Covid-19 (Health): Statements

We now move to the statement by the Minister for Health on Covid-19 and questions and answers on Covid-19. The Minister has ten minutes for his opening statement. After that the usual order prevails. Fianna Fáil has 15 minutes and everybody else has ten minutes.

I very much welcome the opportunity to once again update Dáil Éireann on the Covid-19 pandemic and our national response to it. First and foremost, I wish to express my sympathy to the families and friends of those who have been lost to this disease since I was last in the House. My thoughts are with all of those who have been bereaved.

We are in the third week of phase 1 of our Roadmap for Reopening Society and Business and tomorrow we will decide whether it is safe to proceed to phase 2. I have now received the advice of the National Public Health Emergency Team in that regard and I will bring it to Cabinet tomorrow morning for its decision.

Throughout this pandemic the people have shown resilience and strength in the face of turmoil and challenge. Today NPHET met and it considered the impact of the pandemic on two age groups in particular. This virus has been difficult for everybody, but it has been particularly difficult for our children and for older people in society. Tomorrow I hope and expect that Government will be in a position to consider how we can support these two age groups who have borne particular challenges on the basis of National Public Health Emergency Team advice.

After so many weeks of hardship and sacrifice, I am conscious that we all have a strong wish to leave this disease behind us and to move forward to better times, but I am also conscious of the reality we live in. The progress that we have made against Covid-19 has allowed us to begin reopening our country, but we absolutely must remain cautious and clear-sighted about where we are.

We have successfully interrupted the transmission of this disease but it has not gone away. It has not been eliminated. It is still here with us. The WHO has said that it may be with us for a long time to come, either at lower levels of transmission or as waves of higher infection rates. The number of new confirmed cases each day continues to be lower than it has been in previous weeks but it is still at a similar level to what it was in mid-March, when we had to first bring in our public health measures. We interrupted the transmission of the disease in circumstances where so much of our society and our economy was effectively closed down. The task of maintaining this virus at a low level will be harder as we start to open up again. Let us be clear on that: it is going to be tougher to manage and maintain this pandemic as we begin to go about what will be a new normal.

I can confirm to the House that our modelling work has now shown a slight potential increase in the R-rate. This week the data suggests that the R-number in Ireland is between 0.4 and 0.7. This is a key metric and, as this House knows, we need to keep the R-number below 1 and cases low to minimise the force of infection. Otherwise, we carry the risk of an increase in cases and larger outbreaks of disease. While we may have seen a slight increase in the R-number, it still remains below 1 and that means we are still collectively as a country effectively suppressing the growth of this virus.

Other key measures of severity also continue to fall. There are 37 people in intensive care and there were 166 people in hospital on Wednesday this week. We have made progress. We have saved lives but we cannot get complacent. We cannot stop now because the day we do that is the day we go backwards. We have to continue to make and maintain progress or we risk the disease getting ahead of us. Our roadmap is clear but progress in reopening our society and our economy is not always inevitable. It is dependent and will remain dependent on the threat of the disease. We do not have a vaccine or an effective treatment for Covid-19. Having said that, we are not powerless. We have now learned how to protect ourselves and others in this country from this disease and we will make progress only if we continue, day in and day out, to practice and do what we know works. If we wash our hands, cover our coughs and sneezes, respect the 2 m rule - it is 2 m - we will make progress. If we keep the number and the duration of our contacts low and we stay away from crowds, we will make progress. Just to dwell on that point, we have seen in figures published by the Health Protection Surveillance Centre, HPSC, that, speaking from memory, about 59% of new cases of Covid are coming from close contacts. We know that as we begin to move about and develop more close contacts and increase the number of close contacts, that does increase the risk of the virus spreading. We need to make a very conscious effort. Regardless of what restrictions may say or what public health rules may be, there is an individual responsibility on all of us to try and keep the number of our close contacts low to slow down the spread of this virus. If we keep ourselves informed of the symptoms of Covid-19, put ourselves forward for testing if we develop those symptoms and self-isolate as we await that testing, we will continue to make progress. If we practice what we have learned and continue to show consideration for each other, particularly for groups most at risk, we will make progress.

We are making progress. Figures from HPSC show that, as of midnight on 30 May, 110 outbreaks in residential care facilities have been closed. That is 110 residential care facilities that had an outbreak of Covid-19 that have now been Covid-free for 28 days or more. Of these, 61 are nursing homes. That figure was just 29 last week. That is a very significant increase in a week in the number of nursing homes that are now able to say they are Covid-free after having a Covid outbreak. It is 32 nursing homes in our country that had Covid that now have not had Covid in over 28 days. I pay tribute to the staff in those nursing homes, the nursing home owners and the local health service for the collective work to make that progress. It shows great progress across our long-term residential facilities, which have been the front line in the battle against this virus.

This will come as a huge relief to families across the country who have been apart from their loved ones for almost three months now. They have not been able to visit a mom or dad, a granny or grandad, an aunt or uncle or a brother or sister in a nursing home. I hope the Government will be in a position tomorrow to consider some issues in relation to trying to ease visitor restrictions in a way that is safe.

On the issue of non-Covid care, I met with the CEO of the national screening service this morning.

I appreciate the need to resume screening is causing real anxiety for people, particularly women, when we consider CervicalCheck and BreastCheck. I want to assure this House, and the people who use our screening services, that a plan for the resumption of service is under way. Extensive work is ongoing and I expect real progress shortly. I have asked that our screening service liaise and meet with, virtually or otherwise, the advocacy group, the 221 Plus group, the Irish Cancer Society, the Marie Keating Foundation, and others in this regard.

I want Deputies to know that our screening service and the clinicians leading these programmes are working incredibly hard. I was left in absolutely no doubt of that. They are not just waiting. To give an example, already CervicalCheck has carried out trials of the new HPV test. It invited women to come forward through both the Irish Family Planning Association and the Well Woman Centre to see how our new HPV test is working. BreastCheck is currently working with infection control specialists to modify their mobile units. We have 20 mobile units around the country. We need to change radically how people go in and out of those facilities. Extensive work is being carried out in that regard, and also on bowel screening and diabetic retina screening. A huge amount of work is being done here. It would be wrong of anyone in this House, because no clinician can do this, to promise a return to screening as normal. Screening will have to change, and we will all have to prepare for that change. It will have to be done in a way that is safe and effective, but we will work with clinicians and staff to ensure they are protected in their duties, and that women and, indeed, men have the confidence to come forward for our screenings, and to work with our service users to ensure they are protected in trying to provide these services in a Covid-19 world. We must and will get this right, and it will be safe. I expect the National Screening Service, whom I hope Members in this House will have an opportunity to engage with, to be able to update in concrete terms how it intends to resume each of the four screening programmes, and that they will be able to provide much more detail in that regard during the month of June.

As we open more of our economy and society, and I hope that tomorrow Government will be able to recommend and proceed with phase 2 from Monday, our individual actions will matter more than ever. The Government, and the health service, can and will take appropriate measures. It will prepare for every eventuality, but we will need individuals more than ever, because the first and best line of defence is all of us as individuals, that is, the people of Ireland following the advice, continuing to wash hands, practise social distancing, and keep their number of close contacts to a minimum. This is the best chance we have of success, so let us do it for each other. Let us work together and protect each other, and in doing so I am confident we can move forward and not backwards when it comes to our roadmap.

Thank you, Minister. The next party to speak is Fianna Fáil which has five speakers lined up to share 15 minutes.

I will take the first five minutes.

Deputy Donnelly will take the first five minutes, and after that-----

The remaining speakers will take two and a half minutes each.

Should the Minister reply to everybody at once?

Everybody would prefer to have his or her own slot, if he or she could.

We might rely on your laser-like focus to make sure everybody gets his or her time.

I will nudge you in a positive direction.

I want to ask the Minister about two different areas. One is the screening services, and I thank him for the update on that, and the second is the contract with private hospitals.

The screening services obviously had to be closed down. We screen approximately 3,000 women and men a day. Closing them for three months has meant that 170,000 screenings, or thereabouts, have not happened. We all back the screening services. We know early detection saves lives, therefore, unfortunately delayed detection can cost lives. Many doctors believe they can open now. I will give the example of cervical screening. In the past three months 70,000 women will not have been screened. GPs and scientists are contacting me saying that GPs are ready, that social distancing measures are in place and they can take tests now. The labs are saying they can do the tests, and the colposcopists and specialist are saying they can take referrals from the labs results now. When are we going to have a date? Doctors are anxious about this. I want to read out what one GP wrote to me this week. The GP stated that we have a tentative date for opening of hairdressers and pubs, but not for cancer screening, and that it is alarming and extremely concerning. I welcome the Minister's update today and that he is engaging with the screening services, but what the clinicians are asking for is a date. When are we going to have a date when they can get back to providing this lifesaving service?

The second question is about the contract with the private hospitals. As the Minister will be aware, I was fully in favour of the initial decision, but not of the ongoing use of it. I do not think it worked well, and welcome the decision to end the contract. I hope we will have some replacement capacity put in place for public patients but I do not understand why it is being run through June.

We will still pay more than €115 million. My understanding is that the reduced capacity stemming from this effort to do both at the same time will result in approximately 10,000 fewer surgeries under general anaesthetic - serious surgeries - for public and private patients. It was also revealed at the committee that no effort was made to ask the private hospitals whether they would consider ending the contract sooner. Why was no effort made to end it sooner such that we could try to get patients the care they need more quickly?

Let me be clear that I, the Department, the HSE and the Oireachtas wish to be in a position to recommence our population screening programmes as soon as possible. It is a collective priority for us all. I am glad to inform the Deputy that the four programmes - obviously, there are four parts to our screening service - will report on their final plans for restarting in the coming days. Yesterday, I had a very good meeting with the CEO of the HSE, Mr. Paul Reid, and its chief clinical officer, Dr. Colm Henry, and I had a very good meeting today with the chief executive of the National Screening Service.

I emphasise that although some people state that certain things can open - I know the Deputy did not mean it like that - there is a complexity in respect of getting our screening services right. It must be safe for patients and staff and give people the confidence to begin to come forward again. We must remember they are often healthy people who volunteer to come forward into the health service. Screening often involves tests or examinations that can present challenges for staff running these programmes in light of the need to comply with physical distancing measures.

A working group has been established and it is chaired by Dr. Caroline Mason, a clinician. I thank her for her work. It reports to the chief clinical officer, Dr. Henry, and is reviewing the individual programme plans for recommencement and developing a framework to support the safe restart of all four programmes. For example, Deputy Donnelly referred to CervicalCheck. There are three parts to it. First, there are the sample takers, who are largely GPs and nurses. I accept they are probably in a good place to go. Second, there is making sure we have treatment pathways from a colposcopy point of view and, third, there are the laboratories. We need to ensure each of those three parts are lined up in order that we can have a seamless recommencement.

On the issue of private hospitals, I wish to ensure we use the time left, that is, to the end of this month, to put a successor arrangement in place. I explained last week in the House that several services have transferred almost entirely from the public health service to the private health service, particularly in the space of cancer care. I listed them last week. I wish to ensure we use the time available in order that we do not hit a cliff edge and have no agreement or a vacuum. That is why we decided to use the time between now and the end of June to negotiate what I think will be a better and more fit-for-purpose deal.

I wish to revisit the issue of cancer screening services. I wish to put the point across from a woman's point of view. Women are worried. I encourage everyone to avail of screening when it is available to them. When a woman turns 50, she gets, for the first time, a letter inviting her to avail of the BreastCheck service. I know of a lady who availed of that service two years ago. Unfortunately, she was diagnosed with cancer. However, she had a great outcome because it was found so early.

Smear tests and CervicalCheck are very important for women's health. Women who are genuinely concerned phone me on a regular basis, as, I am sure, they contact many other Deputies. I acknowledge the answer provided by the Minister to my colleague, Deputy Donnelly, on this issue, but it is very important that we get clarity. We need to reopen cancer screening services as quickly as possible. I understand the obvious health and safety challenges posed by the pandemic. In light of the answer provided by the Minister, can he clarify whether people who were tested prior to the suspension of cancer screening services in March and April have been receiving results in the interim period? I know the laboratories have been under pressure due to the pandemic, but surely administering results of those who were tested prior to the suspension should be the first step. All Members are aware that the earlier one catches cancer, the easier it is to treat. If people do not get their diagnosis, they could, in turn, be in serious trouble down the line.

I wish to emphasise my very strong belief that we need to address the Covid-19 pandemic issues to the greatest possible extent on an all-Ireland basis. Having a memorandum of understanding between the health Departments North and South is welcome, essential and needs to be built upon.

Perhaps we need more measures to be implemented at sectoral level through the North South Ministerial Council to give out a clear message on the value and importance of the all-island approach across different areas of our daily lives. The gradual re-opening of the economy, North and South, which we will all welcome, will entail more movement of persons, goods and services, with attendant risks. In Border areas such as Cavan-Monaghan, my constituency, the people need to be assured of the similarity of approaches and implementation of strong measures, North and South, to deal with this pandemic for the benefit of all on this island. That message could help to emphasise the continued need for a prudent and diligent approach.

I raised previously the need for a compatible app system for tracing purposes, North and South, between the HSE and the NHS. For some weeks, unfortunately, Cavan has recorded the highest incidence of Covid per head of population and Monaghan the third highest; this has been a trend since the third week of April and continues at present. There is a considerable difference in incidence rates between my constituency and the two counties with the lowest rates, Waterford and Wexford. An investigation, which I have called for through parliamentary questions and in other debates, should be carried out by public health officials to determine the reasons for the virus rates occurring in the Cavan-Monaghan area. If particular deficiencies are identified in healthcare provision in this area, I would appeal to the Minister to ensure that the necessary resources are provided to the public and private healthcare providers to address such deficiencies.

I appreciate the good reasons for the cancellation of routine hospital work at the onset of this pandemic. With more speed now, we need to see both public and private hospital capacity being put to much greater use, as referred to by my colleagues, Deputies Donnelly and Butler. I spoke to clinicians who are very concerned that they have been unable to attend to patients who need assessments or treatment. They believe very strongly that a balance can be found between increasing hospital capacity very substantially and retaining a necessary complement of beds for Covid patients. Again, I welcome the Minister's reference to the cancer screening services, but we need a timeframe for all of those services to be restored.

I ask that the Minister would answer the questions of the last two speakers before I come to mine.

I might write to Deputy Butler with more detail on screening so as not to use up her colleagues' time. I know how important this issue is and how many times she has raised it. The national screening service is holding daily meetings on this. I am very satisfied with the work being done by Dr. Caroline Mason Mohan, who is the interim director of CervicalCheck and a public health doctor as well. She is leading the working group and I think it is appropriate that this is led by clinicians. I believe, however, that they need to link in with the advocacy groups and inform them as well. I am hopeful we will have more news on that very shortly.

In response to Deputy Smith-----

The Minister can communicate with me in writing.

I will do that. I agree with the Deputy in regard to the importance of cross-Border measures and I can send details on what we are doing. I will also write to the Deputy in regard to the statistics on Cavan and Monaghan.

I have a number of questions. First, will the Minister confirm whether the refreshed A Vision for Change will be brought to Cabinet this week for the purposes of publication? Second, has there been any progress on establishing a cross-departmental task force on mental health, which will be very badly needed? Third, can the Minister give clarity on physiotherapy? I have had a number of requests from physiotherapists, including neuromuscular physiotherapists, and those in similar professions, who seem to have a lack of clarity as to when they will re-ope. Fourth, on a similar question with regard to screening programmes, it would appear that all non-essential retail services can reopen at the end of the month and that would appear to include sunbed facilities. It would be quite grating for the public if people could get a sunbed at the end of the month but are not able to get cancer screening.

I echo my colleagues' calls on screening. On the turnaround time for the results to come back, we have heard stories of women having to wait weeks and months on end without any clarification on their tests. This is important when we talk about screening.

I want to remember all of those who lost their lives to Covid-19 and the terrible impact this has on families and friends, including not being able to spend the last hours with loved ones, not being able to say goodbye, and the deep sense of grief of those who cannot celebrate these lives in the usual funeral rituals that are so important to the grieving process in Ireland.

Covid-19 has had a devastating impact on hundreds of families, not least those in my constituency of Cavan-Monaghan, as the Minister has just heard. The Minister will be aware that Cavan and Monaghan, unfortunately, have had the highest number of cases in the country. Currently, Cavan has 844 cases and Monaghan has 515 cases. Will the Minister explain the reason identified for this? We have seen mapping for Ireland where Cavan really stands head and shoulders above any other county for the very high number of confirmed cases. What has the Government, the Minister and his Department done to support Cavan General Hospital and the Monaghan Hospital, which are on the front line firefighting these cases? How is the Minister assisting them in dealing with this high number of cases? Will he indicate where the clusters are occurring and reoccurring? Is it the meat factories or is it family clusters? We heard Dr. Illona Duffy speak about this yesterday. There are questions over this but I am sure the Minister, his Department, and his team may have possibly identified that. What is the Minister doing to suppress the spread? Are extra resources being put in place for testing and tracing to stop the spread? I would like to hear the Minister's response on that.

I will answer as many of the Deputies' questions as I can in the time available and I will write to the Deputies on the other two queries.

On Deputy James Browne's question on A Vision for Change, I have heard very clearly the calls on a cross-party basis in this House for the publication of the refreshed A Vision for Change. It is my intention to bring it to the Cabinet this week, I hope this evening, with a view to my colleague Minister of State, Jim Daly, briefing the advocacy groups early next week and publishing the document next week. It will be for approval by Government this week for publishing next week. It will be a matter for the new Government to implement it, but I believe it makes sense. Colleagues in this House persuaded me of that also. The cross-departmental piece falls into that also. When talking to Mental Health Reform and others, it is very important that whatever structure we put in place links in with A Vision for Change.

I note Deputy Niamh Smyth's comments on screening and I will write to her on that. I note also her comments on funerals. I hope that as we move to phase 2 next week, we might be able to see if there is something we can do to increase, even in a slight way, the number of people who can attend funerals. Deputy Kelly raised the issue here last week also.

On Cavan General Hospital, I will send Deputy Smyth a note and the statistics for Cavan and Monaghan. I believe there are a number of reasons, as opposed to any one reason, a county can see spikes at certain times. I will write to the Deputy on those items this week.

Last night I received from the Minister's Department a reply to a parliamentary question that advises me the bed capacity in the public and voluntary system, not including private beds, has increased to 11,907. This means that because of Covid-19 we have been able to increase the capacity in our public hospitals by 1,407 beds compared with what the bed capacity review said we had in 2018. This is an increase of just over 1,400. The Minister will be aware, because I have been saying it to him for a long time, that along with the health sector unions - the INMO, the IMO, SIPTU, the IHCA, Fórsa and others - we have been calling for all closed beds in our hospitals to be opened. It is very frightening to think that when we had more than 700 patients on trolleys in our hospitals, more than 1,000 beds remained closed purely and simply because the Minister would not tackle the recruitment and retention crisis to ensure we could get the necessary staff to be able to open those beds. It beggars belief when one considers that very often it did not even make the news. It is hard to conceive of it now. When one speaks of waiting lists, it is a little like déjà vu. It hardly even made the news unless it was close to 700 or more. That was a daily occurrence and now we find that the beds in the system did exist and what they simply needed was the staff.

I am looking for a breakdown of where these additional beds are, by hospital, and I will take that in writing if the Minister can provide it. I want a commitment from him that, as we exit the Covid-19 crisis, he will ensure that every hospital bed which has been opened in the public system will remain open because they will all be needed.

I am also seeking an update from the Minister on how many beds will be temporarily set aside in the public hospital network to take account of the additional infection control measures. I am being told informally that this could take up to 25% of the beds out of the acute hospital system. That is deeply worrying. To be cognisant of infection control measures, will the Minister provide an update? Is the figure of up to one quarter accurate? Will he confirm that as these beds start to be reopened, and some will, this will happen in accordance with the safe staffing level agreement reached with the INMO? It is just over a year since nurses and midwives were on the picket lines looking for safe staffing. There is an existing agreement that has set the benchmark on what is safe, and I and others seek confirmation from the Minister that he will adhere to the agreement.

I am also seeking an update on the restarting of care. I appreciate what the Minister said in respect of screening. This is an issue I have raised on many occasions with him. I welcome the confirmation but what we need to see are dates, firm timeframes and a commitment that the missed care will be caught up on. Will the Minister confirm that there will be a twin-track approach to this? Will there be a catch-up programme? Most importantly, will there be an information programme for women? Many of us will be nervous and anxious going back to the screening service. We know how important it is, and we have spoken at length about it, but I want to be able to say with confidence - and I want to have the confidence myself as a user of the service - that people can go back. We need that information campaign. It is absolutely imperative.

With regard to restaurants opening up in June, will the Minister confirm that pubs with restaurant licences will be able to open at the same time? Anyone who is as old as I am will remember in the late 1980s and early 1990s when we had to get a bag of chips or a plate of manky curry for the venue to be able to continue to serve alcohol.

I remember it well.

The Deputy is showing his age. Will this be the case? Will the two be linked?

I bet the Minister never ate the mushy peas in those places.

He was not around in the early 1980s.

Chicken in a basket.

I do not think we ever did that in Greystones at any stage. We will have to ask Deputy Donnelly as he is at little bit older than me.

I thank Deputy O'Reilly for the questions. I had a really good meeting with the INMO and SIPTU health on Monday and I am due to meet both again next week. We have started to discuss with them the issues raised by the Deputy on how we prepare to provide non-Covid care and for winter in the knowledge that the virus will be with us. Many of the issues the Deputy has raised are issues they have started to discuss with me.

I will get the Deputy a the breakdown of those extra beds no problem and I will send it to her in writing. The Deputy asked me whether I can give a guarantee the beds will remain open. If I remain as Minister, that is certainly my intention. I am conscious of the fact that at some point the House will elect a new Government and these will obviously be matters for that Government. There is no doubt that we will need all of the extra capacity we have opened and that we will need more. The conversation I had with the unions, although they did not need me to explain it because they know it because they are on the front line, was that it will be about more than this. It will be about a new model of care. It will be about all of the things we speak about every year but we are really going to have to actually do them. I refer to moving care out of the hospitals and keeping as many people as possible out of them, looking at how we try to interrupt the flow of older people who end up in hospital every winter or reassessing how some procedures can be done on an outpatient basis. There is a big body of work that will need to be done in this regard.

Yes, the safe staffing levels will have to be adhered to. I use the figure of approximately 20%, but up to one quarter of beds is a real possibility in terms of infection control. This is something the CEO of the HSE is bottoming out at present. We discussed it only this week.

With regard to non-Covid care, and I acknowledge the many times the Deputy has raised screening with me, I want to be careful. I do not intend to give any commitment on the floor of the Dáil regarding how the programme will be resumed because it has to be clinician-led. In the past, perhaps I have given commitments that people have been critical of in respect of screening and I will not do that again. It has to be clinician-led. The Deputy's point on the need for an information programme for women, and for men who use some of the screening programmes, is vital. I would like the Irish Cancer Society, the 221+ group and the Marie Keating Foundation to be invited to meet those who operate the screening service.

Many of them have been in contact and I have asked for that to happen.

On the issue of pubs and restaurants, I cannot get ahead of the Government decision-making process. We will have to consider this as we get to the further phases. I will come back to the Deputy on the curry and mushy peas. I will write to her about that.

More than 1,000 people in nursing homes across the State have been killed by Covid-19, at least that is according to the HSE figures. Over 112 of these deaths occurred in my constituency, Kildare North, where we paid a remarkably heavy price. We learned from the Special Committee on Covid-19 Response last Tuesday that the HSE, the Department of Health and the Minister for Health had no proper plan for protection in place in nursing homes, despite knowing that our elderly were at particular risk, despite having the advance warning from Italy and despite health care workers begging for PPE. Our elderly could cocoon in their own homes but if they were living in nursing homes, they had to take their chances with the virus. This is a devastating inequality for those who died without having their hands held by their loved ones, the families grieving without the comfort of a traditional Irish funeral and the health care workers who risked their own lives to protect these dying patients without adequate PPE.

The Minister was right to seek additional acute hospital beds. I would have done the same but he was wrong to relegate the nursing homes to an inferior position and to allow age to place a discount on people's lives. The Department was careless, so much so, according to HSE figures, that the equivalent of three jumbo jets crashed across our country and everyone on board died. If planes had actually crashed, we would have had days of national mourning. Luckily, there has hardly been a murmur so far. The story in The Irish Times this morning about the HSE figures make it even more important to have an independent investigation. Any investigation must be independent because, in view of the loss of lives, we cannot have the HSE and the Department of Health investigating themselves. These tragic deaths were not inevitable. In Kildare North and across the State, people want to know the hows, the whys and the who's, not for blame - because that is just finger-pointing - but in the context of accountability. Accountability makes us hold up our hands, take responsibility and learn. History shows us that we need this from the HSE and the Department of Health.

I previously asked the Minister to publish details of the fair deal private nursing homes pricing mechanism review. Despite sending a reminder, I am still waiting for a reply. We should have this information in order to establish whether there is a correlation between homes deemed unviable by the review and clusters of Covid-19. If there is a correlation, I ask the Minister to take these private nursing homes into public ownership. Care of the old people should not be commodified, privatised or monetised. Will the Minister establish an independent investigation into the deaths at nursing homes? Will he agree that in the case of a correlation between these figures that these nursing homes will be taken into public ownership? That would be a first step towards the single-tier health system that would befit a real republic.

I thank the Deputy. I am not sure that she wants an independent investigation because she seems to have already delivered the verdict, which is rather disappointing. To endeavour to say that there was no proper plan and that nobody did anything-----

That is what came across from the committee meeting.

-----does not reflect the reality of what I have seen as Minister. I have seen the most incredibly dedicated people in the HSE, at local level, and in the Department of Health working 24-7 against a global pandemic. As I stated last week, the villain here is not someone working in the HSE or even some bureaucrat, or even a Minister; the villain is a virus - the worst we have seen in a century - that has taken the lives of so many people, particularly older individuals. I think 90% of people in this country who have died as a result of the virus had underlying health conditions. We know how infectious this virus is and we know how hard it is to keep it out of anybody's home.

I do, however, agree with the Deputy on several points, particularly on the lessons learned in terms of the model of care.

The Minister's time is up.

I will revert to the Deputy in writing on the last few points.

I wish to address the waiting lists for child and adolescent mental health services, CAMHS, in County Kildare, where I come from. This is more important now than ever. It has always been important. There is an ongoing crisis in CAMHS. The waiting list comes up every year. The Minister and his predecessors have wrung their hands and promised that things would improve but all the evidence shows that they have not. There is a recruitment crisis, ongoing delays and children are being turned away from the service because their symptoms do not match the severity that the service is struggling to cope with.

Children continue to be admitted to adult services and there is no 24-7 service. This is even more shocking in the context of the €17.4 billion, and rising, health budget.

I spoke to a father during the week who told me it would have been better for his son if he had presented with cancer because at least there would have been a swift diagnosis and a clear path to care for him. This is a shocking indictment of the reality of mental health services for young people. I also spoke with a mother who sleeps in her teenage daughter's room. She sleeps there because of fear and because she feels that if she does not sleep there that daughter will take her own life. These people are being left behind by a system that is broken, that can barely deal with the most serious cases and that certainly cannot stop the rising tide of cases that become serious much more quickly because of neglect. Many people with mental health issues are trapped in a vicious circle. This circle sees them discharged from the system as quickly as possible with a handful of tablets. Inevitably, they return in a worse state and we need a lifelong approach to ensure their health is maintained. Health is about mental health and about keeping it maintained.

I urge the Minister to start taking this crisis seriously. Urgent action is needed to address the situation. It is important that we get full implementation of A Vision for Change. We need fully staffed child and adolescent mental health services, CAMHS, teams, investment into mental health primary care and a school curriculum for positive mental health. We also need these changes to begin today. We do not need more reports, meetings and passing of the buck. We need this to be looked at now. Sadly, the delay in addressing this crisis is costing lives. This needs to stop now.

I thank the Deputy for raising the very important issue of mental health, particularly youth mental health. This week, the Government will consider the new A Vision for Change document that the Deputy referred to. A lot of work has been put in by a lot of expert people on this and I hope, subject to Government approval, to be in a position to publish that next week. I know that is something the Deputy and her colleagues have been looking for as well and they have written to me in that regard.

I want the Deputy to know I take this crisis extremely seriously. This pandemic will have had a real and lasting impact on the mental health of all people in this country, particularly younger people. I will not go through all the funding allocations in the time available to me but I will write to the Deputy about that. I agree with the Deputy about the need to try to provide more mental health supports at primary care level. We have introduced a new grade for an assistant psychology post within the HSE and we have seen significant and positive impacts come from that. We had seen the CAMHS waiting lists fall before this pandemic. We need to see more progress in that and I will write to the Deputy this week detailing what further measures I intend to take.

I commend the Minister, his officials and in particular, our healthcare and front-line workers for their unwavering commitment to those who they treat. I am conscious that Ireland's response to Covid-19 has been a momentous effort and one that has brought many communities together, even while physically remaining apart. Everyone I meet acknowledges Ireland's swift response to the crisis in comparison with other countries which are experiencing greater difficulties.

The mental health crisis triggered by Covid-19 is escalating rapidly. Flattening the mental health curve is the next big coronavirus challenge. While all population groups are affected, this crisis is especially difficult for students, particularly for those pushed off a college campus and now facing economic uncertainty. We have youths suffering from unemployment, adults with children at home and struggling to juggle work and carry out homeschooling, our elderly suffering with cocooning and physical distancing and our front-line staff and healthcare workers risking their lives to save others. With a concerted effort, clinicians and policymakers must meet this challenge head on, ensuring waiting lists are reduced and access to services is prioritised. How does the Minister intend to flatten the rising mental health curve? I welcome him bringing the new A Vision for Change document to Cabinet this week. We need to ensure our HSE statutory services, such as CAMHS, community psychology, adult mental health and the community service groups, such as those operating in my constituency like Mindspace Mayo and Mayo Mental Health Association and the various family resource centres are given direction.

The Minister may recall visiting Mayo University Hospital in November 2016 when he witnessed at first hand the excellent work being done by the hardworking staff there.

Thankfully, as of Wednesday, I note that no new suspected Covid-19 cases have been admitted to Mayo University Hospital for a fifth consecutive day. I am aware of some physical changes to the hospital, including a new entrance. Having spoken to some local health workers, however, I wish to point out that concern remains about staff working within Covid and non-Covid patient pathways. Any information available from the Minister or the Saolta hospital group would be greatly appreciated. Are there any plans to update Sláintecare to include greater provision for isolation rooms and facilities to counter infectious diseases, in addition to an increase in bed capacity and further capital investment?

I remember visiting Mindspace in Mayo with Deputy Dillon. It has written to me a few times and kept in touch with me, and I am very taken by the work it does. The Deputy is right to highlight the issue of mental health as one of the next huge challenges coming down the track. The Ceann Comhairle and I have been in correspondence in this regard. I think there will be a big body of work that this House, collectively, whoever is in government and whoever is in opposition - all of us - will be duty-bound to do in how we deal with the mental health fallout of this pandemic. We know we faced many challenges regarding mental health before Covid. We know that that will be compounded as a result of Covid. Deputies on all sides of the House have told me that one of the first steps should be the publication of a new Vision for Change. That will then mean that the new Government will not have to spend months and months deciding whether to publish, amend, review or think about it again; it will be out there. The Government's focus can then be on the implementation. This House's focus can then be on overseeing that implementation. Then there will be no excuse for a programme for Government, whoever wishes to form a Government, not to address this properly. I will keep in touch with Deputy Dillon on that.

Regarding Mayo University Hospital, I commend the staff there on the really good work they are doing. In the interests of time, I will write to the Deputy on some of the work being done to ensure separate pathways of care for Covid and non-Covid patients in that hospital. I am delighted to hear there has been no new Covid case for five consecutive days. The Deputy is entirely correct that the issue of isolation has always been a challenge in the Irish health service. It will only become a bigger one now. The Sláintecare office in my Department and the HSE board are both looking at Sláintecare, what is ahead of schedule and what is behind schedule as a result of the pandemic, and where we now stand. A new Government will have the benefit of that work when it takes office.

Like the Minister, I wish to express my sympathy to the family and friends of those who have been lost to this disease. My thoughts are with all those who have been bereaved. I thank again all the front-line staff. One section of the front-line staff I wish to thank is the Garda. Last night I was driving home to Sligo and was stopped by gardaí in Castlebaldwin. They asked me where I was coming from and where I was going to. As a citizen of this country whose grandfather was one of the first gardaí in An Garda Síochána, I again thank the Garda for helping to dissipate this threat against our country and our citizens. It is not the first time since the foundation of the State that the brave men and women of An Garda Síochána have stood up and defended this country and its people and institutions against threats. I wish to put on the record how proud I am of the men and women of An Garda Síochána, past and present. I have said that here before, and sometimes we do not say it loud enough. The gardaí who stopped me were courteous and inquisitive but very professional, and again I thank them.

If staff go away on holidays and they are supposed to self-isolate on their return, are the employers responsible to oversee their staff in this regard, be it in education, hospitals or the public service? Is there an obligation on the employees or any mechanism in place?

Perhaps this is a curveball. The High Court has ruled that Gemma O'Doherty and John Waters must pay the High Court costs for the failed attempt to challenge the laws introduced by the caretaker Government. It is a five-figure sum. What are the Minister's views on that, or does he have any?

Finally, people have been applauding and criticising the Swedish approach. Sweden has a softer approach towards curbing the spread of Covid-19. It did not impose a strict lockdown, and there is for and against on that. Does the Minister have any views on the Swedish approach to Covid-19?

Before the Minister comes in I wish to point out that in respect of the court case you have alluded to, Deputy Feighan, there is the prospect of a possible appeal. I think it would be unwise to make any comment at this stage.

I will respect your view on that absolutely, a Cheann Comhairle. I wish to join Deputy Feighan in thanking our front-line staff in the health service, as we do, rightly, every week. I have had really good engagement with the unions representing several of those workers this week. I also intend to meet the general practitioner representative body, the Irish Medical Organisation, next week. We need to continue to keep the spirit of partnership going.

Deputy Feighan is absolutely right to thank the gardaí. As the Minister for Health I am keen to thank them as well. Not only have they done their job as gardaí in terms of enforcing the law and regulations - I thank them for that - but, most important from my perspective, they have been incredible when it comes to community policing, including checking in on older people, going to the shops and doing messages. They have been really helpful lookouts for vulnerable people in our communities. I join with Deputy Feighan in that regard.

Deputy Feighan asked about the issue of self-isolation. Self-isolation is a public health measure and public health advice. In the first instance the responsibility is on each person as a citizen. If a person develops a symptom, that person should self-isolate and ring the GP. The person need not wait for a test but should self-isolate while awaiting instruction from the GP and follow the GP instructions carefully on when it is safe to self-isolate no longer. The GP will guide the person through that process rather than any duty on an employer.

Deputy Feighan asked about the Swedish model. We are all learning more about this pandemic every day. There is a great effort to draw league tables and compare countries. We do it and everyone does it. It is difficult to do, though, because this pandemic is still ongoing. In many ways, it is akin to asking the surgeon to come out of the operation halfway through to see how they have been getting on. We will know more about the different responses each country took, hopefully, when we are in a post-Covid-19 era. I have no doubt every Government, group of people, country and all public health experts will have done their best to protect their people. Which strategy turned out to be the best? Only time will tell us.

Thankfully, the trend is going in the right direction but we must be mindful that, as of yesterday, 1,659 people have lost their lives to Covid-19 in this country. Behind that statistic are many broken hearts and bereaved families.

Once again I wish to put on record our appreciation of the work of the Minister and the Department and the work of all who continue to serve on the front line of the pandemic and its wider impact on our health services.

I support the comments the Minister made yesterday regarding the demonstration which took place in Dublin last weekend. Those of us who uphold values of respect and inclusiveness abhor the brutal murder of George Floyd and the disgraceful response of the President of the United States at a time when leadership was needed. I appreciate too that people here and around the world wanted to make it known that they were appalled by the Trump regime. Yet, surely there must be another way. For example, a petition on behalf of the people delivered to the United States Embassy could have made an impact. We cannot risk the gains we have made. We cannot put our front-line workers at any undue risk. We cannot put the lives of those over 70 years of age at risk. Like our President, I hate the term "cocooning" but our older folk have made immense sacrifices.

Those responsible for day services for people with disabilities are waiting on direction from the Department of Health and the national public health emergency team on how to open up their services. Many people who avail of these services have been at home since March living with parents. Many of these parents are elderly, struggling to continue with care and have had no respite in that time. Families want these services to re-open, the service providers want to re-open but they need guidance and support to do so.

Will the Minister give a brief overview on health services available to the Traveller community during the Covid-19 pandemic? Has the Department ensured that all Traveller families have access to a Traveller primary care nurse and healthcare team? Is the Department aware of the particular challenges faced by Traveller families during the pandemic on access to basic services, ability to maintain social distancing and good hand hygiene as well as access to mental health and peer-led support services? Several urgent items need to be addressed to support our Traveller community. I am mindful that there has been no increase in spending on Traveller primary healthcare since 2008. We need to publish and implement the national Traveller health action plan as a matter of urgency. This includes the establishment of a planning advisory body for Traveller health with dedicated staff and budgets to drive its delivery and implementation. We need the appointment of a senior-level official with exclusive responsibility for Traveller health within the Department of Health and the HSE. This person would prioritise Traveller health needs and ensure Traveller health is mainstreamed within all divisions and policies of the Department of Health and within the work of the HSE. The person would also support the implementation of the national Traveller health action plan. Sláintecare recommends access to universal GP care within five years. We recommend that Travellers be prioritised and fast-tracked in this process. Moreover, Travellers employed in primary healthcare projects are entitled to a medical card.

The Traveller-specific health infrastructure, including Traveller health units and Traveller primary healthcare projects, should be protected and receive increased resources for its expansion and development. A clear budget should be allocated and protected to address Traveller health inequalities at national level.

I commend the Minister's Department on the partnership approach it adopted early on during the pandemic to Traveller advocacy and development organisations to ensure that information was forthcoming and Traveller specific, and on the way in which local authorities responded to accommodation needs. My main concern, however, is that there has been an historic underfunding of services, leading to poor health outcomes for children and families. This needs to be an ongoing priority for the next Government.

Regarding Covid, I have heard no discourse whatsoever about our Roma community. Like our Traveller community, members of the Roma community are particularly vulnerable, if not more so due to an absence of any infrastructure to support them. Out of an estimated population of 4,000 people, 60 have contracted Covid and, sadly, there have been eight deaths. What specific healthcare supports are on the ground to support the Roma community during the Covid pandemic?

When will the roadmap for the opening up of full medical services be made available to the public? Many patients are waiting on services and surgeries that, although elective and possibly non-urgent, would have a major impact on their quality of life. Last week, I mentioned video fluoroscopy services at Temple Street. Thankfully, they will be up and running in June. I welcome that development and thank the Minister for it. His Department has indicated to my colleague, Deputy Ossian Smyth, that the roadmap has been developed. The Minister indicated in the Dáil on 21 May that he expected the roadmap to be available within two weeks. As such, I would be grateful if he could inform us of his Department's progress. Clear and effective communication to patients is highlighted as one of the key principles of the roadmap, but there is currently no such communication.

I attended the Covid-19 committee meeting on Tuesday and was happy to hear that work had resumed in respect of orthopaedics, rapid access cancer services and actively growing the number of cardiology and stroke attendances. I understand that private hospitals are being utilised in that respect. It is good to hear that their capacity has increased to 54%. Will the Minister provide some clarity on the number of patients to whom this relates? As outlined to the committee, the aim now is to increase this capacity for the remaining weeks of the deal. Will the Minister clarify how this is to be done and what services will be resumed?

I thank Deputy Noonan for his questions. I echo his comments on the protest. There is an onus. It is easy to criticise a protest when one does not agree with its cause or the reason behind it, but it is more difficult to do so when one does support the cause. That does not mean we can be silent on it, though. What happened to George Floyd disgusts and repulses everyone in this country and probably all sane-thinking people across the world. At the same time, we must be conscious of the fact that any gathering, no matter how worthy the cause, is a danger to public health at the moment. As the Deputy mentioned, there are other ways to make our voices heard. The Deputy's party has a proud tradition of protesting and highlighting social issues, so I appreciate the call that he is making for people to adhere to public health advice.

On the issue of disability day services, there was a good meeting with Inclusion Ireland yesterday where this was one of the topics we covered. I expect that the HSE will have an update this month on how it will begin resuming those services. We might have some encouraging news in respect of children with disabilities as part of the move to phase 2. On the general issue of reopening day services, however, a great deal of work is being done with various organisations. Helpfully, some of them had redeployed their staff to assist us in the Covid effort. There remains a bit of work to do.

I appreciate the Deputy raising the issue of Traveller health. It has been one of my great regrets that we have not got the Traveller health action plan published yet. I urge whoever the next health Minister is to get that done quickly. It is nearly there. It is a good piece of work that has been in the making for quite some time.

I will write to the Deputy on this matter, but many measures have been put in place to assist the Traveller community during the pandemic, including regular meetings between Traveller health units and the HSE's social inclusion units. They were initially occurring at three times per week but now happen once per week. A national helpline has been up and running since March. There is a specific website resource page as well as extra communications. Under the criteria, Travellers have been classified as a priority group for Covid testing by GPs. There is a Covid Traveller response team. Travellers have been included in specific guidance for vulnerable groups. There are posters and videos. There is a digital partner pack on the HSE's website. The primary healthcare professionals in Traveller health units continue to work. I am satisfied that a great deal of work has been done, but I will write to the Deputy in detail.

Similarly, the HSE has produced specific guidance on preventing and responding to Covid-19 in the Roma community. While the Roma do not live in congregated settings such as homeless services, they often reside in overcrowded accommodation in the private rented sector, which can pose a similar risk in the spread of Covid-19. There is a national helpline for queries from the Roma community and more than 700 calls have been made to it.

We have translated information in booklets and on posters into Romanian, Czech, Slovak and Romani. The HSE produced a Roma information video and outreach work in the Roma community was done in CHOs 5, 6, 7, 8 and 9. I will write to the Deputy with more details on this.

On the issue of non-Covid care and the plan for same, the Deputy asks a very valid question. The Secretary General of the Department and I met the HSE's CEO, chief operations officer, chief clinical officer and the chairman yesterday. The HSE plan was to go to the board of the HSE yesterday evening and it will then be shared with my Department. My understanding is that the HSE board was considering the plan yesterday evening. I expect the HSE to be in a position to update us on that in the coming days. Really good work is being done by the HSE in that regard.

In the context of how we utilise the private hospital capacity, the HSE has identified a number of additional patients who may be suitable for treatment during the month of June. It amounts to over 4,000 additional patients but I will write to the Deputy with some more detail on that. The NTPF has identified the patients in question.

We need to watch the clock to make sure that the Minister does not overstay the two hours again this week-----

I thank the Deputy for his concern.

I am very concerned because I would have been a close contact according to the Minister's logic.

I am in the full of my health.

I am glad to hear it. I have two sets of questions and would appreciate it if we could block them into two sets of five minutes each.

We have been promised the HSE's roadmap on numerous occasions. It is late at this stage. Will it be published tomorrow? This is singularly the most important issue in Ireland now, without a shadow of a doubt. It is more important than anything else. We need to get services back up and running. Surely the Minister knows when the plan is going to be published. Everything relating to non-Covid healthcare is dependent on this plan. I refer here to people who cannot get screening services, for example. It is no good for the Minister to say that he had a great meeting with the director of the national screening service unless we have dates. I would like to know when they will start the process of re-engaging to set up the services. Women and men in this country know when they will be able to buy a pint but they do not know when screening services will begin. We all know that there will be challenges but we do not even know when they will begin which is downright ridiculous and wrong. We also need the plan to deal with many sensitive issues across healthcare and I will pick one in particular. I plead with the Minister on behalf of people with intellectual disabilities for whom the lack of services is having a massive impact. I have raised this week on week but still nothing is happening. We cannot just leave these people isolated. When will the plan be published? What are the timelines for screening and the resumption of services for those with intellectual disabilities?

I have a few other questions in the first round, one of which is on modelling. We are doing modelling on everything related to Covid but I presume modelling is also being done in respect of all non-Covid matters. In that context, I ask the Minister to tell us about morbidity and mortality modelling in the context of the lack of health services over recent months. How many additional people will be affected in terms of morbidity and mortality? I am sure that the Minister has that data in front of him. That would be obvious information for the Minister of Health to have, in my view. How are we using Coivid-related data from other countries to inform our decision making?

Questions relating to acute care were asked previously. I do not want to go over the ground again, but I will ask, in light of the decisions that the Government has made on service provision, whether modelling been done on community and acute capacity and how that will be affected across the various regions.

The first point I would make, which the HSE would make if its representatives were here, is that the HSE is not waiting for a point in time to resume non-Covid care. I know that Deputy Kelly knows this too and is aware of it from hospitals in his constituency. The number of vacant hospital beds has significantly decreased, despite the fact that the number of patients with Covid-19 in our hospitals has also, thankfully, decreased.

There are 35 people on trolleys in Limerick as I speak.

Without getting into the discussion about trolleys, the fact that we are seeing more people attending accident and emergency departments and GP surgeries and occupying more hospital beds this week compared with last week - fewer of them have Covid-19 - is a sign that the health service is getting busier and is trying to get back to as much business as usual in a very different way. The Deputy made the point to me in this House and to the Taoiseach that the non-Covid care plan had to belong to the HSE, not NPHET. I agree with him - it does belong to the HSE. I do not say that to pass the buck. The HSE is doing a great job on the plan, which went to its board last night. I expect it to be in a position in the coming days - and before I appear in this House next week - to be able to share the details of that, but I am satisfied that it has done a huge amount of work. I do need to say that the number of vacant beds is falling significantly.

On the national screening service, it is not unreasonable for the Deputy to ask for a date. Dates for when programmes will be resumed will be provided in the calendar month of June. However, I have been down this road of screening before and I will not give commitments that cannot be stood over. It will involve screening being done in different ways. It may involve a phased recommencement and clinical decisions as to who is to be called first. Those decisions should be made by clinicians. There is a working group. I will write to the Deputy regarding the date on which it was established because, truthfully, I do not know. It is chaired by Dr. Caroline Mason Mohan. The Deputy made a point about buying a pint but I know that he knows the screening service far better than that. We could say today "You can turn back on screening because the sample takers are ready or the labs are waiting" but all we will do is create a backlog if we do not have all parts of it ready. We need to get that right as well.

Regarding intellectual disabilities, the Deputy is right. I do expect that we will be in a position to recommence some of them at the end of this month. On the issue of morbidity and some of the data, I will have to write to the Deputy because I do not have the relevant information to hand.

What communications and meetings took place in respect of the roadmap and the parameters NPHET set for the HSE? The HSE can only work within the parameters set by NPHET. For example, 2 m instead of 1 m would have a significant impact on any roadmap.

Dr. Anthony O'Connor, who the Minister knows quite well, appeared before the Special Committee on Covid-19 Response. He stated that because the Minister made a political decision to get rid of the private hospitals, there is a backlog of over 1 million people waiting. Those are his figures. Time and again, the Minister has stated that he follows public health advice. I have a number of statements here from Paul Reid, the chief executive of the HSE, who said that he wanted to keep that contract in place. Why did the Minister go against the chief executive and board of the HSE in the context of that decision? Remember, it is a political decision. I do not have time to read Mr. Reid's statements to the House but they are all on record. Why did the Minister go against the chief executive and board of the HSE regarding that decision considering that he consistently says he goes with public health advice?

The second issue relates to the vaccines. I asked the Minister last week whether he would ask the Chief Medical Officer about this matter. On the question of whether it would be better to give free vaccinations to everyone rather than what the Minister introduced, the Minister wrote back to me saying that the current programme represents the maximum impact we can have within the resources available to us. I take it, therefore, that this is the view of the Chief Medical Officer because I asked the Minister to ask him. The Chief Medical Officer is saying that it is the maximum impact we can have within the resources available to us. I find that amazing. In light of where we are at the moment with Covid-19, surely any chief medical officer would advocate for a vaccination programme for the flu because we do not want Covid-19 and the flu arriving at the same time. We must limit infection as much as we can.

Will the Minister confirm if a joint order for PPE was made with the Northern Ireland Executive? On 27 March, the Minister of Finance for Northern Ireland indicated, in an address at Stormont, that a joint order with Dublin had been secured. He stated: "This is a joint effort with the Dublin Government, the order has been placed." On 3 April, the HSE stated that no joint order was made. Can the Minister confirm to the House what happened before 27 March or whether there was any communication before 27 March with the Northern Ireland Executive regarding the joint purchase of PPE? Remember, a memorandum of understanding regarding such a possibility was not signed until 7 April. What is going on here? How could the Minister of Finance in Northern Ireland say on 27 March that joint order for PPE involving the Government and its counterpart in the North had been secured? Could the Minister clarify the position in that regard?

I am certainly not aware of any joint order. Obviously, the HSE would be fully informed and I fully endorse the position of the HSE in respect of this matter.

There is no joint order between the Republic of Ireland Government and the Government of Northern Ireland. There has been excellent co-operation between myself and my counterpart, the Northern Ireland health Minister, Mr. Robin Swann, who is a very decent and hardworking person. Along with the two chief medical officers, we have had excellent engagement in what is called the Quad. The engagement between myself, the Tánaiste, the Northern Ireland Secretary of State, the First Minister, deputy First Minister and the Minister for Health in the North is really good. There is an memorandum of understanding, MOU, but there has not been a joint order, to the best of my knowledge. I am happy to clarify that for the Deputy.

On the 2 m versus 1 m issue, as has been made clear by the CEO of the HSE, Mr. Paul Reid, the health service will operate within the public health parameters and public health advice. The Deputy is correct that there is a difference between 2 m and 1 m in terms of the impact on capacity in hospitals but, again, we do not want to end in a situation where a person in a hospital bed ends up getting sick with Covid.

The two remaining questions were around the vaccine and the reason the Government went against the HSE's position in regard to the private hospitals

On the private hospitals issue, it was a political decision. It was a decision taken by the Government of Ireland on a memorandum brought to Government by me. There is no passing the buck. It was a decision taken by the Government, which decision many in this House advocated from a variety of political spectrums should have been made. It is not for me to speak for the HSE but it wants to know that there is additional capacity available should it be required. I have made clear that any new agreement would have to include the ability for us to step in and take 100% of the private hospitals should we need it.

On the issue of a vaccine, the letter I wrote to the Deputy reflects the position in terms of trying to maximise the amount of vaccine that we can acquire within the resources available to us.

It is a very strange that the CMO would say that.

I welcome the Minister's announcement that the review of A Vision for Change will be published next week. The next step is to urgently establish the implementation group so that action can be commenced in regard to existing challenges and the very substantial Covid-related mental health challenges that are emerging. I urge the Minister to make an early announcement in that regard.

On Tuesday, the IMO appeared before the Special Committee on Covid-19 Response, where it made a very strong case for urgent attention to be paid to where we go from here. We were reminded that our hospitals have been overwhelmed and operating at dangerous levels of capacity for many years and that this is the result of the neglect of successive Governments of the public health service. The IMO made a number of proposals on the basis that it is untenable that we would continue with the historic deficits in manpower and bed capacity in the context of the growing waiting lists. The point was made that between inpatient and outpatient lists there are now 800,000 on the public waiting lists. The point was also made that while there is much talk about a surge in regard to Covid, which thankfully we have not experienced, there is a surge that is the norm in our hospitals every winter. At this point in the year, we need to start preparing for the regular surge that takes place in our hospitals at winter time, when, hopefully, we will not also be catering for, or preparing for, a surge in regard to Covid.

The IMO also spoke about the roadmap and expressed regret that the arrangement with the private hospitals is to end. It also expressed the view that for the remaining period we need to ensure that private and public services open in tandem based on patient clinical need. I have also made the point to the Minister that for the remaining period of the agreement there should be a single list, with every bed in the private sector being utilised every day until the deal ends to progress through that waiting list. The point was also made by the IMO that it was hoping that when the current deal ends whatever arrangement is reached with the private hospitals it would not include the National Treatment Purchase Fund, NTPF, because the IMO is of the view, as am I, that this would deprive the public system of investment and enable the continued neglect of public services. That is a very strong point, one that those involved in negotiations for government should take on board.

The IMO is calling for a different approach. There are possibilities for the UK model in which some targeted purchasing is negotiated.

I regret that the Government is going to end the deal at the end of June. The Minister admits it is a political decision, but it is the wrong decision. A deal could have been renegotiated that would serve the interests of public patients. Given that a single list operated for Covid patients, we should now be operating a single list for non-Covid patients as well. The situation is regrettable because there was potential for doing something worthwhile by continuing with a form of agreement. Let us hope that, whatever new arrangement the Government enters into, it is not one like the National Treatment Purchase Fund, NTPF, but something fairer and more meaningful.

Regarding the underprovision of hospital beds, it has been recognised that we need at least 2,000 additional public hospital beds. Let us start moving on that now. Much can be done with temporary modular builds, as was done in Tallaght and elsewhere. The IMO called for this Government and the incoming Government to really start moving on modular builds. It is fine to talk about big plans for the future but we need action now and we urgently need additional hospital beds in the public system.

Manpower is another issue which was raised by the IMO. There are now 500 vacancies among consultants and much can be done in improving and increasing manpower at that very important level. The IMO said we should acknowledge, in particular, our non-consultant hospital doctors, NCHDs, who have been at the front line of care for Covid-19 patients. Our public health specialists also play an invaluable role in health protection and should be awarded consultant status, in line with the recommendations of Dr. Scally. That is a really important point and an awful lot could be done about that matter now. NCHDs who were due to finish various contracts in July have not been guaranteed any post to stay in the Irish system. It is crazy at this point, given all we know about the shortcomings in the public health service, to see another generation of Irish-trained doctors leaving the country. They are available now and many of them came back to help in a time of crisis, so contracts should be offered to them. NCHDs going through the training system who are due to finish in July should also be offered acting-up contracts. Those are very practical proposals from the IMO and I hope the Minister will take them on board. Let us not go back to where we were before. Let us build on what has been done in recent months and embed some of those changes into our public health system.

Strong points were also made by the Intensive Care Society of Ireland. As the Minister knows, the baseline critical care capacity in this country is very low by international standards, with only 5.2 ICU beds per 100,000 people. It is the lowest per capita level in Europe and that must be addressed as a matter of urgency.

Finally, the issue of screening programmes is really urgent. There has been a lot of slippage in the production of the roadmap, but the whole screening area must be given absolute priority.

I thank Deputy Shortall and acknowledge that it was she who called for me to publish the Vision for Change document. We ran the risk of setting up ad hoc structures, special committees and the like, and the Deputy counselled against that. Subject to Government approval today or tomorrow, we will publish that document next week and the Minister of State, Jim Daly, will engage with stakeholders and advocacy groups in advance of publication. The Deputy is right that the next big challenge will be implementation. I presume that, at some point, some of this will fall to a new Government.

I think at least by having it published before a new Government takes office everyone can form that Government with their eyes wide open in terms of the work that needs to be done in that regard.

I thank the Deputy for making the points on the Irish Medical Organisation, IMO. I heard much of what it had to say at the committee this week. I am due to meet it next week. I will make a couple of observations. I share the view regarding public health specialists. Seeking recognition has been a long and arduous road for them. That will now fall to a new Government and is something that should be acted upon quickly. I do not think it should be pushed into an elongated process. They have been heroes in this regard and we have seen the benefit of them ten times over. We could have done with an awful lot more of them. Had things been even worse in our country in terms of a surge we would have needed even more of them. There is a lesson to be learned.

Let us not lose them.

Let us not lose the ones we have. It would be an appropriate recognition of the work they have done. I am in their corner on that and if I have a role to play in the next Government I would like to advocate to make progress there.

Deputy Shortall made a fair point on non-consultant hospital doctors. I will discuss that with the HSE. Obviously we made a decision to bring forward a number of graduations to get more medical students into intern years and I will establish the facts on that.

In regard to the Intensive Care Society of Ireland, I always listen very carefully to what its president, Dr. Catherine Motherway, says. With the additional capacity now in place, we have a chance to try to regularise some of that. It would be a crying shame if we did not.

I hear the Deputy on screening. She has not played politics with it in the House. I am not going to. I am going to follow the clinical advice on recommencing the programmes in a safe way.

On people power in the health service, the Sláintecare contract provides an opportunity. It was hard fought to get agreement on it and arises from the Sláintecare committee. We now need to hire new consultants on the basis of the Sláintecare contract. I will reflect on what the Deputy said about private hospitals and put some of my thoughts in writing to her in that regard. I hear what she is saying in terms of trying to come with a new and imaginative way of doing things rather than continuing with the old way.

Deputy Gino Kenny is sharing time with Deputy Paul Murphy.

I have questions for the Minister. Before speaking about them I want to pay tribute to and remember Melanie Hill Rutherford, who sat in the Gallery three and a half years ago to observe the passing of legislation on medical cannabis. Unfortunately, she passed away two weeks ago. She was a great advocate for medical cannabis and used it for her pain. If she was still here, she would ask the Minister please to get on with the programme because people need it and are being denied it or have to go elsewhere. I want to send my condolences to her family at this terrible time.

My first question concerns the 8,000 healthcare workers in this country who have contracted Covid-19. We have one of the highest rates in the world. Would the Minister support the INMO in its call for an inquiry into the level of infection among healthcare workers? As of 26 May, over 35% of the 8,000 workers affected were nurses. The rate of infection is quite high. Will the Minister call for an inquiry?

I offer my apologies to Deputy Kenny for the fact that we never got to have a debate on Spinraza. I am following up on some of the issues we discussed and which the Deputy raised with me in the House last week. I join with him in extending my sympathies to Melanie and her family and acknowledge the advocacy work he did with her. Perhaps it is a conversation we can pick up at another time and I would welcome that opportunity.

The Deputy is quite right to highlight the issue of healthcare workers. They have been at the front line at a time when the rest of us have stayed at home to protect our health. They have gone into work environments where they are more susceptible to catching the virus. We think of each and every one of them, in particular the seven healthcare workers who have lost their lives during this pandemic. We have prioritised the testing of healthcare workers in this country and have a broader definition of healthcare workers than some other countries, but that is a matter for another day when we look at the statistics. I had a very good meeting with the INMO on Monday and with the SIPTU health division. They have agreed to meet the Health Protection Surveillance Centre, HPSC, this week, presumably tomorrow or in the coming days, to get the data they are looking for and the answers to their questions. I am due to meet both again next week to check whether further information needs to be obtained. I am very happy to facilitate that. What modality that might take depends on how the meeting with the HPSC goes and whether their questions are answered satisfactorily.

My second question is on the screening programme, particularly BreastCheck. I know the Minister spoke about this today. I have been contacted by a number of women in Dublin Mid-West about the length of time it takes to get an appointment which is not acceptable, either post-Covid or pre-Covid. There is no logic in women having to wait so long. We now need to look at the long term, the short term and so forth. Based on what Covid has done to society, we need to increase capacity regarding resources, nurses and access to public healthcare. The two-tier system is simply not sustainable. Even people who might have believed it before the pandemic are saying that public healthcare systems such as those in mainland Europe and in Britain are actually better for society. They are the fault lines the next Government should fix. Particularly with BreastCheck, of course there are issues with the 2 m distancing in confined spaces. Would the Minister call for more capacity for BreastCheck because many women are experiencing anxiety while awaiting an appointment?

In addition to my meetings, I read at the weekend a comment from the clinical director of BreastCheck in one of our national newspapers outlining her hope that the programme can resume in the autumn. The priority at the moment must be symptomatic people. I urge anyone with a symptom of cancer to come forward. The GP surgeries are open, and the GPs want to see such patients. If it is an emergency, people should call 999. The Deputy is correct in saying we will need extra capacity. We have about 20 BreastCheck mobile units. We need to do that in a safe way so that healthy people do not go to BreastCheck and end up getting the virus. We need to get this right so that women can have confidence to use the service.

For more than two months I have been saying that we have been paying over the odds to private hospital owners like Denis O'Brien and are being ripped off. I pointed to evidence that suggests we are paying four times as much per bed as was being paid in the UK and I have repeatedly asked for a breakdown of costs. The Minister refused to publish those costs and instead tried to dismiss what I was raising as being some sort of conspiracy theory.

On Tuesday at the Covid committee, Mr. Martin Varley of the Irish Hospital Consultants Association also said that this deal was poor value for money and agreed with the call for complete transparency. I believe the Ceann Comhairle has been in contact with the Minister over his non-answer to a parliamentary question of mine, but I think has had no response yet.

Does the Minister accept that these concerns are valid? Does he accept that given the history of sweetheart deals with various big business people, people want to see the cost breakdown published? Does he accept that he should now publish the breakdown of costs so that people can see it for themselves?

The Deputy comes into the House and makes valid points as a Member of the Oireachtas, as he has a right, duty and obligation to, and I have an obligation to answer his questions and give my view. I find it very frustrating that he then puts in little loaded terms like "sweetheart deals".

We need to remind ourselves what was happening here. I know the further it gets away from that possibility he might hope people will forget, but I do not believe the people of this country will forget. We were looking around the world at people gasping for breath and a shortage of ICU beds and ventilators. People on all sides in this House were asking regularly, "Will we have enough ventilators? Will we have enough isolation beds? Will we have enough ICU beds?" We did everything humanly possible to secure as much capacity as possible. I am delighted beyond belief that we did not have to use some of that capacity. I am delighted that some of the best the Deputy can hurl at me is that we had vacant beds that we paid for because that meant we did not have Irish people in those beds desperately sick and fighting for their lives.

The HSE's financial advisers have received the information on costs. It includes the management accounts for the hospitals for the six months prior to the arrangement. The information is as set out in schedule 2 of the heads of terms I laid before the House. The information has been verified by a firm of accountants working on behalf of the HSE. On the basis of the information, the cost of the arrangement for April was €87.5 million. As these hospitals are private enterprises - the Deputy and I might not like that fact - the details of payments to individual hospitals and groups are regarded as commercially sensitive and, therefore, in accordance with the heads of terms, the details have not been published.

In the interests of transparency, it is intended to publish more summary financial information. I think that will be useful because I agree with the Deputy regarding the need for this House to scrutinise that information.

There were no sweetheart deals. Those are loaded terms to let them deny it. This was a situation where private hospitals were providing their facilities to us on a cost-only, open-book model, whereby the hospitals would be reimbursed only for the operating costs properly incurred during the period. I assure the Deputy that many of his constituents did benefit from procedures. Many were public patients who got an opportunity to darken the doors of a private hospital for the first time.

The Minister can talk about other issues if he wants to, and I will go on to talk about other issues. The reality, however, is that I have been looking for these figures for two months now. The idea that they are commercially sensitive in a context when all the private hospitals are in on the deal just does not seem credible. We have a situation where €300 million of public money is going to be handed over. To be clear, and I think the Minister knows this, it is not that I am against having these beds being part of the public system. I am for these beds being part of the public system, but I am not for being ripped off to have them.

The problem I have now is that we are going from bad to worse, in the sense that the Minister is giving up on that deal but we are going to lose the capacity of these beds. We are going backwards as opposed to going forwards to a national health service. I refer to nationalising the private hospitals and bringing them into the public system. My point is that the Minister said we must have equality of treatment for the coronavirus and that we should not treat people based on the size of their wallets. Why, then, is it okay to do that for patients with cancer, heart disease or depression?

I would like to create a universal healthcare service in line with Sláintecare. I think the Deputy's group is the only one that possibly has not signed up to Sláintecare. We both agree we need extra capacity, but Deputy Murphy wants me to just go in and take it. I recognise the reality of the world and that we might have to pay for it. The Deputy did not like the deal we had. We ended that deal, and he is not happy now that I am going to do a new deal. We are going to do a new arrangement, and it will be an arrangement that will enable the State to step in if, God forbid, there is a second surge or wave of Covid-19. It will also explore how we can secure extra capacity for non-Covid-19 care. When I have that arrangement agreed and brought to Government, we will share the information with this House.

I have several questions regarding nursing homes. They have been, sadly, the epicentre of deaths as a result of Covid-19. At the beginning of this health crisis, the decision was taken by the HSE to clear hospitals of older people and transfer them to nursing homes in anticipation of the surge of Covid-19 patients. This was deemed by the HSE "as a necessary risk". I believe, however, that this was deemed "a necessary risk" solely to avoid bed blocking in our hospitals.

I would like to know what measures were taken to assess the risk posed by these transfers to older people already residing in nursing homes. Will the Minister direct the HSE to publish the risk assessment which deemed this transfer of patients to nursing homes a so-called "necessary risk"? I asked the Minister's Department, via a parliamentary question, for the publication of this risk assessment more than two weeks ago. The response I received referred to the fourth revision of the discharge guidelines and not the original version, which was entirely focused on getting people out of hospitals.

My fear is that no risk assessment of the impact on nursing home residents was carried out before the decision was taken to move patients from hospitals to nursing homes and, as a result, the proper protections for nursing home residents were not put in place. Some of those discharges, sadly, became the vector for the spread of Covid-19 in those nursing homes.

I thank Deputy Naughten for raising this issue, and I will direct the HSE to share with him any information it has. The HSE should do that and it should want to do that, because I believe it did everything it possibly could in this situation. I do not share the Deputy's view that the transfers were done to reduce bed blocking, or any similar phrase.

If we think back, there was a view that our hospitals were going to be very dangerous places, and often places where infections would be picked up. The idea, after looking at other countries, was to get people out of that situation. I will, however, certainly direct that that information be shared with the Deputy.

I do not wish to use up the Deputy's time.

Obviously, there are many ways an infection can get into a setting. There is the fact of visitors. The CMO has shown evidence regarding how that does not work. There are people being admitted and there is also the fact that staff must go into the setting to provide essential care and services. We need to avoid predetermining how the virus gets into those settings.

I agree with the Minister that staff were clearly another vector. However, it took weeks before staff and residents of nursing homes were screened for Covid-19. As he is aware, 21 days ago I asked that all residents and staff be rescreened due to the inordinate delays in returning the original test results. The Minister promised me that would happen. When will the residents and staff of nursing homes be retested? I am so concerned by this failure to retest because the time delay between taking the original test swabs and receiving the results is undermining the credibility of the screening programme. In one instance, a front-line nursing home staff member had to wait 13 days to receive an asymptomatic positive result, during which time she continued to work in the nursing home. She worked in a large nursing home in the east of the country. Amazingly, the HSE had no plan to retest the residents or employees of the nursing home in question. What was the purpose of testing in that nursing home?

In other instances, people waited three weeks only to be told that no test result was available and they had to be retested. What is the benefit of testing when it can take in excess of 24 days to inform someone that they are asymptomatic positive? Testing and delivering results in the shortest time possible is key to success in managing Covid-19. The delays we have seen are totally unacceptable and contribute to the spread of the disease. What are the current turnaround times for informing people of test results? Does the Minister believe these are now acceptable?

To be clear, I am told that since 18 May the average wait from swab to result is one to two days, with overall end-to-end turnaround times of within three days. I will share the data I have with the Deputy rather than taking up his time now.

He made the very important point that testing is only a point in time. I think he would acknowledge that we have built up a lot of extra capacity that we can put to work in trying to manage and suppress the virus further. The ECDC has issued very important guidance relating to the testing of staff in particular in the nursing home setting on a regular basis. The national public health emergency team met today specifically on this matter and will make an announcement later today if it has not already done so while I have been in the House. My understanding is that this will result in all staff in nursing home settings being tested on a weekly basis for a month. We know that when we did the last widespread test of all staff and residents, including those who were asymptomatic - I think we are one of the few countries to so do - thankfully, the positivity rate was very low. In addition, the current policy is that if a facility has a first case, all residents and staff are tested, regardless of symptoms.

I welcome the figures provided by the Minister in respect of the turnaround from test to result. That must be not the case just for positive results. Rather, it must be for positives and negatives. I have already given an example of a situation where a negative result delayed people being informed that there was no result for them and, as a result, there was a delay in providing a positive result. It is important that there is a swift turnaround time from testing to the receipt of results for both positive and negative results. I welcome the Minister's comments in that regard.

I also welcome the commitment to test all the staff on a regular weekly basis for the next month to try to eradicate this virus from nursing homes. Regardless of from where it came, the important thing is to get it out of nursing homes. I acknowledge that a tremendous amount of work has been done in building up testing capacity. Credit must be given in that regard. I have been so critical on this issue because the contact tracing system has fallen down fundamentally. I do not have confidence in it, based on the evidence I have received.

With regard to the meat plants, I am informed that, in some instances, only about one third of the close contacts of those who have been identified as positive within the meat industry have been followed up. That is completely unacceptable. It is creating a significant community risk and it is, I believe, down to the failure to have an effective contact tracing system.

This day two weeks ago, the Minister wrote to me in the context of very serious allegations I had made to him in writing regarding meat plants and nursing homes. He informed me that NPHET was to consider the report of the national outbreak management team on 22 May, which is now two weeks ago. On foot of that, the Minister was going to be in a position to address the very serious issues I had raised with him. Two weeks later, I am still waiting for answers to some very serious questions.

In the interests of time, I suggest that I respond to the Deputy in writing on the matters he raised. I am reluctant to disagree with Deputy Naughten because he is often right, as I find out in this House, and he highlighted very important issues here before. My information, for what it is worth, is that when it comes to contact tracing of meat plant staff, and I specifically asked this on foot of contact from the Deputy, the amount of contact tracing is much higher than one third and is between at least 60% and 70%, although there are a number of cases in which there are contact and communications difficulties. We have a national outbreak team chaired by a very good doctor, Dr. Mannix. I suggest that I put the Deputy directly in contact with her for a briefing on the work being done in regard to the meat plants, considering the Deputy has highlighted so many important issues.

With regard to the negative test results, I should have said that, in order to speed up the process, since the middle of last month we have been delivering negative results by text message. I am told by the HSE that, in the community and the hospital, these text messages are now delivered within a couple of hours of receiving the lab results. The HSE has advised that an end-to-end turnaround time of two days for negative cases is now being achieved in about 80% of cases.

I acknowledge what the Minister has just said. However, I took my concerns regarding the meat plants directly to the HSE six weeks ago in advance of bringing them up in the House. It was well aware of this a long time ago. That is all I will say.

I call Deputy Danny Healy-Rae, who is sharing time Deputy Michael Collins.

I need to talk to the Minister again about nursing homes. I asked him on the last occasion when I was in the House for questions to open up the nursing homes to family members so they can visit their elderly parents or relatives in a controlled fashion. The situation is becoming clearer. The worst aspect of the whole pandemic was that elderly people, after having spent all their lives working for their families, working for their communities and working for our country, had to die alone, with nobody holding their hand or able to talk to them for a few minutes. I think that was the saddest and the worst part of the whole virus. I am asking the Minister to open up the nursing homes to allow relatives to visit in a controlled fashion and to give them access. I know of elderly people who are asking their daughters and their sons, "Why are you not coming to visit me?" I ask the Minister this again.

With regard to Cahersiveen and the refugee and asylum centre that was opened there, it has become clearer that the HSE did not give the approval for this centre. Is the Minister satisfied that the well-being of the people of Cahersiveen and of the residents is not being compromised? I ask him to please check it out and make sure. I ask him again to move those people out of there. They want to get out of there themselves and the people of Cahersiveen are not happy, so I ask the Minister again to do that.

On testing, which Deputy Naughten raised earlier, it is clear that the testing being done is taking too long and there are too many delays.

It is well over 20 days before some people get notified. This is not satisfactory. One cannot have efficient contact tracing when it has been going on for that long. The Minister needs to address this.

I ask the Minister, and I also asked the Taoiseach today, to reduce the distancing requirement from 2 m to 1 m. We will not kick start our economy or get our local economies going again if we do not do this. The World Health Organization, WHO, has suggested that 1 m will do. Why do we have to maintain the 2 m? We need to give hotels, pubs and the hospitality industry in Kerry a chance to get going. Spain is opening up for tourism on 1 July and if we do not allow our industry to open their doors on 29 June they will clean this country out. People who have given their lives and their fortunes and who put the whole of their efforts into the tourism industry will not get going this year. The Minister for Health is a member of the Government and is a very important part of the Cabinet. I ask the Minister to ensure the wellbeing of those people who gave so much to tourism in Kerry and around the country, including west Cork and Clare and all the other places. This is our one chance to open up tourism for domestic holiday makers because they have only those six or seven weeks. After 15 August families will be going home to get ready to go back to school. If Spain is opening up, and we are all under the one sky, then why can we not help our people and allow them to open their doors to get economic activity going? We need income and we need the benefit of the income from these places to trigger and kick start our economy. I appeal to the Minister as a member of the Government to do his best to ensure this. If the WHO has said that 1 m will do, why do we have to have a 2 m distance? That is my question. I am eating into Deputy Collins's time. I thank the Minister.

Bantry General Hospital has been a centre of excellence through this Covid-19 crisis and before. It covers more than 80,000 people in west Cork, many of whom are three hours away from Cork University Hospital, CUH. Yesterday I was informed by a family member in Bantry, who is only 1 km from our hospital, which is a centre of excellence, that their 88-year-old mother fell at 10 a.m. The family member rang the ambulance service at 10 a.m to take her to Bantry General Hospital, to be told their mother would not be taken by ambulance to the hospital next door and would instead be brought to CUH. The family insisted but to no avail. Three family members lifted their 88-year-old mother to the car and drove her, in pain, to Bantry hospital to find out she had a broken pelvis. Thanks to all in Bantry hospital she is making a great recovery and the family is truly grateful to the staff there for the way their mother is being cared for. I put it to the Minister that the game is over here. What is the plan for Bantry General Hospital? The buck stops with the Minister and we need answers. The HSE has sent experts to west Cork for the past nine months trying to sell alternative plans to the doctors and politicians but no-one is buying this plan. It would cost lives. The HSE cannot keep hiding behind Covid-19 and pushing the appointment of an anaesthetist down the road until we are in a crisis situation in Bantry. Will the Minister give me a cast-iron guarantee here today that the emergency services at Bantry General Hospital will not be reduced in any way going forward? In all fairness, the hospital should be getting an upgrade because it serves some 80,000 people in west Cork and parts of Kerry.

I shall now raise issues around the HIQA standards for care of the elderly facilities, specifically the bedroom and sleeping accommodation. In care of the elderly facilities, public and private, 80% of the bedrooms should be single bedrooms, with no more than three to four patients in multi-occupancy rooms. Infection control, privacy and the dignity of our elderly in nursing homes and community hospitals are the reasons given by HIQA for the need for these standards. I understand that the implementation date for the 80% single-occupancy standard was 2016. This was extended by statutory instrument to January 2021. Who signed this statutory instrument? What date was it signed on? Was a risk assessment done on infection control before the statutory instrument was signed?

If so, will the Minister supply it to me? In terms of State-owned care of the elderly facilities, such as community hospitals, did financial consideration play a role in the decision by the Minister to defer the implementation date of these HIQA standards? Does the Minister accept that multi-occupancy rooms make infection control very difficult, especially for old and vulnerable people? Does the Minister accept the statutory instrument has probably cost lives? Will the extended date of January 2021 be met in all of our community hospitals?

I thank Deputies Danny Healy-Rae and Michael Collins. Deputy Healy-Rae made a very valid point on nursing home visits. I have been speaking to residents in nursing homes via FaceTime and I know how lonely people are feeling. I know how incredible the staff are in trying to ease that loneliness. I know how relatives go up to the window of a bedroom and phone from outside and have a conversation with their mother or father. People are trying very hard and it is very tough. The visitor restrictions were introduced to save lives and I am eager that if it is safe to allow visits again in some circumstances it will happen. The National Public Health Emergency Team considered this today and will be providing me with some advice tonight, and I will brief the Government tomorrow. I will keep the Deputy informed. I hear what he has to say.

With regard to Cahersiveen, I do not want to take up all of the Deputy's colleague's time so I will write to him directly on the issue. No one should be waiting 20 days for testing. I hope it is from a different time. If the Deputy has any cases where people are waiting I ask him to send them to me because I am very clear about what the HSE says about its turnaround times.

I am absolutely sympathetic and understanding of the very big challenges that sections of our economy face, the tourism sector being one. We have to follow the public health advice, I get that, but the Government will consider all these issues as we continue to work through our roadmap.

To respond to the Deputy Collins on Bantry General Hospital and the National Ambulance Service, I am glad his constituent is doing well and I am sorry to hear it happened. I will certainly seek a report from the HSE and the National Ambulance Service in this regard. Obviously, I am not familiar with the details and I thank the Deputy for bringing it to my attention. I can give a guarantee, and I gave it during a campaigning time when the House had been dissolved, that there are no plans to reduce current services in Bantry General Hospital. I have visited it and I look forward to visiting again and to the programme of investment there continuing.

With regard to the statutory instrument and the HIQA standards, in the interests of accuracy I will write to the Deputy on his specific questions.

As a nation we have done very well in dealing with the Covid-19 to date, primarily due to the huge sacrifice made by our people but I do not take from the crucial role the Minister has played in this regard. We will have a very difficult time ahead as we look to what will happen next winter. As the Minister knows, our hospital sector is set up in clusters. In the mid-west, the area I know best, we have University Hospital Limerick in Dooradoyle, which is a tier 4 hospital that takes acute patients. We also have hospitals in Ennis and Nenagh and St. John's Hospital, which are tier 2 hospitals. All Covid patients in the area who require hospitalisation are sent to University Hospital Limerick, which places a huge burden on that hospital as it does in all such hospitals. There is almost segregation in the accident and emergency unit between Covid patients and non-Covid patients. Obviously, the two cannot come into contact with one another. If we have patients in corridors there is almost an inevitability of cross-infection and that people who go to hospital with a broken hip, such as an elderly person who has fallen, will come into contact with Covid, which could have disastrous repercussions for them and the broader community if they go back to it. There are huge challenges lying ahead.

University Hospital Limerick has been consistently the most overcrowded hospital in the State. We are not second-class people in the mid-west. One hundred years after the foundation of the State we deserve a decent healthcare system. Today, in the middle of summer, 35 patients are on trolleys in Limerick. I bring this to the Minister's attention now because I can only imagine what lies ahead for me, my family, my neighbours, the people I represent, and, most of all, the patients in the hospital and the doctors and nurses who have to work in those conditions.

We know that only people who need acute care should go to University Hospital Limerick and all others should be treated in the tier 2 hospitals. This is what we were promised when the structure was set up but it is not what has happened to date. I am not here to apportion blame for the past and for what has not happened up to now.

This desperately needs to happen now. In the Special Committee on Covid-19 Response, the representative of the Irish Hospital Consultants Association, IHCA, was sitting exactly where the Minister is sitting now and he said it was not because hospital consultants were not prepared to provide care and outpatient services in Nenagh, Limerick and St. John's. What is now planned to make sure that only those who need to go to Limerick go to Limerick, and those who can be treated in the other hospitals are treated in them? That will involve a huge escalation in the capability of Ennis to deal with the local injuries unit and the medical assessment unit as well as outpatient facilities so that we do not have the overcrowding that looks almost inevitable now. It is like looking at a car crash from six months away.

There is a minute and a half left and I urge the Minister to provide some succour to the people of Clare.

I thank Deputy McNamara for his questions, for his work on the Covid-19 committee, and for his engagement with my Department and the HSE. I acknowledge that the mid-west has been failed for decades in terms of bed numbers. I am not here to apportion blame either but we all know the story. Changes were made, beds were promised but beds never came. I can go through the list of the beds coming now. I will not do that but a 60-bed modular unit is being built now and there are 48 other beds - 24 now and 24 due to come on stream this summer. That is a big help.

The Deputy is entirely correct. Capacity in and of itself will not be enough because the hospital was already extremely busy. These are legacy beds that it should have had years ago. We know that in addition to the hospital being already busy, the capacity constraints of Covid-19 will place further pressures on it. I agree with the Deputy that there will need to be a change in patient flow. I am just being honest. I am not proposing reopening emergency departments and the like. I am proposing that we make better use of our model 2 hospitals. I have spoken to the chief executive officer of the HSE about this. I have also started to engage with the Irish Nurses and Midwives Organisation, INMO, and the SIPTU health division will be meeting with the INMO about different pathways of care to keep people out of the level 4 hospitals in the first instance, where it is appropriate to do so, and I will be happy to engage with the Deputy more substantively on this.

I greatly welcome the fact that there is movement towards treating those. I accept that not everybody will be able to be treated in Clare but those who can be need to be treated there. We need more facilities there. I do not wish to take time from my colleague.

I thank Deputy McNamara. My question is related to his. The Minister is probably fielding questions from all over the country and about every hospital in the country.

Much was made in the early stages of the Covid-19 crisis about the Ireland's call initiative asking health care workers to come back and work in the health service. The idea had some merit but there was very little thought put into how it would be carried through. That is the problem. I know of one doctor who registered for the Ireland's call initiative, returned, and weeks after coming home had not heard from it. She went out and got about four jobs herself and still has not heard from the Ireland's call initiative. In this past week a nurse in Donegal spoke on local radio saying she had returned home 11 weeks ago having registered for the Ireland's call initiative and has not received any word from it. That is being repeated throughout the country. The Minister probably will not have the figures now but he might provide them to me. How many people applied for the Ireland's call initiative? How many were accepted? How many shifts or positions have been offered to staff in each county? That is vitally important. It is disappointing to hear stories like this, given the crisis and the fact that so many people did return.

Now we are getting to the point that hospitals are starting to reopen for normal health care, if we can call it that, and some will have difficulty, through lack of staff and infrastructure, in having a Covid-19 stream and a normal stream, which will be necessary to ensure that the health services can work through some form of new normal. Will additional staff be hired? I know there are budgetary constraints but this is a very different time and budgets will have to be different.

We need to address this because our hospitals will face a big crisis. A crisis is coming if we cannot deal with Covid-19 and normal healthcare because normal healthcare will have to resume and will have to continue on, regardless of what happens in the future. I would like to hear the Minister's thoughts on that.

I agree with the Deputy. The fear of any Minister for Health, including myself or any successive Minister for Health, and the collective concern of this Oireachtas should be that at any moment in time people will decide that the pandemic has passed when it has not. We have to try to get back to living alongside it in a safe way for the sake of the economy and all those important things but we will be in a health emergency for the foreseeable future. We all have to start thinking like that, whatever our political traditions or persuasions or whatever side of the House we sit on. This will require a new way of doing things and it will cost money. It will not just cost money, however, it will also require us to do things differently and in fairness, our staff have been up for that and they have shown that willingness in so many ways. I agree with the Deputy in that regard.

On the issue of Be On Call for Ireland, I also heard that story about a nurse. I read about it on my social media feed and I have asked for a report specifically linked to that. I am not in any doubt about the story but I was not happy to hear about it so I want to find out what went on there and I will revert to the Deputy on that directly. I will also provide the Deputy with the information he sought that I do not have to hand but I have information to hand to the effect that 1,976 people have been successful in interviews for Be On Call for Ireland. Some 124 of those have been placed and 1,203 are in clearance. Those figures are as of 29 May so that is about 1,300 so far and in addition to that we have hired 1,082 student nurses and midwives. It is important to remember that we offered those student nurses and midwives employment as well. We have hired 80 medical scientists and there have been 98 rehired retirees. Some 926 newly graduated doctors have been hired in addition to 1,412 posts that have been filled through the HSE national recruitment service. Those are some of the figures but I will try to provide the Deputy with the county breakdown and the specific hospital breakdown he is looking for.

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