? My understanding is that this is currently not the case and that direction is required from the HSE and NPHET regarding family visits to hospice settings.

I tabled a question, No. 380, to the Minister on the Covid channel on 27 April. In response, the Minister referred the matter to the HSE for answer. It is now a calendar month later. I have followed up on the matter twice and still have received no response. Is it not important when a roadmap to our country's recovery is based on statistical information that we know how many people were referred for testing because they presented with symptoms but were never tested, or tested too late to give a positive result? Does the Minister agree that the prevalence of referral without follow-up has led to a lack of public confidence in the HSE's capacity to test in a timely manner and will he explain the delay in the HSE's provision of this data?

I wish to commend the network of community sewists across the island who are making and distributing DIY cloth face masks to vulnerable groups. Will the Department run television advertisement campaigns to highlight their effective use and washing? Will the Department advocate for more widespread use of cloth masks?

Finally, can the Minister provide the House with an update regarding progress towards achieving a second cath lab for University Hospital Waterford? The deficits within the south east have been well documented and the region needs absolute clarity on this matter.

I will try to get through these questions. First, I had a meeting with the Disability Action Coalition, the Disability Federation of Ireland and the National Federation of Voluntary Service Providers in respect of a number of the issues that the Deputy has raised regarding disability funding. There are three elements to it. First, there is the 1% efficiency cut, saving or whatever one wishes to call it that they were meant to achieve this year. Being blunt and honest, they will not be in a position to achieve it and I have made that clear to them. We need to look at how we can formalise that and provide them with peace of mind in that regard in the coming days. Second, there is the issue of Covid costs. They have experienced Covid costs. They have done an incredible job of adapting their services. I have heard from them and from service users, particularly of the use of technology, which is something we will want to keep. My Department would like to support them in meeting the Covid costs like we have for other sectors. The third element is we need to see the full implementation of the Catherine Day report. That will be a job for the next Government. It should feature prominently in any programme for Government and this House should make sure that it happens.

In relation to private hospitals, we need to be intelligent enough to say when the situation changes in terms of the route of the virus that we need to show our flexibility but I need to be clear the HSE's view is that it will require that capacity, and that is my view too. That is how we make sure we get that right in addressing the issues the Deputy raises.

I must come back to the Deputy on the video fluoroscopy scans in Temple Street. I am not familiar with that but I will come back to the Deputy on it.

On the issue of visitor restrictions for hospices or for nursing homes, as I stated earlier the National Public Health Emergency Team will look at this. It cannot be beyond us as a country to work out ways of ensuring visits on compassionate grounds. One can get sick of loneliness. It has been a lonely and long time for people. Obviously, I am acutely aware of the issue the Deputy raises regarding people in hospices.

I am very sorry and angered that the Deputy has not received a response one month later. I will follow that up for the Deputy.

In relation to the issue of face coverings, I am a big believer in these. There is now public health guidance that one should wear face coverings on public transport and in indoor areas where it might be difficult to socially distance. We use the term, as the Deputy did, "face coverings", instead of "face masks", and that is intentional. It is easy to make these at home. We have advertisements to do that but so far these are on social media. I take the point that a wider public awareness campaign could be useful. I will take that up with the HSE.

On the issue of University Hospital Waterford and the cath lab, which is an issue I get asked about a lot, I will send the Deputy an up-to-date note because I do not have the information at the top of my head. The development of a second cath lab is funded and under way. It is crucial that Waterford has a second cath lab before it can provide a 24-7 service. There is a national cardiac review under way which will inform whether to provide a 24-7 service, and in what parts of the country too. I will return to the Deputy in writing on that.

I jest that I was not to raise UHL, only that I have heard so many promises in relation to it. The fact is it is the most discriminated hospital in Ireland. The region is discriminated against, with the lowest amount of beds, consultants, nurses etc. The plan, not only the beds, needs to happen. The Minister complimented Ms Colette Cowen and Dr. Gerry Burke and I thank him for doing so. The Minister might also wish the same Dr. Gerry Burke, probably the most publicly-oriented clinical aide I have ever met in my life, the best on his retirement tomorrow.

I have six questions for the Minister. I will list them off and give the Minister time to answer them. On nursing homes, the 400 pages of documents and the famous letter that everyone is talking about that the Department received from HIQA, the Minister might send us a copy of that letter but also might tell us when he himself read it. The Minister stated yesterday that the Department read it when it arrived and passed it on straight away. I accept that but when did the Minister himself actually read it? We need to correlate outbreaks versus that document. We need to see whether HIQA was on the money with its concerns. I am sure the Minister has done that already.

It would not have required a huge exercise by anyone in the Department to correlate the information. Has it been done? If not, it is bizarre. When I was a Minister sitting where the Minister for Health, Deputy Harris, is sitting now, one of the first things I would have asked yesterday was whether we could see what happened in all the nursing homes listed in the letter and about which we are concerned. The Minister might tell us the position on that. He should please tell me he has done what I have mentioned.

My next question is very direct. Regarding the nursing homes that have had outbreaks, was the Minister's Department or the HSE made aware of any care concerns beyond those related to Covid but arising from patients having to be transferred or nursing homes having to be taken over because of Covid? I will leave that with the Minister.

I have a straight question on private hospitals. Given the work of a number of Deputies, including me and Deputy Shortall, does the Minister believe it is a good idea, in order to fast-forward the bed capacity we all know we need under Sláintecare, to nationalise some of the hospitals? It is a straight question demanding a straight answer. I am not saying a Government would approve the proposal but I want to know what the Minister for Health believes. He obviously knows my views on it.

On cancer screening, which I always speak about, I presume the Minister has measured the changes in outcomes. I refer to issues relating to morbidity, delayed outcomes, delayed diagnoses, etc., because screening is not happening. Could we have a table for each month? I presume this work is ongoing.

With regard to the famous children's hospital, which has not gone away, what is the Department's current estimated cost? I presume the work is continuous. As of today, what is the estimated cost?

The Minister announced a change regarding the vaccine recently. I still do not understand why we are not just giving the vaccine to everyone for free for the coming year. It would be cost-effective. The Government does not even have to commit to providing it every year. It could be provided just next year, and maybe the year after. I would prefer it to be every year. Why will the Minister not commit to it? Considering that we are always talking about public health, and presuming every single person in NPHET believes in vaccination, why could the Minister not ask NPHET to consider it? Given that we go to NPHET for so much, all I am proposing to the Minister is that we ask it whether this would be a good idea. Must I write to it myself? Will the Minister please ask NPHET whether it would be a good idea and appropriate to introduce free vaccination for everybody in the country so we will not have to deal with both the normal flu epidemic and Covid in the coming year?

My final question relates to the National Maternity Hospital. I am sure the Minister is aware of the concerns Dr Peter Boylan has been expressing. While the facility, worth €500 million, is very much needed, are we 100% certain there is no issue in regard to the letter that has been sent from the Vatican regarding the transfer of ownership and allowing for the alienation and transfer of the lands to a secular body? I fully hope the information I have is true. Can the Minister confirm it is the case and that it is his interpretation? As far as I am concerned, it will be a first from the Vatican, so we are creating history. Could the Minister please confirm this?

I join the Deputies in wishing Dr Gerry Burke well on his retirement. He is a very dedicated public servant and clinician.

In relation to the letter, I think — I say “think” because I read a lot of documents — I read it for the first time today. If the Deputy does not mind, let me explain the issue here.

As long as the Minister allows time for all the questions.

Absolutely, I will allow time for all the questions. What I wish to say in this regard is important. I would like these documents to be shared with the Covid committee. I am aware the Deputy asked for the documents concerning Nursing Homes Ireland and the Department. I would have thought it important for the Deputy to have the documents involving the Department and HIQA also. That is quite important; it is actually more important.

On 13 March, HIQA wrote to the Department of Health about 19 HSE nursing homes that had been identified as having multi-occupancy rooms, which created challenges for infection prevention. This was sent on to the HSE. Dr. Colm Henry, Mr. David Walsh and other really good people in the HSE were doing work, recognising that multi-occupancy rooms make it harder to contain the spread of the virus, as the Deputy can imagine. HIQA did that. I believe there is a lack of clarity in one respect; on 31 March, NPHET asked HIQA if it would assess all nursing homes for risk. NPHET made this request of HIQA, which is represented on NPHET, if that makes sense. HIQA carried out this assessment. It produced a document of two and a half pages which I have here and which we will publish. I will not read it all because I will not then be able to answer other questions. One part of it said that in the context of managing the Covid-19 outbreak, HIQA estimated that 124 public and private nursing homes, out of a total of 580 nursing homes, would potentially need some level of additional support. This list was shared with the HSE. In addition, the provider was mandated to report any Covid-19 outbreak to the chief inspector and to share an updated status report to include a risk assessment with the HSE each morning. The Deputy should have time to read this document and can then come back with further questions but that is the status with regard to HIQA-----

Had the correlation been considered?

-----and the Department. I asked only today for that correlation to be considered. We thought in the same way in that regard. The question the Deputy put to me as to whether there are any other concerns makes me believe he has an answer which I am not aware of. He will need to be clearer on this question to me because I do not quite understand it. I would welcome clarity in that regard.

On the issue of private hospitals, I am in favour of creating a universal healthcare system in line with Sláintecare. That is my view as Minister for Health. I am not in favour of compelling the nationalisation of all private hospitals.

Not all of them.

I am open to the idea of having a conversation with regard to private hospitals that are available to provide capacity. My current priority, however, is providing for the needs of the HSE with regard to capacity. We should be clear that we will need that capacity beyond the end of June. That is my very strong view.

With regard to cancer screening, I met representatives of the national cancer control programme - I believe it was yesterday, it was certainly this week - to initiate a conversation about screening. I have spoken to Ms Anne O'Connor, chief operations officer of the HSE, and Dr. Colm Henry. I have asked that the screening roadmap be a part of the non-Covid framework which the HSE is due to publish within the next week. I spoke to the CEO and chairman of the HSE about this matter again this morning. I will ask that information be made available. I do not have it but it is fair for the Deputy to request it.

On the national children's hospital, the cost remains the same. I am running tight on time but, as I said earlier on, the impact of health and safety measures relating to Covid-19 on the cost of many capital projects is not yet known. It certainly requires an in-depth look rather than a representative of the construction industry just deciding in this Chamber what it will look like and then having to retract that.

With regard to the flu vaccine, I will ask NPHET, as the Deputy has requested.

I cannot give the Deputy the assurance he requests in respect of the National Maternity Hospital because I am in the middle of a global pandemic. I welcome the fact that a letter has issued from the nuns but the matter will have to go through due diligence and proper scrutiny and return to the Government before it is decided to proceed. I outlined very clearly the tests I want to see met before the hospital project proceeds. Those tests still apply. I welcome the letter but it needs to be legally and robustly scrutinised.

Will the Minister publish it?

Has the letter not been published?

None of the documentation in this regard has been published.

I will certainly publish the letter. It will probably be for the next Government to make-----

There is other documentation involved, not only the letter.

I am happy to publish any relevant documentation but, at this stage, it will be a matter for the next Government to decide whether those tests have been met.

First of all I will return to issues that arose yesterday at the meeting of the Special Committee on Covid-19 Response and to two questions I posed to HIQA. The first related to infection control reports. HIQA had carried out annual assessments and repeat offenders came to light - nursing homes about which there were particular concerns. We were told by the chief inspector that this list was sent to the Department in February and March and drew attention to HIQA's concerns in respect of Covid and poor infection control standards. The Minister made reference to 13 March. It was said that this letter was sent to him in February and in March. That is when these details were sent to him. This date, 13 March, was within the first two weeks of the virus arriving here. Will the Minister tell us what action was taken on foot of this letter? It was flagged to him that HIQA had serious concerns about 19 nursing homes.

Can he be more explicit about what was done at that stage? Surely alarm rings should have started to ring.

The second question I posed to Mr. Quinn was in relation to a point HIQA has been making consistently, which is that it had serious concerns about the lack of clinical oversight of the nursing home sector, and private nursing homes in particular. When I put the question to him about what he did with those concerns, he said he would have been in touch with the Department on several occasions in relation to them. I am asking the Minister what happened in response to those concerns being raised about the manner in which the nursing home sector operates and the fact, in an extraordinary way, that there is no clinical oversight of private nursing homes catering for the most vulnerable in our population. What did his Department do, if anything, in response to those serious concerns being raised? Perhaps he will come in on those two questions before I move on to the next.

I thank the Deputy. Regarding correspondence from HIQA, I will have to check what was received in February, because my note says 13 March. I will revert to the Deputy on that and I am not doubting what Mr. Quinn said.

The chief inspector said there was a series of communications.

On 13 March, there were 19 sites identified by HIQA to the Department as having multi-occupancy rooms and creating infection prevention challenges. I do not mean it in any sort of smart way when I suggest that it will not come as a surprise to anybody in the Department or the HSE that multi-occupancy rooms have extra infection prevention challenges. On the same day, 13 March, that information was sent on to the HSE. Dr. Colm Henry wrote back to the Department in April stating:

Please forgive the delay in providing you with a response. As you know, our engagements with you on the issue have been ongoing since then. I appreciate the items requested are now discussed daily but I would like to share the requested information with you.

He went on to say:

Regarding the list of HIQA-identified residential centres with multi-occupancy rooms, I can assure you that all centres mentioned in your communication are included in the ongoing implementation of the specific capital plan for the redevelopment. Progress has been made to enhance these environments. At the time your query was received...

Dr. Henry then goes through each of the items. In the interests of time, I will share the letter with the Deputy rather than going through them all now. There were very clear actions taken.

However, it seems that critical weeks were lost.

Let us debate that in due course. I would point out that on 31 March, NPHET itself put in place a range of specific public health actions for long-term residential care facilities and home supports. There were two special meetings of NPHET specifically dedicated to-----

I am asking about the 19 centres that were highlighted and what the specific response was in regard to them.

There were quite a lot more than 19 in question. However, I have answered that point. As I said, Dr. Henry wrote back to the Department. I am making the point, because it was not made yesterday, that it was NPHET which requested HIQA to carry out that risk assessment. I think that is an important piece of information.

I do not think that is accurate.

It is accurate.

This was based on a series of infection control assessments that were done over a number of years.

I wish to be really clear because the Deputy and I may be at cross purposes and we may both be right. On 31 March-----

Let us read the letter.

----the NPHET minutes show - these are all published - that HIQA was asked by NPHET to risk assess all nursing homes.

That does not answer the question but let us leave it. Will the Minister answer my other question about the lack of critical oversight?

Excuse me, Deputy Shortall. In order to conduct the debate in some kind of orderly fashion, we must have only one speaker at a time.

The Deputy is correct. It is a long-known fact - indeed, the Sláintecare plan speaks very much to this - that there is a lack of integration between our nursing homes, be they public or private, and the HSE in general. I am not sure GPs and others would fully accept the view that there is no clinical involvement or governance, but I do think it is a shortcoming in relation to the long-term residential care setting in Ireland and it is something that needs to be addressed.

It will be interesting to see if there is any response on that point. The other issue I want to raise is the question of mental health services and the review or refresh of A Vision for Change. Several of us have raised this with the Minister previously and he has responded that while the review was completed and passed by Government and all of that, going back to December or January, that it is not his intention to publish the review because he would be criticised for it.

Today, a letter was sent to the Minister from representatives of Fianna Fáil, Sinn Féin, the Green Party, the Social Democrats and, afterwards, a couple of the Independent groups calling on him to publish the review of A Vision for Change. I have just received word that the Minister of State, former Deputy Jim Daly, has also written to the Minister urging him to publish it. The Minister has political support for doing it and I put it to him that given the urgency of the situation with mental health services he should commit to publishing the review. Everybody wants him to do it and nobody is going to complain or criticise him for doing so. Will the Minister commit today to publishing it immediately?

The reason I am saying it must happen immediately is that, apart from the fact that there has been a delay of several months, we are facing a situation where the level of mental health problems is huge at this point not only with regard to ongoing issues in mental health but also with regard to Covid-specific issues that are arising across the population. We know that is the case in every age group. There are major levels of stress for older people cocooning and for those in nursing homes. There is also stress with the impact of Covid-19 on family members. There is stress for front-line workers. Given the nature of their jobs, they are under enormous pressure and stress, which result in issues with mental health. In the case of young people, in particular, there is the fact that there are big question marks over their futures, their education, the restrictions on their social lives and so forth. Covid-19 is having a major negative impact on people's mental health across the population. For that reason it is extremely important that the review of A Vision for Change is published as a matter of urgency, the implementation group is established and the group draws up an immediate response to the immediate problems arising from Covid-19 and also the medium-term and longer-term responses. I strongly urge the Minister to publish it immediately.

When one is Minister for Health one is criticised probably ten times before breakfast, and often correctly, so I am not afraid of criticism in this regard. It has not been brought to the Government. It has been brought to a Cabinet committee but it has not been approved by the Government. Frankly, I find it hard to mount an argument to what the Deputy said. I will give a commitment to revert to the Deputy by the end of this week and see if it is possible to bring it to the Government, as I will have to get permission to do that. I believe an early and quick publication of this is important for the reasons the Deputy has outlined. Mental Health Reform makes the point, and I am not trying to speak for the organisation, that it does not wish to see another ad hoc or willy-nilly process put in place. It wants it to be aligned with A Vision for Change. That makes sense and its representatives told me that when I met them.

I have not seen the letter from the parties and groups, but I will respond to it by the end of this week with a view to seeing if I can get permission to bring it to the Government immediately.

I appreciate that. The Minister will appreciate that many different proposals are being made by people because there is such anxiety to have an immediate response to the largescale mental health problems that are emerging now, as we can see around us. There is no point in setting up task forces, sub-committees or the like. It should be the main implementation body for our mental health strategy and it has to be put in place at an early stage. I welcome the Minister's commitment and look forward to positive news next week.

I am sharing time with Deputy Paul Murphy. If we run out of time, I will accept written answers from the Minister. Earlier I heard one of the Fianna Fáil Deputies say it is impossible to get everything right during a pandemic. Nobody doubts that, but I wish to talk again today about how wrong we got the care of our elderly. Yesterday showed me that the model of an overwhelmingly private care service for the elderly has utterly failed us. Where did that go wrong? It started with a political and policy decision of Fianna Fáil, supported by Mary Harney and with a tax break given by Charlie McCreevy, which was continually implemented by successive Fianna Fáil and Fine Gael Governments. A study by Julien Mercille shows that investors in the sector were attracted by the opportunity to avail of tax breaks rather than an interest in, or an understanding of, the dynamics of the care of older persons.

Multiple health Ministers, from Mary Harney to the Minister, Deputy Harris, have advocated and encouraged a regime where international investors were attracted to building and running private nursing homes. Ironically, it was a Deputy from the Minister's party who pointed out yesterday that this is a lucrative trade attracting the great and the good of the Irish wealthy and international investors with a keen eye for profit. I refer to companies like Bartra Capital, vulture funds etc., which have recently invested in this lucrative industry but how lucrative it is we do not know because many of them are registered offshore and do not have to publish their accounts. We do not see the profits they earn or the taxes they pay but we do know from international studies that where private care is given to the elderly, lower standards and poorer care emanate and the staffing levels are generally 20% or more lower in those settings. That said, I wish to compliment the staff in those settings and thank them very much for the care, extreme courtesy and compassion they showered on the people who lost their lives in those settings. The tax base and the largesse showered on these investors is not acceptable and, at the same time, this State has cut back the real supports that could have helped to keep people in their homes and their communities. All of that has been privatised and micromanaged to such a degree that it is impossible for the workers in that sector to look after elderly people in their homes. We have failed them at every hand's turn because we see elderly people and the provision of pensions as a burden. As we live longer we see that as a problem rather than something to celebrate but there is nothing surer than we are all going to get older and that we need to think in the future about the way we are delivering the care of the elderly, both in settings and in their homes.

The committee meeting yesterday showed that there was a very clear neglect of the need of those homes when the Department of Health was alerted that they lacked staffing, PPE and testing. We were very slow to deliver that. To pretend otherwise is a nonsense because as I said yesterday, we passed the parcel from one agency of the State to the other but, in reality, there was a total failure and the eye was taken off the ball. That is why I repeat the call I made for an independent public inquiry into what has gone on, not to look back in anger or examine who failed who, how and who is not telling the truth, but to learn. The Minister said here recently that he believes the entire system needs an overhaul. I doubt that if we sit down and discuss the kind of an overhaul he believes it needs we will agree. We need a national health service in this country, not a Sláintecare but a national health service that is publicly run and publicly funded from the cradle to the grave in order that every aspect of our healthcare is accountable and in the interests of the public and that no individual, vulture fund or set of investors profits from people's health.

I have a couple of questions for the Minister. First, will his expert panel examine how we can achieve that and begin that discussion as soon as possible? Second, what steps is he and his Department taking to ensure that the homes listed as the most vulnerable by HIQA will be properly staffed and equipped to deal with a possible second wave of Covid-19? Third, can the Minister confirm the exact date his Department received the list from HIQA of those homes thought to be vulnerable to Covid-19? It was not clear yesterday from the questions and answers and from the accusations, toing and froing, what exactly happened here. I am prepared to accept those answers from the Minister in writing.

A catastrophic crisis is unfolding in our meat factories. Last week, 40% of all new Covid-19 cases in the entire country were among meat workers. That crisis was preventable but the State agencies, and the Ministers responsible, were asleep at the wheel. Does the Minister agree that it is scandalous that there were zero on-site Health and Safety Authority, HSA, inspections in regard to coronavirus until Monday, 18 May? More than two months after the pandemic really hit Ireland there were zero inspections on-site despite the fact that there had been close to 300 complaints. Does he agree that it is inexplicable as to why the Minister responsible for the HSA and the Workplace Relations Commission, WRC, Deputy Humphreys, would say last Thursday that she did not know how many meat factories had been inspected at that point in time and that she did not need to know?

We were having a special debate in the Dáil about this catastrophic crisis and she did not have any figures and did not think that she needed to. Does the Minister agree that it is outrageous that the Minister for Agriculture, Food and the Marine dismissed concerns raised almost a month ago about meat factories as an attempt to smear factory owners? Does he agree that we need urgent inspections of meat factories? This is a significant problem in that only 67 HSA field inspectors have been allocated to deal with coronavirus-related issues. Where will the needed inspectors come from and when? I have a second question which I will come back to.

The commentary about my colleagues is the Deputy's view. The substantive issue about the 67 inspectors is important. The Deputy is right that 67 is not an adequate number with the volume of work that we need the HSA to do. I am pleased to let the Deputy know that my Department will provide approximately 200 environmental health officers to supplement the HSA's work. We will make sure that they work with the HSA to incorporate compliance with the protocol in its usual programmed inspection activities. The environmental health service is responsible, among other things, for enforcing food legislation, hence its relationship with the food businesses. Approximately 45,000 food businesses in the country fall into that category. Further consideration is also under way with regard to an appropriate public health support to the HSA. We have significantly increased the number of people working to make sure the protocol is implemented.

I believe on-site inspections at meat factories are very important for public health and I am pleased that they are now happening. I am also pleased that there is a national outbreak control team. I have spoken to the clinician who leads that team. I am also pleased that between 55% and 60% of people in meat factories who had Covid-19 have recovered and returned to work. I look forward to that number increasing further.

I thank the Minister for the answer. Will he clarify if all 200 officers who are being allocated by the Department of Health will be engaged in on-site field inspections, and if not, how many will? That is crucial. It was reported in the Irish Examiner on 19 May that the Department of Business, Enterprise and Innovation had assured people that the HSA was getting additional inspectors from the WRC to inspect workplaces. I do not know if that is still the case or the plan. I have seen internal emails, which show that the management of the WRC is not planning to redeploy any site inspectors to the HSA. Due to Covid-19, it has suspended all on-site inspections for its regular work and is instead phoning and emailing employers about employment disputes. I do not know if the Government is counting on that but it is certainly saying internally that it is not doing that.

The 200 environmental health officers, or inspectors, will all carry out on-the-ground inspection activities. They will do so as part of their usual programmed inspections. Environmental health officers already do that and we are basically saying that they already have a remit for a significant number of businesses, with 45,000 food businesses in the country, and telling them to inspect sites under the Return to Work Safely Protocol.

We move to the Regional Group.

We offer our condolences to family members who have been bereaved by Covid-19 and again give thanks to front-line healthcare workers and all those in the healthcare sector who are doing so much at this very difficult time. On 24 April in this House, the Minister expressed to me his wish to see the second Waterford cardiac cath lab built, with a construction tender to be awarded as soon as possible. Last Thursday in the House, the Taoiseach also committed to seeing this project get over the line while acknowledging the inordinate delay it has suffered since it was first announced on 18 September 2018. I thank both of them for their public commitment to this project. This development has suffered inexplicable delays since the Minister's original order to approve it. In fact, 20 months have elapsed and we have yet to approve a formal build tender for construction.

Given the inordinate, unexplained delays, on behalf of the people of Waterford and the south east, will the Minister provide Oireachtas Members from the south east a contact liaison within his Department concerning this project? The Department has circulated completely new timelines for this development and I believe elected representatives could provide support to ensure that further slippage in proposed delivery schedules are avoided. I believe everybody in the House understands the significant Covid pressures that are dominating health planning at present. Appointing a Department liaison available to Oireachtas Members from the south east would deliver enormous comfort to the people of Waterford and the region while we await the second cardiac catheterisation laboratory and the improved standard of regional care it will help to deliver.

I refer to other health matters relating to Covid risk and disease management. On 23 April, I asked in this House why senior nursing staff in residential care settings were not being tasked and trained to take Covid swab tests of residents in their care. I believe it is happening in a small number of centres, but clearly on-site staff managing that activity would help improve the turnaround times that are so critical to the safe running of residential care homes. It would also minimise the trauma to vulnerable patients by having invasive swab testing taken by people known to them. As well as taking patient duress into account, faster response times improve the management of isolation needs and possible staff shortages where self-isolation is required. Faster test times also reduce the Covid care burden protocols where a negative test result is found.

Can we agree that it should not take weeks of deep analysis to decide if we should let nurses nurse? I know that for some a small amount of training will be required, but I believe every qualified nurse working in residential long-stay and short-stay settings is more than capable of managing this task, and would be happy to do so as a proactive infection-control measure to safeguard the patients in their care.

I also highlight another significant headwind affecting the private nursing home sector. More than 100 small nursing homes are facing insurance renewals over the coming weeks and months. They have been advised that no business interruption cover or liability cover is on offer for anything Covid-19 related. Lack of liability cover is a major concern as these operations do not have the financial reserves to protect them against a significant Covid-related injury claim. Many of these homes are already losing revenue because they are keeping isolation capacity available. Allowing them to be further unsupported because of our dysfunctional insurance environment will force many to close their doors permanently. It would be ironic if Government action to save residential care lives could not be harnessed to support these same patients who are at risk of losing their present care facility and their quality of life because of insurable risks. I ask the Department to seriously look at this matter.

The Minister recently announced the creation of a Covid-19 nursing home review panel. The panel complement does not have a contributing member from the nursing home sector with recent direct and material experience of the challenges that befell nursing homes following the arrival of Covid-19. As I feel this is a lost opportunity to examine and fully understand the sectoral problems, I ask the Minister to consider the appointment of such a person to this review body.

As part of continuing NPHET Covid planning, the Department may wish to extend the private hospitals contract for a further period. I and other Members of the Regional Group are of the opinion that conditions and terms of this contract need to be reviewed and significantly revised before the Government commits to any further extension. Given the significant cost involved at €115 million per month, bed occupancy and service activity at private centres must be maximised where currently they are well below available capacity.

Although some elective procedures and day case services have been decanted from public hospitals to private hospital settings, these are largely being carried out by public doctors. This is because a significant number of clinicians, operating as private subcontractors in the private healthcare area, have found themselves presented with changed working conditions to which they cannot agree as they have no offer of recompense for the cost overheads they are forced to carry.

The private hospitals deal secures the facilities but not all the staff to provide the clinical services. These private consultants operate on a fee-per-procedure model, reimbursed by private health insurers, but since this contract was initiated, insurance fees have not been payable for such activity. This is having a significant effect on both public and private waiting lists as these doctors could be treating both hospital patient streams under the present arrangement if revised. As a member of the Regional Group, I ask the Minister that if he is minded to extend the private hospitals contract, he should sit down with the private health insurers, VHI, Irish Life and Laya Healthcare, to devise a new temporary service contract arrangement to include these subcontracting clinicians.

A new arrangement could ensure both our public and private patient streams can benefit from maximum participation of all medical care givers.

As we welcome the continuing phased release from required lockdown measures, many are cognisant of the possibility of a future upsurge in Covid infection rates and a possible increase in hospital activity. That said, it is fair to state we have learned a great deal about the transmission, management and mitigation options in respect of the disease. Hopefully that will guide us towards finding appropriate balanced strategies in the future. One analytical tool required for greater understanding of the impact of Covid is the publication of patient range data, by decade of life, for Covid infection rates and clinical outcomes. The data, purely for statistical analysis, should record just gender, age, care pathway and clinical outcome and would not create any issues in respect of data privilege. The information is needed to risk-assess future strategy. I ask the Minister to prevail on NPHET to publish these data to allow greater and wider analysis by our healthcare experts.

As we get further into 2020, society is coming to terms with living with Covid-19 while we wait for a scientific breakthrough to overcome this virus. We must begin to rebuild our shattered economy with specific attention on the small and medium-sized enterprise sector. Possession of these pertinent data will allow both public and private thought leaders contribute to best planning, mitigation and treatment strategies in the future. It will also allow for more effective public health policy planning and in so doing, hopefully will ensure we will have learned from some of the avoidable mistakes of the past and will have made adequate provision for the future.

I will arrange for someone in the Department to liaise with the Deputies from the south east. We had quite a good arrangement during the last Dáil, when we were all allowed to meet in person, and I am eager to keep it up, whereby local representatives are brought together to provide us with the benefit of local knowledge and local connections to get this project moving. I want to see the delivery of the cath lab. I note the new timelines referred to by the Deputy. Contractor selection is under way, the tender will be completed during the summer and construction will commence in the autumn. There cannot be any more slippage - I get that - and we are all eager to see that delivered.

On testing by nurses in long-term residential care facilities, the Deputy will be glad to know that not only do I agree but so does Dr. Tony Holohan and the HSE. That will be part of our testing strategy in nursing homes. We have a lot of extra capacity and how we best use that will be considered further by NPHET at its meeting tomorrow.

On the insurance industry and the renewal of premiums, I met representatives of Nursing Homes Ireland on this matter, I think during this week. I asked an official to link with that group. Nursing Homes Ireland was going to provide examples of nursing homes experiencing challenges in this regard that we then would provide to colleagues in the Department of Finance. I am also conscious that the Central Bank has a role in this issue from a consumer protection perspective. I would hate to hear or see any price gouging or any attempt by an insurance company to make a quick buck off the back of nursing homes and, most importantly, the interests of their residents during this pandemic. We should all keep a very close eye on that. I certainly intend to.

I take the point on the need for expertise on the nursing home expert review panel. I spoke to the group's chairperson, Professor Cecily Kelleher, a very eminent public health lead, yesterday. There will be a geriatrician, a senior nurse and a public advocate. I have made it clear to Professor Kelleher that if she needs further inputs or membership, I will look very favourably on her advice. One way or another, there will be a significant consultation.

On private hospitals, as I have already set out, the Government will consider this matter further on Friday. We will need extra capacity but the question of what is the right agreement in the future is under consideration.

I will ask the Health Protection Surveillance Centre, HPSC, if it can provide the information relating to data.

Deputy Danny Healy-Rae is sharing with Deputy Mattie McGrath, is that correct? They have ten minutes.

I am glad to have the opportunity to raise some issues. The thing that hurt me and many others the most, which I raised earlier with the Taoiseach, is that people died in nursing homes and hospitals without any family member being with them. I do not know who made that decision. We must go forward. The Government did several things right but there were a number of things that were not done right and this is one of them.

This is one thing I feel should not have happened. My own father died five years ago but I can remember every one of the last hours and minutes that I was with him. If I was denied being able to be with that man after all the years, or thought that nobody was with him, it would break my heart forever. I might as well be dead as well. I feel for all the families that went through this.

I ask the Minister to devise a way to let people in to see their family members who are in nursing homes. I have been asked about that several times, including this morning and yesterday. What benefit is there in stopping people from visiting their mother or father? I had another person contact me after lunch today on the same matter. I ask the Minister to review the situation. Discussions are going on to assess the benefit of that approach. I do not think it was of any benefit. Visiting could have been allowed in a controlled fashion for five, ten or 15 minutes. That would have kept many people happy.

I want to go forward. We must try to scramble out of the place we are in now to get back to where we were. We pay a lot of money to the WHO, which says that 1 m social distancing is sufficient. If the Government does not follow that recommendation, many places will not go back to where they were. Many hotels, restaurants and pubs will not open because it is not possible to manage a distance of 2 m in small places. Rural places are different. We are told that this pandemic is affecting and will affect rural places more than urban locations such as cities and bigger towns.

I heard the Taoiseach say home care packages could be the way to go. No one asked for an increase in home help hours more than I did in the previous Dáil. Day after day I asked for it because I know that people really want to spend as long as possible, or even the last days of their lives, in their own homes. I was glad to hear the Taoiseach say that might be the way to go or that he was considering doing that but the fact is that at the height of the pandemic he cut the home help to many people. I am sorry about that. Many of those who worked in the home help area did not get another job. Perhaps they were being kept back in case they were needed, but the fact is that it did not happen, and many people were left without their home help. I ask the Minister to restore the home help that was taken from people and to increase the home care packages so that people can remain longer in their homes and have the same people dealing with them. If that happened, they would not have to go into nursing homes or hospitals. I ask the Minister to ensure that happens.

Testing is not sufficient. A man got out of his bed at 4 a.m. last Sunday morning and finished up in a hospital. The doctor said he should be tested but some other official came along and said he could not be tested because he was not being admitted. That is not an adequate response.

Many people were in touch with me to help them get the Covid payment but yesterday and the day before two people contacted me who are trying to get off it. They must go online to do it but they have no broadband. They tried to make calls and were kept waiting at the end of the telephone line. They are like the two fellows who were stuck on the train who wanted to get off at Mallow. They finished up in Cork because the train was going direct to Cork. I am sorry, I have gone into my colleague, Deputy Mattie McGrath's, time.

I spoke to the Minister two weeks ago about the situation regarding private hospitals. It is shocking. I know the reason we took them over and now it is time to give them back. Private health cover is not a privilege in Ireland; it is a necessity, as many middle-income families are not entitled to a medical card.

It was right at the time but it is wrong to continue it now. It is shocking. I have received figures from a woman from Cork who contacted me about her sister. Her case is so sad. For the last 45 years her sister has paid into the private health insurance to cover all hospital stays. She has never asked the taxpayer to pay for her medical treatment. She is now 66 years of age and in need of urgent surgery for a stage 3 prolapse which could progress to a stage 4 emergency at any minute. Her consultant tells her she will have to wait until July or maybe September. Each day this surgery is delayed means further damage to her body.

This is shocking. There are thousands of cases like this around the country. It is particularly upsetting at the moment, when private hospitals have the capacity to deal with the situation at no expense to the State. It is shocking to be blackguarded this way after 45 years paying insurance. This woman also gave me figures concerning the inpatient beds and bed occupancy in hospitals in Cork. She has provided the figures for Bon Secours Hospital in the weeks of April 14, April 20, April 28 and May 7. I hope the Minister is listening to this and knows what is going on. On April 14, Bon Secours Hospital had 30 occupied beds. There were 16 the following week, 85 the next week and 103 the next. That is out of 300 beds. This is a shocking waste of facilities.

Mater Private Hospital Cork has a capacity of 102 beds. Its counterpart in Dublin is probably worse. There were six beds occupied one week, 25 another week, 37 the next week and 23 the next. This is shocking. Women there are waiting for cervical smear tests. There are all kinds of checks to be done and private consultants to do them, but they are not being done. The Government is fighting and wrangling over accounts. What is going on? Is this a scamdemic or a pandemic? I think it is a scam and this is a scam. People are being bled dry. They pay €100 a week for health cover and they cannot get it.

Another poor man from my own constituency contacted me last night. Mr. O'Brien is a decent man, a grandfather, father and husband. He spent 17 years in the Irish Defence Forces. He attended the accident and emergency department in Clonmel at 11 p.m. last night and was discharged again at 2.30 a.m., having been told that no urologists were available. He was in excruciating pain. His family brought him to University Hospital Waterford. I support the previous speaker on the cath lab for the south east. Today the family were informed that there is no urologist on duty at University Hospital Waterford due to the current situation. What is going on in the hospitals? The authorities suggested transferring him to a care home, without being tested for Covid-19 or anything else. What is the Government doing? Is this man no longer fit for a hospital or for treatment because he is 73? Is he just to be put into a nursing home? People with the Covid were put into nursing homes and infected all that was inside of them. That is what the Government did.

Ministers and senior officials are being held to account today in the Supreme Court of Spain. That will have to happen here too. Wilful waste makes woeful want. There is blackguardism going on here.

I also want to ask the Minister about St. Bridgid's Hospital, a community district hospital in Carrick-on-Suir. It is a wonderful place. I have outlined its benefits before. There are three hospice beds there as well as other beds for convalescing. They have been commandeered for Covid-19 and now nobody is in there and the lights are out. When will that be reopened? When will the families who raised funds for those hospice beds be allowed to see their loved ones in their last moments in hospice care? That facility has the palliative team to provide this care and an excellent staff and management.

Another big fanfare surrounded Our Lady's Health Centre in Cashel. The Minister saw it a couple of years ago with a group of TDs which included myself. His jaw dropped when he saw the conditions it was in when empty. Hey presto. If Covid-19 would grant one wish, we thought it might open up the beds in Cashel. There are still no patients in there, despite the groundwork laid outside and the new flowerbeds and kerbs. What the hell does that have to do with anyone in the hospital? Now the hospital cannot get curtains. I heard the Minister on the "Six One News" saying that he could not buy a curtain because the home care shops are closed. Surely to God the HSE can procure curtains, blinds, or something to put up in the windows to cover them some way. This is a scamdemic.

It costs €200 per test. I have heard from people who have been tested twice when going into hospital and people who have not been tested at all, as described a moment ago by Deputy Danny Healy-Rae. The availability of capacity is a matter of the luck of the draw. People are making a lot of money out of this. A sum of €200 per test is outrageous. It is extortion. It should not be allowed. I heard from a woman who visited Cork University Hospital. She was instructed to get a test, which she did. Three days later she was told that the test was out of date and she should get another one. That was €400 down the drain, not for her thankfully but for the taxpayers. Where is this going to stop? When are we going to get the private hospitals and the consultants back? We have listened to Professor Michael O'Keefe and many others and to the doctor here in Dublin who resigned because of the blackguarding and the lack of oxygen available for patients in nursing homes. How can the Minister sleep at night thinking of this? How can Dr. Holohan and these people introducing these laws?

A very close relative of mine attended Cork University Hospital last week and was asked to keep a social distance of 1 m in the hospital.

We now move on to the independent Independents.

So good they named us twice.

I have had no time to respond to the Deputy.

I will take the Minister's response in writing, please.

We have gone through the ten minutes plus.

It is a question-and-answer session so I would appreciate-----

We never get answers anyway.

If the time is eaten up by the question, there is no answer.

The people want-----

(Interruptions).

It is a matter for the speakers to control their verbosity in such a way as to be able to get an answer.

(Interruptions).

We can have a question-and-answer session or we can take all this time.

It is the same amount of time as for everybody else, no more and no less. I call Deputy Harkin, who will share time with Deputy Connolly.

I raise the same issue as Deputy Mattie McGrath. Perhaps there will not be quite the same level of fire in the belly, as it were, but it is just as heartfelt. I raised the matter with the Minister last week and about three weeks ago with the Taoiseach. At the time the contract was put in place with the private hospitals, it was the right thing to do. In fact, it was the only thing to do. Circumstances have changed, however, and while we know we could be hit with a second or third wave, we have nonetheless put structures in place to help us contain, hopefully, a spike if it were to occur. The Minister stated a few moments ago that when circumstances have changed, one has to show intelligence and flexibility. It is beyond urgent that we put in place a system that maximises the capacity in our public and private hospitals. I get a sense, not from the Minister but from others, that there is intransigence here. It is about marking territory and, to some extent, about ideology. We just want a system that works for people.

We have many reasons for this. The figures released today that outlined the medical background of those who have, unfortunately, died from Covid tell us something, namely, that almost 84% of them had underlying conditions. That term "underlying conditions" strikes terror into the hearts of people but it has a human face. It is about heart issues, diabetes, cancer etc. Those chronic conditions require ongoing treatment and management, and many people are not getting that, which means they are at greater risk from Covid if they contract it. Think about all those people who are on waiting lists, perhaps for a biopsy or other urgent surgery, knowing that if they do not get it, they will end up with an underlying condition.

I said to the Minister last week that it is like a slow car crash. I ask him again to do whatever he can, because he is the person in charge, and to intervene to ensure that patients - non-Covid and Covid - can access the maximum capacity in our hospitals.

I thank the Deputy for raising this important matter and for being honest and truthful. I share the view that there was no alternative option, when we were looking at what was happening in other countries, other than to ensure we had every possible bed, ventilator and ICU bed. That is what everybody in the House was rightly questioning at the time and, thank God, we secured that capacity and, even better, did not have to use it all. That is a sign of success.

I share the Deputy's concern that this cannot be about ideology. This is not about anyone becoming Nye Bevan or about advancing the legitimate issues the House may wish to advance in respect of Sláintecare and the like in what one might call "peacetime". It has to be about showing pragmatism and common sense in getting the best outcome. The current arrangement is, effectively, an arrangement for five months with a break clause after three months, which will come in at the end of June. We have an automatic right to extend for a further two months, which would bring us to the end of August.

The Government will consider this matter on Friday. There are two things we need to try to achieve. First, we will need to have more capacity for a potential second wave, which is a very real prospect. I would not like to be the Minister who gave up that capacity and then needed to start looking for it again in a second wave. Second, we need more capacity now to deliver non-Covid-19 care also. Deputy Harkin spoke passionately about people with cancer and we are now seeing a lot of public health services beginning to be provided with the private capacity. Cancer services for public patients have moved from St. Vincent's University Hospital to St. Vincent's Private Hospital and from the Midland Regional Hospital Tullamore to the Hermitage Medical Clinic, and so on. It is about providing the potential for a Covid-19 surge capacity that we may need. If we are even to provide the normal health service, inadequate though that may be in trying to provide more capacity, it is about trying to get that balance right, which we will do over the next few days when the Government considers this again on Friday.

I will ask again about private hospitals and nursing homes. Having read what I have read, I am more convinced than ever that nursing homes were not put to the top of the list. The Minister said many times in this Dáil that HIQA was the voice of the nursing homes. I looked at the minutes and I did not see HIQA as the voice of the nursing homes. HIQA had the expertise and the knowledge, more than any other body in the State, on this. If the Minister, the Government, or any of the experts of NPHET, had asked, they might have found this out. HIQA was fully aware of all the gaps in the nursing homes and it has carried out reports year after year. HIQA was in position in December and January and should have been the first port of call for the Government to ask, "What have you identified for us and what are the gaps?", but the Minister did not do that.

I now turn to the issue of private hospitals. I preface my comments each time in the Dáil, and I preface them again, that I am an absolute passionate advocate of public medicine. What has happened here, however, with the Government's agreement with the private hospitals is nothing short of scandalous. The two private hospitals in Galway are operating at between 20% and 30% capacity. If the Minister has better figures, I ask that he please give them to me. Most unusually, I am relying on information I am getting from private consultants. I would be happy to be corrected. On top of this, the rehabilitation department of Merlin Park University Hospital, of which I am very proud - I had a family member there as a patient - was moved completely. The Minister might explain this to me. The gymnasium and all the facilities stopped and the patients and therapists were moved to Bon Secours Hospital Galway, which is a private hospital. The nurses were moved down to the public hospital to sit in a lobby to be called and put into a different ward every single day. Patients and therapists are all gone to the private hospital while Merlin Park University Hospital has been left empty. Perhaps the Minister will explain the logic of this.

A private consultant, who is a specialist in gynaecology, was interviewed on "Drivetime" on Monday. The consultant explained that she has 350 patients, 50 of whom need urgent surgery but she cannot do it. There are 300 awaiting consultations. The more I reflect on the Covid-19 crisis, the more it seems to disproportionately affect women and children. There is no cervical screening, no BreastCheck, no elective surgery carried out and emergency surgery is very limited. This is while we have the two hospitals practically empty. It is certainly 70% empty and God knows what the percentage is in Merlin Park University Hospital. I could pull a figure out and say 50% but I imagine it is much higher. We are paying €150 million per month, in advance I understand, for empty hospitals for three months and then we will renew it. There is absolutely no pathway to tell me that the women and men who are waiting for surgery will be seen. The list builds up and up and those in the private sector are now told to go into the public sector, which puts even more pressure on it. Even after they have been diagnosed and seen by consultants people are now going in to get a further diagnosis. Incredibly, consultants who are on a different contract in the public system are allowed to still see private patients, while the private consultants cannot see any of their patients. Inequity is built in to every part of this agreement. Furthermore, the ultimate insult is that we cannot see the contract because it is commercially sensitive. I would appreciate it if the Minister would deal with some of those issues.

I thank the Deputy. The up-to-date figures I have for the Bon Secours Hospital Galway are for an inpatient bed occupancy of 48% on the week of 11 May to 15 May. That dropped to 41% on 18 May to 22 May. The Galway Clinic figures show 15% for 11 May to 15 May, and this increased to 26%.

I get the point that there are challenges and difficulties. However, I still believe it was absolutely the right thing to do. I get the point that we need to finesse it and get the best possible arrangement in using all of the facilities. I also get the point, however, that we cannot allow public patients with cancer not have their services and private patients with health insurance continue to get them. In Galway city, in the Bons hospital we had 378 public patients discharged from inpatient beds, along with 298 day-case procedures. We had 434 public patients in the Bons hospital in Galway, who would never have been able to darken the door before, actually have diagnostics carried out there. Some 710 public patients had outpatient appointments in the Bons hospital in Galway as well. I can give the Deputy the figures for the Galway clinic as well but I will not waste her time. I will send them to her.

This is about equity of access.

It is about inequity.

There is no equity in this. The Minister is talking about private patients going into the public system where the public system has significant waiting lists. If what the consultant stated on Monday is wrong, then the Minister should challenge her publicly about a three and a half year waiting list for gynaecology in the public system in Galway. I am too familiar with this. I appreciate the Minister has done a deal under pressure-----

It was the right deal.

-----with good will. Very quickly after that, however, it became apparent that it was not right and that the Minister is paying €115 million for empty hospitals. He then filled the private hospitals with public patients out of Merlin Park Hospital.

The Deputy would be the first in this House to criticise me, rightly, if we did not have available bed capacity if a Covid surge came.

We need to get the best arrangement. As the facts change, we need to alter that. We are, however, going to need to keep some of that private capacity to help public patients. Otherwise the public health service will not be able to function in a Covid environment.

Up to €1.2 billion will be spent in a year on this system.

Sitting suspended at 5.25 p.m. and resumed at 5.45 p.m.