Covid-19 (Health): Statements

Given that all the strawberries in Wexford have been picked, we can resume our business, which is a statement by the Minister for Health on Covid-19, followed by questions and answers. The Minister, Deputy Harris, is very welcome. He has ten minutes for his opening statement.

I welcome this opportunity to once again update the House on the Covid-19 disease and our ongoing national response and effort to it.

First, and most importantly, as I do every week I wish to express my sympathy to the family and friends of those who have been lost to this disease since I was last in the House. We should always be conscious of them as we talk about progress, statistics and numbers. Behind statistics and numbers are real people who are grieving and feeling an immense sense of loss. Our thoughts are with all of those who have been bereaved. I hope that as we work to move through the next phases of this journey and try to resume some sense of normality, even if it is a new normal, we will have an opportunity as a country to find a way to remember those who have passed away from this virus.

It is hard to believe, but it has been three months since I first addressed this House on Covid-19, and while the world around us has changed, the threat of the virus remains the same. My ask, in many ways, is the same as it was on 19 March. We need people to continue to wash their hands regularly and properly, keep up cough and respiratory etiquette, dispose of tissues, and indeed, limit social activity. Even though people, thankfully, can now move around and see each other more, we still need to be responsible in terms of trying to minimise our social activity and keep our close contacts as low as we can.

This week, I have an additional ask with regard to the wearing of non-medical face coverings. It is a matter we have discussed in this House on a number of occasions, and there have been many different views and different debates that have, in many ways, created a lot of noise which has perhaps interfered with the clear communication of the message. The very clear public health advice is that we are asking people to wear face coverings when they use public transport, in indoor public areas, including retail outlets, when they are visiting the homes of those who are cocooning or are being visited in their homes by those who are cocooning, when they are visiting a residential care facility, or in any environment where it is not possible to maintain one's social distance. Let us be honest, this can feel difficult, odd and peculiar. It is a strange thing to do in this country. Culturally, we are not used to wearing face coverings in a way people in some other countries are, but we need to get used to it. Just as we pick up our keys, our mobile phone and our wallet and put them in our pocket, we need to pick up our face covering, stick it in a bag in our pocket and have it with us. It is a habit and a behavioural change we need to get used to, because it is necessary. It will not protect someone from Covid-19 in the sense of a magic shield, but it will help protect those around them. This virus is transmitted through droplets, and the face covering makes it harder for the droplets to leave one person and reach another. Let us remember, as we all do, that a person can feel well and be well and still have the virus. It is imperative, therefore, that we protect each other from the spread of Covid-19 and face coverings help in this regard. They are an additional hygiene measure. I urge everybody in this House to help spread that word and encourage people to wear them when they can.

I have a second request today. In general, people in this country are really good at going to work when they feel unwell. Culturally, we get up in the morning with what we perceive as a sniffle, a headache or a bit of a cough, take a glass of water and two paracetamol and go about our work. We are proud of our work ethic, but if one is sick, one needs to stay at home. One should not take paracetamol to suppress how one feels in terms of one's symptoms and then go to work. We are now seeing a trend where the number of clusters in private households is beginning to increase, and there is some concern this is from people putting off seeking help for their symptoms in the hope they feel better.

That is something we normally do, but we cannot do it during a pandemic. My appeal to anybody who is feeling under the weather or showing any of the symptoms, which are well known to us all at this stage, is to please stay at home. I ask them to self-isolate within their homes immediately, phone their GPs and seek their assistance. That is a crucial thing to get good at if we are to try to continue to suppress this virus.

I now want to update the House, as I always endeavour to do each week, on the latest modelling work on the reproductive rate of the virus. It is very important to note that we now have a very small numbers of cases. Thankfully, the average number of cases has been nearly constant for the last two weeks. Thankfully, the number of people in and admitted to hospital and ICUs and the number of deaths continue to decrease. I have been informed by Professor Philip Nolan, the chair of the modelling group, that the reproduction number remains below 1 and is estimated at 0.7. This is good news. Despite the fact that we are reopening, the number still remains below 1. As long as it does so, we are continuing to suppress and reduce the prevalence of the virus. Professor Nolan would also make a point which I wish to make to this House, namely, that the smaller the number of cases of the virus, the more difficult it is to estimate the reproduction number. While we are satisfied that it is less than 1 and estimate it at 0.7, the need to remain vigilant and careful not to catch or transmit the virus remains as we go about our daily business. More modelling updates will be given on Thursday, as Members are aware.

As colleagues know, we are now in the second phase of our reopening. This week the remainder of our retail outlets were able to welcome their customers back. The shopping experience is not going to be the same as it was before but, thanks to the incredible work of businesses across this country, it will be a safer experience. I have seen people go to huge lengths to reopen their businesses in a safe manner. As colleagues will be aware, tomorrow the National Public Health Emergency Team, chaired by the Chief Medical Officer, will meet to examine the next steps, monitor the virus and advise the Government on how to condense or merge the remaining three phases of our roadmap into two phases. This has already been flagged by the National Public Health Emergency Team at previous meetings. I hope to be in a position to bring its recommendations and views to the Cabinet on Friday of this week.

This week also saw the reopening of nursing homes to visitors. I want to take this opportunity to thank nursing homeowners, staff and residents, who have been working to adapt to this reality. I am conscious of how lonely people have been in recent weeks and months. The doors of nursing homes have been closed for many months. While our new visiting regime is gradual and slow, as it must be, it should be a relief to us all that loved ones now have the opportunity to spend time their relatives and friends.

I am very pleased to inform the House that the number of clusters in nursing homes is thankfully significantly decreasing. This week's figures show that there were 256 clusters of Covid-19 in nursing homes. Of those, 174 have now closed. That means 174 nursing homes that were deemed to have had clusters of Covid-19 have now been Covid-19-free for 28 days or more. A significant amount of work is required for a facility to reach that point. It is welcome news and a sign of progress.

Deputies have rightly been seeking the resumption of overall health services and I am pleased to say that the HSE is finalising plans to re-establish vital non-Covid-19 supports and services. As I advised the House last week, I expect the HSE to provide an update in the coming days. I want to refer to two specific elements of this planning work that I know are of particular concern to Members. I share their concern. The planning in question involves very careful and detailed work on the part of the disability sector. Community healthcare organisations and section 38 and section 39 agencies continue to work together at a regional level in order to plan and co-ordinate efforts. Considering the very serious nature of the pandemic and the vulnerability of people with disabilities as a care group, any plans to safely commence all disability services and supports must comply with guidance developed by the national public surveillance centre in the HSE. However, I am pleased to report that the HSE has now developed a number of important guidance documents to assist disability services, including the Framework for the Resumption of Adult Disability Day Services and Reshaping Disability Services from 2020 and beyond in line with Covid-19 restrictions. We all know from our constituency offices and our own lives that this is really necessary.

I wish to particularly focus on adults with disabilities. We have put a summer programme for children with disabilities in place. Adults with disabilities often have not had access to any service for several months. This is taking a real human toll. It is absolutely necessary for many families around the country that these services are opened safely. I expect progress in this regard by the end of the month. The publication of the Framework for the Resumption of Adult Disability Day Services is an important step in the process.

I am also pleased to inform the House that work relating to the resumption of our four screening programmes is on track. As I advised previously, the four screening programmes are now finalising their plans for a phased reintroduction of screening. It remains the case that management expects to be able to give restart dates for each of the four programmes at the end of this month.

The mental well-being of our people is often discussed in this House but it has been a particular focus in the context of the pandemic. I am very pleased to confirm the refreshed A Vision for Change policy has been launched today by my colleague, the Minister of State at the Department of Health, Jim Daly, and is available on the Department's website. I will be happy to provide a briefing on that for any Member of this House. Importantly, Sharing the Vision, as it is called, includes an implementation roadmap. Let me be clear; as we hopefully edge towards a new Government, implementation will be the key concern. The policy allocates ownership of recommendations to lead agencies and sets time-bound implementation targets against the actions relating to each recommendation. Who must do what by when is made very clear. Yesterday, we also helped launch a new text line for young people facing mental health issues. Members should save the number, 50808, in their phones. It is a 24-7 service that is free, inclusive, anonymous and there for anybody who wants assistance or support. Both of these measures come at a time when our world is rapidly changing, particularly in light of the Covid-19 pandemic.

Many of us have found the lockdown difficult. Many of us have felt lonely and isolated. Many people have had to battle problems like addiction behind closed doors. The lockdown has been tough for everyone, but for some sections of society it has been tougher. Some of us have found the reopening of society hard too. I hope this Oireachtas and the new Government will ensure that we confront the challenges Covid-19 has brought upon us, including those related to mental health. I hope we work together to help people in the same way we worked together to confront this pandemic.

While I am happy to report that we are making progress we must not forget this virus is still among us. Complacency is now a major risk. The future behaviour of the virus is dependent on our actions. Thankfully, the data show that the level of the disease is remaining stable. This is due to the incredible efforts of people in this country. We now need to keep the disease pushed back while we continue to reopen our society and our economy.

I will share time with colleagues and take two and a half minutes for questions and answers.

I wish to express my sympathies and condolences to the families of those who lost their lives in the couple of weeks since I last spoke. I wish to raise matter of the drug dexamethasone, which has been mentioned in the past 24 hours. It is a low-dose steroidal treatment that can be used in the treatment of coronavirus and is now being used by the NHS in the UK. It has been described as a major breakthrough in the fight against coronavirus and has been found to cut the risk of death by one third. This existing treatment has been described as a workhorse steroid and is used to fight inflammation in cases of arthritis and asthma. Most medical practitioners are familiar with it and know how to use it. It has been described as being cheap as chips, with an entire course costing as little as €5.

Has this drug been stockpiled by the HSE? Will it be made available to patients here? Will we be sourcing supplies so that we can have this drug in stock in the event of a second wave? It is hoped that more drugs that can be used in the treatment of coronavirus will be found. That one such drug exists is very positive news.

I thank Deputy Browne for raising the important matter of dexamethasone. As he rightly says, this is something we have been hearing an awful lot more about in the last 24 hours. In March, the Randomised Evaluation of Covid-19 Therapy, RECOVERY, trial was established as a randomised clinical trial to test a range of potential treatments for Covid-19, including a low dose of dexamethasone, which is a steroid treatment. More than 11,500 patients were enrolled at more than 175 NHS hospitals in the UK. A total of 2,104 patients were randomly chosen to receive 6 mg of the drug once a day for ten days. They were compared with 4,321 patients randomly selected for the usual care alone. As the Deputy says, among the latter group, 28-day mortality was highest among those who required ventilation, intermediate among those who required oxygen only and lowest among those who did not require any respiratory intervention. Dexamethasone reduced deaths by one third among ventilated patients and by a fifth among patients receiving oxygen only. There was no benefit among those patients who did not require respiratory support. Based on these results, the University of Oxford indicates that one death would be prevented by the treatment of approximately eight ventilated patients or approximately 25 patients requiring oxygen alone.

There was a significant trend showing that the greatest benefit was among those patients requiring ventilation. However, the university states that it is important to recognise that it found no evidence of benefit for patients who did not require oxygen and the study did not examine patients outside of a hospital setting. We are awaiting the full details of the study. I have today asked the public health experts in my Department to contact the HSE about our plans to make this already existing treatment available. Deputy Browne makes a valid point and I will revert to him in writing on the matter.

As Deputy Browne did, I pass on my sympathies to all families who have been affected by Covid-19.

Forty-nine residents of St. Patrick's Hospital in Cashel have been transferred to Our Lady's Hospital in Cashel. Can the Minister clarify that the planned capital investment for St. Patrick's will proceed as normal? It is great to see Our Lady's eventually being utilised to near full capacity after years of lobbying by my colleagues and I in this Chamber, and by the community activists who never gave up on it. However, it would be a mistake if the good news for Our Lady's came at the expense of St. Patrick's, the staff of which have, for generations, been looking after residents and patients. I would like confirmation that the capital programme for St. Patrick's is unaffected by recent developments and that the 50-bed unit promised for the hospital, plus the ten-bed dementia unit, will proceed as per the HSE capital plan.

The confusion around St. Brigid's District Hospital in Carrick-on-Suir continues because the HSE has been vague in its responses which has led to uncertainty. The resulting vacuum has been filled with rumour and fear for the future of this excellent facility. St. Brigid's was to be used during the Covid-19 crisis as a step down facility for recovering Covid patients as they left the acute system. However, my understanding is that only four patients used the facility. Thankfully, those patients are now well and have returned home. The Minister can understand the fear that is generated when there is no activity at the hospital and no clarity from the HSE on its future. We do not need a specific date for its reopening but we want a commitment that, when the Covid crisis is over, it will return to its previous use.

When will we begin to see a return to normal activity in our hospitals so that regular and routine appointments will be kept? There is great fear out there that people who are suffering from potentially serious illnesses have lost almost three months in their care and treatment with down-the-line concerns about their making a full recovery. There is also fear that many illnesses have gone undiagnosed during the lockdown which is a serious problem. Health screenings of all kinds have been on hold which means that we could lose the ground that had been made on illnesses such as breast cancer. We need a clear roadmap that outlines when we will begin to return to normal and lays out clearly where each health discipline is positioned on that map. We owe a clear outline to the public who have worked so hard to control the virus.

I thank the Deputy for his questions. I will come back to him directly on his question about St. Patrick's Hospital, a site which I remember visiting with him quite a period of time ago. My commitment and that of the Department of Health and HSE to continuing the outlined capital development projects for that hospital, the 50-bed unit and the dementia unit, remains intact. Those projects remain in the capital plan and we will deliver them.

St. Brigid's District Hospital in Carrick-on-Suir will return to its previous use and, as the Deputy rightly and fairly said, the timing of that will be in the context of the HSE's view on the Covid situation.

So as not to take up the time of the Deputy's colleagues, I will write to him on the issue of non-Covid care. We are eager to see the resumption of those services.

It has come to my attention that medical card dental patients are being told that they cannot access dental care due to Covid-19. As we know, personal protective equipment, PPE, has become a major issue and, in dental practices, the cost of PPE is, in some cases, being added to the cost of the treatment. The Dental Council of Ireland, the regulatory body for dental professionals, has stated that dentists are free to decide on the fees they charge. If a dentist is making an additional charge for PPE, that must be listed on the display price list and be made clear to patients prior to treatment. However, the increased cost in providing PPE is not covered for patients who have medical cards. This has meant that patients with medical cards have not been permitted to access dental services. This is discrimination of the highest sort and the Government needs to sort this out. We need to cover the cost of treatments. We cannot allow anyone to be unable to access treatment.

The range of treatments dentists can safely provide during this crisis is already limited. There are mutterings of an establishment of centralised hubs for the provision of emergency dental care provided under the auspices of the HSE, staffed by the dental treatment services scheme, DTSS, contract holders. Is this where medical card patients are meant to go now? Are we allowing this to happen? Will the Minister clarify this matter for me today? It is serious.

My next question applies to the Department of Health and the Department of Education and Skills. It is important we discuss the matter. Third year social care students from Carlow IT were conducting their placements when the Covid-19 crisis began and the placements were suspended. On average, students had completed approximately 75% of their placements. Those students had hoped to gain full-time employment contracts upon the completion of their three years in social care because they would have been qualified social care workers. The recognised registration board for social care workers, the Health and Social Care Professionals Council, CORU, has stated that students must still complete their placement hours before they become recognised as qualified social care workers. Could the Minister do something about that for me? Many students have got in touch with me on this important issue.

Several people have contacted me about the serious issue of the high cost of being left on waiting lists and having to resort to paying privately for procedures. An elderly couple approached me a few weeks ago. These people had private health insurance and were waiting to see what would happen at the end of the month. The lady in question needed eye injections and could not wait because her eyesight was deteriorating. She had to pay €1,600 for an injection. These people are old age pensioners who came to me having raised their family. To such a person, €1,600 is a considerable amount of money. How can we help these people to get back that money? It is important.

Is this my second, third or fourth question? I have asked the Minister so many questions that I have nearly confused myself. When are doctors going to see patients one on one? It is a concern. Doctors have been ringing patients and I know that some doctors are seeing patients. There are many patients who might be nervous to go back to doctors and to have a one-on-one session. Can the Minister provide a timescale for that? When will appointments be available again in public hospitals for public patients? Several people have queried that with me. I must share my time with my colleagues so I ask the Minister to come back to me on those matters.

I thank the Minister for being here and answering questions. I express my sympathies once again to the 1,709 families who have lost loved ones since the Covid pandemic began. I also recognise the more than 25,000 people who have contracted the virus in the Republic thus far.

I want to put on record my appreciation of the front-line workers for the care and skill they have shown and assistance they have given to people throughout this pandemic. I also want to put on record my appreciation for the cleansing, catering and retail staff for their efforts throughout. Special mention should go to the transport companies that have kept things moving across the island throughout the crisis.

I have previously raised the following issue with the Minister and seek clarity on it. I know the National Public Health Emergency Team, NPHET, is meeting tomorrow and there will be further discussions about the reopening and lifting of restrictions but there are still many questions for many sectors of the economy, businesses and individuals. There are only eight working days left until the reopening and lifting of restrictions on 29 June. People are still unsure about the permitted sizes of family gatherings and weddings and whether they should be indoors or outdoors. We have heard today that about the potential lifting of restrictions for public houses as social distancing requirements fall from 2 m to 1 m. I believe the guidelines that were issued have recently been rescinded. There are only eight working days left in which to give clarity to businesses. That clarity needs to be given and, hopefully, today.

We have discussed the reopening of hairdressers many times in this Chamber but it is necessary. I believe the date of 29 June was given for that reopening and the Minister might clarify that.

There is also the issue of drive-in cinemas. There are ambiguities in the legislation for something as bespoke and unique as drive-in cinemas. We need clarity about that.

I turn to consider St. Augustine's school in Blackrock in my constituency. The Minister is familiar with this special school because he has dealt with it over the past number of years. I understand there is a lack of funding for St. John of God, the organisation that runs the school, and that four clinical staff - two psychologists, a speech and language therapist and a social worker - may have to be redeployed. I ask the Minister to give clarity on that either in the House today or in correspondence. The latest correspondence I received from the Minister on this matter contained reassurances that the HSE would ensure that a review would take place as soon as possible. That was in 2017. The correspondence stated that, until the review is complete, the HSE would not permit any reductions or other changes in services at St. Augustine's. That issue has arisen again. Parents are understandably wary and need clarity on that matter.

Does Deputy Stephen Donnelly wish to contribute?

I will allow the Minister to respond.

There is quite a bit to cover in quite a short space of time.

Deputy Murnane O'Connor asked about dentists. As she said, the guidance for dentists was issued from the Health Protection Surveillance Centre on 15 May. Professor Martin Cormican and his team did some very good work which outlined how the profession can resume the provision of routine care. The work outlined detail on the personal protective equipment that may be required for routine dentistry. The Dental Council has indicated that dentists should carry out a case-by-case assessment when deciding if additional PPE is warranted. I met representatives of the Irish Dental Association on 8 and 15 May. My officials met association representatives on 26 May. Yesterday, I discussed with the chief executive officer of the HSE the availability of PPE for dentists who have public contracts. I am hopeful that the HSE may be in a position to assist our dentists and I expect progress on that shortly. I take the point made by Deputy Murnane O'Connor but I am not keen to see additional charges for public patients or for people on medical cards.

Deputy Murnane O'Connor referenced the issue of social care and the people in the third level institution. The Health and Social Care Professionals Council, CORU, is an independent regulator, but I will certainly forward her views to CORU and ask the council to correspond with her.

I know our GPs have been heroes during this crisis. I know they have to operate on a case-by-case basis but I see significant evidence that more patients are now being seen in person through general practice. We took a decision last Friday to extend the Covid-19 financial supports to GPs until August. I hope this will help.

Deputy Murnane O'Connor asked about the non-Covid care plan. I have outlined the fact that the HSE board will be considering that further this week.

Deputy Devlin made the legitimate point that many people are waiting for clarity and certainty in an uncertain world. I am conscious in particular of those trying to plan weddings and of businesses trying to open. NPHET will meet tomorrow to advise the Government on what should be in phase 3 and phase 4. I will take its recommendations to the Government, probably on Friday. I would hope we will be in a position to provide more clarity on some of these things at that point.

Deputy Devlin knows St. Augustine's school in Blackrock well. I am familiar with the school too. I will certainly follow up his question. The parents there are understandably weary. I will come back to Deputy Devlin directly.

I apologise to Deputy Donnelly - that was as quick as I could do it.

I do not think we will do much in ten seconds. Deputy Louise O'Reilly is next.

I am sharing time in slots of seven, four and four minutes, respectively. If it is okay we will do four and three minutes for my slot, with four minutes for questions and three minutes for answers.

Earlier this month my husband was an inpatient in Beaumont Hospital. He had an operation for cancer. He is recovering now and is doing extremely well, but I want to take this opportunity to thank the healthcare workers in Beaumont, on behalf of myself and my family, for the care, kindness and compassion they showed to my husband. I am raising this because my husband's case is one example of the health service working really well and of the screening programmes working really well.

I have raised the issue of screening with the Minister on several occasions. I have some specific questions that I want to put to him today. We know that approximately 20,000 cervical screening appointments have been missed every month. That comes to over 60,000 since the start of the pandemic. I fully understand why the services had to be closed. However, the women - it is mostly women who are contacting me - are expressing dismay at the fact that there seems to be a concerted national effort to reopen tourism and hospitality but there is not the same emphasis on reopening and restarting the screening programmes. If the Minister opens the newspapers today or listens to the radio, he will read and hear all about 1 m versus 2 m, the substantial meal referred to in previous discussions - that was a feature of my youth coming back - and the bizarre suggestion that 90 minutes somehow gives more protection than 91 minutes. We have heard reports from Fergal Bowers that more than 2,700 people are waiting for an urgent colonoscopy and a further 19,000 people are waiting for a colonoscopy. I understand that the go-ahead for the resumption of services has been given. When will these services resume? What will the capacity be? Will the Minister commit to a comprehensive catch-up programme and an information campaign? Can the Minister confirm that he has sourced the additional laboratory capacity that will almost certainly be required to do the catch-up and restart the screening programmes? As requested the last time we spoke on this, I have sent the Minister the names of some women who have been affected. Will the Minister please follow up with them because that has not happened? I fully respect the fact that people are busy but these women are highly distressed.

Peter McVerry has said that addiction services are in crisis. We see a report today in the Irish Daily Mail on the disastrous consequences that resulted from the closure of the Keltoi drug rehabilitation unit in the Phoenix Park. Will the Minister commit to investigating the deaths which occurred following service users being discharged from Keltoi with little or no support? Will the Minister look into the concerns raised in writing by clinicians directly with HSE management regarding the risks associated with the closure of this vital support service? Can the Minister confirm that this facility will be reopened? Can he give a date for that reopening?

I also want to ask about services for people with intellectual disabilities, such as Prosper Fingal in my area. When will these services resume? People with intellectual disabilities and their families are at their wits' end. They see how their loved ones have regressed. They are looking at July provision. That is not going to be enough for them to make up the time that has been lost. The families are worried. They know the July provision will not be enough. Can the Minister give them a date for the resumption of the services, including respite services? The respite services are becoming absolutely essential at this stage. Can the Minister give a date? This would give them some hope that they might get some respite or relief. They are at their wits' end.

I note the pat on the back the Minister gave workers. He said we were all a bunch of troopers and referred to how we all go to work regardless. In a situation of a national emergency, a public health emergency and a pandemic, sick pay becomes an instrument of public health. I join with the Minister in saying to these workers they should not be troopers. They should join a union and ensure they get a decent sick pay scheme. If they cannot go to work, they should not go to work but they should ensure that does not put them into poverty. I do not believe these workers are troopers in that way. They want to do the right thing but they cannot afford to stay at home and that needs to change.

First, I am happy to wish Deputy O'Reilly's husband the very best. There are not many people in Sinn Féin that I can say I have campaigned with, but I remember being at a campaign event for Together for Yes with her husband. I am glad to hear he is doing well and has had a good experience.

The reason Deputy O'Reilly highlighted that point was screening. We will be led by the clinicians on this. I have given a commitment in the House that restart dates will be given at the end of this month. I am due to meet representatives of the national screening service again tomorrow. I will be happy to provide an update to Deputy O'Reilly and anyone who is interested post that meeting. I will 100% commit to an information campaign. That will be essential. It is not that I will not commit to a catch-up campaign but I want to be led by the clinicians so that I do not make the mistakes that perhaps I have made in the past in respect of some of these issues. I will come back to Deputy O'Reilly and the women concerned specifically and directly on the cases she has written to me about.

To be clear, I do not think I used the word "trooper" about anyone. I was simply making the point that we need people to stay at home if they think they have the virus. I finally get to use the phrase that it might be a matter for the next Government in terms of some of the broader issues raised by Deputy O'Reilly on sick pay and schemes in that regard.

Deputy O'Reilly asked about an important issue that has been highlighted by the Irish Daily Mail in respect of the Keltoi addiction centre. I thank the Deputy for raising this because I have been following the matter closely since I read of it. Most important, I wish to offer my sympathies to the families of the two people who died due to drug and alcohol related factors. We know that drug and alcohol addiction is a recognised risk factor. We know that it is a key focus of our national drugs strategy. Obviously, I cannot comment specifically on the two deaths but in speaking about the Keltoi rehabilitation unit in general I am aware that the service was repurposed to provide self-isolation facilities for vulnerable groups during the Covid-19 pandemic. I am informed that everyone in the unit had completed their residential programme prior to the repurposing of the facility and that after-care supports were subsequently provided to clients, including health and social supports and consultant psychiatrist support, as required. I understand the HSE is undertaking a review of the treatment and support to two individuals. I will absolutely consider this once completed and we will decide if further action is needed. I do not have a specific date for the reopening of Keltoi, to be honest. However, in line with all addiction and residential treatment programmes that have been unable to operate during the Covid pandemic, the HSE is working through a process of resumption of services in a safe manner. It will resume. It is the intention to reopen the services.

I do not want to use the time of Deputy O'Reilly's colleagues but I will comment quickly on intellectual disability services. I genuinely believe the publication of the HPSC advice on the safe resumption of those services is a key moment. I have met several organisations that are looking for guidance. They want to open and are looking for guidance. I will correspond directly with Deputy O'Reilly when we have a little more detail. This is a priority area. I assure Deputy O'Reilly that it is far more important to me than some of the other issues that dominate the Covid pandemic discussions. The families and individuals concerned really need these services resumed.

Will the Minister give an assurance that disability services will not be affected by Covid-19?

I wish to tell the Minister about a situation that is close to my heart. Since 2007, I have been working alongside a number of families on the issue of a group home for people with physical and sensory disabilities in Carrickmacross. At that point, the families had already been campaigning for a number of years. They are predominantly parents of adult children who have been cared for their entire lives at home. Their parents wanted the group home built so that they could have the assurance of their children being looked after should anything happen.

Since 2007, their campaign has met frustration and delay followed by frustration and delay. I cannot count the number of interactions we have had with Monaghan County Council, the Respond housing association, which was subsequently tasked with building the home, the Department of Housing, Planning and Local Government and, in latter years, the Department of Health and the HSE.

The building was completed in 2017. I have letters from the HSE dating back to 2011 assuring me that, once completed, it would operate the building. I have a 2016 letter in my hand from the HSE assuring me that, once completed, it would operate the facility. I have letters from every single year since indicating that the matter would be considered in the following year's Estimates. Two weeks ago, I submitted a parliamentary question to the Minister that was passed on to the HSE. The latest response I have received is that the HSE is unable to comment on an opening date due to the current Covid-19 pandemic. This is a disgrace. It is demeaning and degrading to the families involved who have campaigned for so long.

I have written to the Minister numerous times about this issue. Every time, it has been passed on to the HSE or a Minister of State. The Minister mentioned that he might not be in position in a week or two's time. Who knows? In this his final week, I call on him to speak to the people in the HSE whose attitude in their treatment of these families has been disgraceful and to instruct them to get their act together and provide the funding to open a state-of-the-art facility that is lying idle in Carrickmacross. I am pleading with the Minister to intervene in this matter personally.

My final week has been predicted so many times - sometimes, Sinn Féin has tried to bring it about earlier than I would have wished - so who knows?

Regarding the important matter that Deputy Carthy raised, I could hear the frustration in his voice, which I can only imagine is amplified among all of the parents and everyone else in Carrickmacross. I will accept the Deputy's challenge and request to take a personal interest. It sounds to me like many different organisations have been involved; the Deputy mentioned councils, housing associations, the Departments of Housing, Planning and Local Government and Health, and the HSE. I can only assume that the lack of an opening date may pertain to the safe resumption of services, but I will look into this directly and revert to the Deputy. If we need to have a follow-up meeting or engagement, I would be more than happy to do so.

I will make two quick comments and ask questions at the end. I have just under four minutes.

My colleague, Deputy O'Reilly, referenced the issue of drugs in the context of Covid. It is one of the issues I wish to raise with the Minister now. Since the lockdown started, people have become acutely aware of drug dealing in their localities. It has been much more visible because they have been at home watching it happen. We do not fund this sector enough. The funding that has gone into drug and alcohol forums has not replaced the funding that was cut as a result of Fianna Fáil crashing the economy in 2008. I am a member of the drugs task force in Limerick and the regional drug and alcohol forum. Between 2008 and 2011, our funding was cut by up to 50%. That amount has not been reinstated. We have a major problem.

Obviously, Covid-19 has affected all front-line services. In our context, most of the staff involved cannot be out and about, so I commend all those staff who have been out and about and doing the best they can in difficult circumstances.

There was good news from Limerick this morning. It saw the largest Garda raid in the State this year, with 60 houses and other premises raided in Limerick, Clare and Tipperary. A number of drug seizures and arrests were made, which we welcome. I commend the Garda Síochána. I also commend the Defence Forces, which I believe were also involved, the Criminal Assets Bureau and, most importantly, the local residents who gave some of the information that led to the arrests.

My first question is about the programme for Government that was announced recently and printed a day or two ago. I have it in front of me. It makes no commitment to increase funding for drug and alcohol forums. We know what will happen if that is the case.

Three weeks ago, I raised with the Minister the deal with private hospitals. At the time, the occupancy rate in the Bon Secours in Limerick was 1%. The Minister told me that the figures he had provided to Deputy O'Reilly had changed and were then 30%, which was fine, but figures he sent to another of my colleague's recently showed the rate as being back to 15%. What is going on? We all welcomed the deal when it was done because we believed it would be necessary if our ICUs became overwhelmed, but as the Minister is aware, public hospital appointments are not taking place. Many of them are being cancelled, as are procedures. Quality-of-life operations, tests and other procedures are on hold for health and safety concerns about Covid-free spaces. The deal is not delivering what we believed it would. Will the Minister outline the occupancy rate in the Bon Secours in Limerick? Will he ensure that the many thousands who are stranded on waiting lists are treated in the Bon Secours? Will he outline what resources he will make available to increase the public health service's capacity to provide access to diagnostics, such as the urgent recommencement of cancer screening programmes and time-critical reviews for patients on surgical waiting lists?

I have in part asked my final question already. Does the Minister believe that the funding for drug task forces under the programme for Government will be enough?

I do not want Deputy Quinlivan to believe that I can be held accountable for a draft programme for Government, but I take the serious point that he makes about supporting drug and alcohol forums. We need to see increases in their funding in future budgets. That will be a matter for a new Government and this Oireachtas.

I share the Deputy's view of the incredible work being done by staff in our addiction services. We have seen that in the low level, thank God, of Covid infections among certain communities, including the homeless.

Regarding the Bon Secours in Limerick, I do not have a percentage figure, but according to the note I have with me, there have been 25 inpatient discharges, 979 day cases, 197 diagnostic tests and 509 outpatient appointments for public patients. Perhaps I will send the Deputy these figures in writing, if that is okay.

Next is Deputy Feighan. Is he sharing time with Deputy Carey?

Yes, at seven minutes and three minutes.

First, our thoughts are with the families of the more than 1,700 people who have passed away due to Covid. The past three or four months have been a difficult time for them.

The Minister referred to the reopening of nursing homes to visitors. Like him, I thank the nursing home owners, staff, residents and the families of residents and staff for quickly adapting to the new reality. For many months, nursing homes' doors have been closed. My town of Boyle in north Roscommon has three nursing homes - the Plunkett home, Abbey Haven and Drumderrig House. They are excellent homes and we are thankful to have such great care. My mother, who is 92 years of age, is in the Plunkett home. It has been great to be able to go to the window, look in and say "Hello". The new requirement to wear protective gear is cumbersome, but it is great to see the nursing homes open again.

I wish to raise a matter. Mr. Leo Gray is a great Sligo Rovers supporter. On Twitter a few minutes ago, he more or less wrote that, if one was a soccer supporter, the question of immunity to Covid after 90 minutes meant that one could not see a full soccer match but that a GAA supporter could watch a full 70-minute Gaelic game. If one is a soccer supporter, then in his words, "you're fecked".

Yes. If one is a soccer supporter, what exactly can one do? What criteria did the HSE use? Perhaps we could have gone to 120 minutes and given the soccer supporter a bit more, but we will see.

Will the Minister update the House on the national review of cardiac services, which has been ongoing for some time? At what stage is it and when is it expected to report?

That review is vital to clear the way for provision of a fixed cardiac catheterisation laboratory service in the north-west region, which will be located at Sligo University Hospital as part of the Sláintecare cardiac service plan for the region. Currently, primary percutaneous coronary intervention can only be achieved in Sligo in an emergency situation by getting a patient by air ambulance to Galway. We need that to change.

Will the Minister update the House on the roll-out of antibody testing nationwide? What will it entail and will everybody be tested? We have seen media reports of Sligo and Dublin being the first counties selected for the new testing system. Will the Minister clarify that?

I share the Deputy's view that it is very heartwarming to see nursing homes able to begin to open to visitors again. I would make the point, which I am sure he will agree with, that they need to do so in a cautious manner and that nobody here is putting pressure on a nursing home to open until its management believes it safe to do so. A nursing home's first duty of care is to the residents for whom it is their home. The process requires a lot of vigilance and a huge amount of work has been undertaken by nursing homes to arrive at this point. I am glad to hear that the three homes in Boyle are doing well. I think I met Deputy Feighan's mum in the Plunkett home when I visited him and I am pleased to hear she is doing well. It was lovely to visit that facility with the Deputy.

In regard to soccer and GAA, the virus, unfortunately, does not care about anybody's favourite sport. It is very infectious and can spread quickly. The lower we can get the incidence of the virus in the country, the weaker we can make it and the more options it gives us in terms of being able to go about normal life again. We are making good progress in this regard. Any measures we bring in are done on public health grounds but there has to be common sense to them as well. The HPSC provides advice to sectors, Departments and agencies and interacts with them to come up with a safe and common sense way of trying to resume services. All of that is kept under review.

In regard to the national cardiac review, I know this is a very important issue in Sligo and the north west. I visited Sligo University Hospital with the Deputy and we discussed this matter. I need to check where that review is at but I am conscious that it is chaired by Professor Philip Nolan who is also chair of the epidemiological advisory modelling group and a member of the NPHET. We have been keeping him very busy. I an eager for the national cardiac review to be progressed and very eager for a new Government to get on with progressing the cardiac services the people in Sligo and the north west need.

I suggest, in the interests of time, that I might write to the Deputy regarding the antibody tests. I am sure he is very pleased that Sligo is one of the two counties being used for testing. The idea is to randomly choose a certain number of people in order to detect the level of antibodies that may exist among our population.

We were very thankful that Sligo was one of the few counties that went 29 days without any further Covid-19 infections. We did have one new case last night but we hope we can go another 29 days without any more.

I thank the Minister and his officials for meeting representatives of the Irish Dental Association, which is something I called for in the Dáil more than three weeks ago. Their situation was an issue that needed to be dealt with and I thank the Minister for doing so.

I will conclude by being a bit self-indulgent in telling the Minister that every night my wife sees him on the television and tells me how old he has become. It makes me feel very good that he is at least 25 years younger than me.

Is the Minister going to answer that one?

The other day I saw a picture of myself on social media that was taken on my first day as Minister for Health. I must say that I got kind of a fright when I saw myself in the mirror shortly thereafter.

In the context of the antibody testing, it commenced on 15 June, from which date a total of 5,200 letters will ultimately be posted to a random sample of individuals aged between 12 and 69, 3, 200 of them in Dublin and 2,000 in Sligo. The sample will be representative of the population by age and sex and it is a very important piece of work.

I wish to raise the issue of air travel and the current 14-day quarantine period for people arriving into the country. The Taoiseach indicated some weeks ago that work was under way to look at this restriction, with a particular view to opening up air corridors with countries in the EU, in the first instance, where the virus has been suppressed. As the Minister will be aware, the aviation and tourism industries are on the floor. One of the recommendations of the aviation task force was for the Government to look again at this question. I am receiving queries, as I am sure the Minister is too, from Irish people who have booked holidays abroad to various parts of the EU and to island destinations where there is a very low incidence of the disease. They are asking me whether it will be okay for them to travel in July or August. Will the Minister answer that question and tell the House what type of work is going on to bring certainty in this matter? Aviation is of huge importance to County Clare, where Shannon Airport is a driver of economic activity in the region. This particular rule is having a damaging effect.

Is there any update on the situation regarding hair and beauty salons? There were some positive soundings last week that they might be able to open sooner than is currently indicated. I ask the Minister for an answer in this regard.

The more progress we make in suppressing the virus, the more we can begin to open up services. The two biggest risks in terms of its re-emergence or a second wave are, first, the risk of complacency and that we all get fatigued by the public health measures, which is understandable but cannot happen, and, second, the risk of imported cases. We all remember back at the start of the pandemic that there was much concern about imported cases, with people asking which aeroplane might have been involved or which country. We need to be very careful in this regard. I realise, however, that we live in the European Union and that freedom of movement is something we value as part of who we are. I know that in the Deputy's region, Shannon Airport is at the very heart of its economy, society and way of life. The Taoiseach advised Government that we would return to this matter in approximately two weeks. We have to monitor it very carefully and watch what is happening in other countries. Sadly, we have already seen a spike in new cases in some countries as they begin to open up. It is something the Government is keeping under review and will return to in two weeks' time.

In regard to hair and beauty salons and other personal services, NPHET will consider at its meeting tomorrow how the parts of our economy that remain to be opened will be phased in terms of which will go into phase 3, which starts on 29 June, and which will be part of phase 4. I will be in a better position to advise the Deputy at that stage. I know that a lot of businesses, hairdressers and the like, are going to huge efforts to prepare for their safe reopening. They are looking for certainty and I hope we will be able to give them that in the coming days.

I want to ask first about the status of the Covid tracking app. I understand that this app will always be in addition to normal contact tracing, not a replacement, but it could make the tracking effort much more effective. If we are in a situation where we are at risk of future infections or a second wave, it could be very good to have this additional measure in place. Has beta testing started on the app and, if so, how many people are involved and when is it expected to launch?

I thank Deputy Ossian Smyth for raising this issue not just today but on a regular basis. The short answer to his question is "Yes", testing has started. My understanding is that beta testing of the early release of the software is seeking feedback aimed at improving its quality before it is released. The application has been deployed as part of a field trial within An Garda Síochána. That trial has been running for two weeks and it will give us some very good information. There is good progress being made and I hope that I, or possibly my successor, will be in a position soon to seek formal Government approval to roll out the app. I have quite a lot of information here and I can arrange for a further updated briefing. It is about making sure that we get the app entirely right. The data protection impact assessment and the source code have not yet been published but I have given a commitment that they will both be published before the launch of the app because that is very important for public buy-in. The field work is under way and I thank An Garda Síochána for its members' participation. I hope to be in a position in the next few weeks to ask Government to formally approve the app and, in advance of its launch, to have the data protection information and source code published.

The Minister has been asked by a number of Deputies about the reopening of hairdressing services, to which he has said that he will consult NPHET and the latter will come back with recommendations. Ultimately, it is a decision for the Minister and the Cabinet as to how to proceed in this matter. There is no personal benefit for me in asking this question as it is a long time since I had any use for the services of a hairdresser but it is a matter of comfort and confidence for many people.

Hairdressers, whose businesses are not very profitable normally, are paying rent and are wondering why when hairdressers across Europe in France, Germany, Italy, Greece, Portugal and Spain are open - the barbers in Seville have reopened - they are not permitted to reopen here until next month. Is there any possibility of the reopening of hairdressers here being accelerated?

The Deputy has no vested interest in the question because he is clearly pure on the matter. I take his point. This is a serious business issue for so many people whose doors have been shut for a lengthy time now. Businesses want to know when they can take staff back on their books. I made the point in this House last week that this is an issue of people's mental health and well-being as well in terms of how they feel about themselves, male and female. I would like to see the hairdressers open as quickly as possible. However, I will not on the floor of the Dáil pre-empt what NPHET might advise the Government on tomorrow. The Deputy is correct that NPHET will advise the Government as to what might fit in phase 3 and phase 4. It is then for the Government to make its decision. I hope the Government will be in a position to decide on the remaining phases and therefore provide the direct answer on Friday. That is my hope.

The Deputy referenced other countries, which are valid references. I have consistently said that the preference is a slow, safe plan that we can speed up if the public health advice allows it rather than a fast plan that we have to slow. That is the approach we have been taking so far.

I thank the Minister. I would like to discuss how it is proposed to monitor the risk of a second wave of infections. There are worrying signs. For example, the schools in Beijing have been closed again. I understand there are 12 states in the United States that have a rising rate of infection. On what basis will the Government decide to roll back on particular measures? For example, is there a specific value of the R-nought that it is tracking? Can the Minister indicate what the criteria are or is it simply a matter of the Government asking the expert on the model if we are okay? Can the Minister explain in simple terms what the criteria are for deciding whether we are moving too fast?

We helpfully published the methodology behind the model in great detail in recent weeks, which I know people in this House had been requesting. Learned minds can give consideration to that. As I have previously said, and more importantly the Chief Medical Officer has said, there is not any one marker. I have heard an occasional criticism of NPHET in this House. For what it is worth, my view as an outgoing Minister is that NPHET will continue to have a major role to play in the public health emergency in terms of the need for close monitoring in a methodical way for some time. This will involve a number of issues, including the R-nought. As I pointed out to the House today, the fewer new cases there are the harder that is to predict. The total number of new cases is a key indicator, as is the R-nought and the translation of that into ICU and hospitalisation and also what we are seeing in regard to testing. One of the most encouraging things we are seeing in regard to testing is the low positivity rate. The positivity rate, the actual number of new cases and the R-nought are probably three of the key issues we will be looking at. The modelling will need to continue its work and to continue to update on a weekly basis.

Several months ago at the start of this epidemic I asked about sick pay for people who do not have it and the introduction of emergency measures to prevent the virus spreading. If people who traditionally do not have sick pay are forced to go to work, the virus could spread as a result. Emergency measures were brought in by this House. I am receiving telephone calls from constituents who work in private nursing homes to the effect that they are no longer entitled to sick pay. Have the emergency measures expired? I am concerned that people feel obliged to go to work because otherwise they will not get paid and will not be able to meet their rent payments. Can the Minister advise on whether sick pay is still available to people working in private nursing homes?

I will have to revert to my colleague, the Minister for Employment Affairs and Social Protection, to get the Deputy an accurate answer on that matter. There is a broader issue around sick pay schemes and so on that operate in some workplaces but that is perhaps for another day's debate. I will revert to the Deputy on the matter tomorrow.

Like others, I begin my expressing my sympathies to the families of the 1,709 people who have passed away because of Covid-19 and my solidarity with those who have been ill.

Unusually for the Opposition benches, I congratulate the Minister and his team and NPHET for handling this unique crisis with great dexterity and skill. The Minister has not been right in everything he has done but one cannot in the midst of a crisis make the right decisions all of the time. All of the actions to date have been based on expert health advice and have been explained setting out the reasons and underlying science for each decision. This has resulted in a response from an intelligent Irish people accepting and supporting each restriction and action to date. It is in this context I want to raise a number of questions, the first of which relates to the leaked guidelines and protocols for the reopening of pubs because I believe they require some explanation.

I appears that pubs that serve food are to be allowed to reopen and pubs that do not serve food will not be able to reopen. This is anchored in the Intoxicating Liquor Act of the 1960s referenced by Deputy O'Reilly, which is about controlling the consumption of alcohol and has nothing to do with infectious diseases. How is it that the consumption of food is an issue and that an arbitrary figure of €9, which apparently is an updated figure on the 5 shillings that was provided for in the 1962 Act, is to be the criterion? Under the protection of health criteria, it is not permissible for a person to attend a licensed premises for 90 minutes and not consume food. All regulations to date are anchored and designed to combat viral transmission. This has to remain at the heart of everything we do. Like others, I am contacted daily by hairdressers and people in other businesses who want to reopen. We need to have sound, logical expert reasoning to give to them. I regret that what is happening in terms of these draft guidelines erodes that. Consuming food provides no additional protection. Consuming a chicken korma or a cottage pie does not provide a person with extra protection against the virus. Why would that criterion be a determinant? I ask the Minister to explain that. Also, why is 90 minutes a determinant? We had a long debate on the two-hour rule in regard to this House. We need to bring people with us all of the time. The Minister mentioned complacency. We cannot be complacent. We must have very clear guidelines. We brought people on this journey with us on the basis of explaining the facts and people understanding and accepting that this was the best advice. I ask the Minister to explain the science in regard to the 90 minutes and the consumption of food.

I thank the Deputy for his kind words. I also thank him for his role. One of the reasons we have been able to bring people with us, apart from the brilliance of the Irish people and their own determination, is because no party has played party politics with this issue. I have sat in meetings with Deputy Howlin, Deputy Shortall and many other Deputies here since the start of this crisis, and particularly at the start of it. The approach of managing it in a public health-led way has made my role easier. I again thank the Deputy in that regard.

The Deputy is correct that viral transmission and suppressing viral transmission has to be at the core of what we do. Let us remind ourselves of how we got to the situation of the possible reopening of pubs that serve food. The public health advice was that restaurants would be in a position to reopen at an earlier stage than the traditional pub environment because people are seated and it is possible to move tables apart, etc. We are all aware of the situation in terms of people crowding at bars, etc.. A number of publicans made the point, not unreasonably, that they effectively operate as restaurants in that they serve food as well. There are some such pubs in my own constituency. There was an effort to accommodate pubs that serve food and operate like restaurants. The Deputy is well able to differentiate between the pub that serves food and has seating similar to that in a restaurant and the busy traditional bar.

I will explain how this happens. The relevant line Department or agency, in this case Fáilte Ireland, engages with the HPSC on how to proceed safely in each unique sector. The key words, as mentioned by the Deputy, are "draft guidance". I appeal to everyone to await the final guidance because I meant it when I told Deputy Feighan earlier that there must be public health advice guidance with common sense. It is important to clarify that cottage pie does not protect a person from Covid-19. In speaking about the production of final guidance, I will refer to the childcare sector as an example. I read everywhere about the debate on how to keep toddlers 2 m or 1.5 m apart, which is not possible. In that case, the line Department worked with the HPSC to come up with a bespoke solution for that sector, which is the pod.

That is the space all Departments and agencies of State need to be in. They should use the HPSC to get the best advice, interrogate that advice and interact with it. I am conscious that this draft guidance, which I do not believe has been published or finalised yet. I encourage people to engage and get a common sense, finalised agreement.

My concern is that we continue to be very clear in our guidelines that the objective is to prevent transmission of the virus, and that everything is understood and explained on that basis. We should not broker a deal on some basis that is self-evidently not anchored in science. That is my concern, but I will await the emergence of the final guidelines.

I want to ask the Minister about the availability of a vaccine, should one become available. Costa Rica has an initiative whereby when a vaccine is discovered, please God, the intellectual property, IP, would be universally owned. It is supported by about 35 countries, though I have not checked recently whether it is supported by Ireland. Under this initiative, every pharmaceutical company in the world would be able to immediately produce the vaccine and distribute it in the widest possible way. As regards our own legislative position, what legal powers does the Minister for Health have to require a compulsory medicines licence? I have checked to see what the specific powers are and while there are some in the Patents Act 1992 that would allow for it, they are very restrictive. The patent has to be in existence for at least three years and there are other restrictions involved as well. Has the Minister looked at this with a view to ensuring that, should a vaccine become available, it is compulsorily licensed here so that it is not the property of one individual company? Many companies have already said that if they discover one they will create a public IP for the public good but we cannot guarantee that the company with the best vaccine will do so.

This is a very timely question because only today I received correspondence from the European Commissioner for Health and Food Safety about this matter and I also had calls with six or seven separate European health ministers yesterday on it. We are spending an awful lot of time at a European level, at health ministers' Councils and the like, trying to take a joint European approach to this. We have invested most of our time and energy in trying to procure any vaccine that may become available on a European level and ensuring its fair and equal distribution among all member states. Four member states have already undertaken an initiative where they have agreed to meet the upfront costs but have also guaranteed fair distribution. While I welcome member states doing anything that is helpful, I am personally of the view that we need a European Commission led approach to this. I have spoken to the Commissioner and I know that is her view as well. I have also asked my officials to advise me on any legal preparations we may need to make here, but I believe Ireland will be best served by approaching this jointly as a member state of the European Union.

To be blunt, I am concerned about the European initiative because it would not actually make a vaccine available to everybody. It would only be available to those countries participating in the initiative and that is not acceptable. We had an online conference with many actors, particularly in Africa and India, regarding the internationalising of this intellectual property and it is important that we take a worldwide view on this in order that every country and pharmaceutical company in the world can produce a vaccine once we have intellectual property on it. I had hoped the Minister would confirm that was also his view.

Deputy James Browne asked about dexamethasone. It was not quite clear from the Minister's response whether that drug is in use in Ireland now, as it is in the NHS for critically ill patients, a diminishing number of whom - thankfully - are now in intensive care.

The reason the Deputy is not quite sure is that I asked my Department only this morning to seek an update from the HSE on the matter. It is my sense that it is being used but I want to get that confirmed by the HSE today. This is something the NHS has started using literally from today and I expect to be in a position to update the Deputy on it by tomorrow.

My view on the vaccine is one grounded in the same principle as the Deputy's, but the point I was trying to make was that, rather than individual member states of the European Union grouping together, though they are perfectly entitled to do so, we should proceed with all member states of the European Union under the auspices of the Commission, in order to ensure Europe-wide availability. However, I also accept and understand the solidarity we owe the developing world.

I want to make a few comments on Sláintecare and the programme for Government. There was a commitment in the programme for Government to "accelerate the implementation of Sláintecare". That vanished out of a later version of the programme yesterday but I gather it is back in it now. It sounds good to say "accelerate the implementation of Sláintecare" if we take that sentence for what it is worth because that is what is needed. Unfortunately, when one digs a bit deeper in the programme for Government and looks at the section that deals with "Reigniting and Renewing the Economy", very regrettably there is a sentence that states: "We will examine, [which is not a commitment], in advance of Budget 2022, appropriate funding measures to support the implementation of Sláintecare." How disappointing is that? There was just beginning to be some momentum behind Sláintecare. While many of us were still concerned that lipservice was being paid to it by the Government and the party supporting the Government, we expected something serious out of the programme for Government. This is absolutely damning and really disappointing. There is not going to be any additional money for Sláintecare this year or next year. The withering commitment, if one can call it that, is that the new Government will examine appropriate funding measures to support it in advance of 2022. That is just pathetic. After all the work that was done, all the talk, the lipservice that has been paid to it and the fact that every party in this House signed up to Sláintecare as the national public health policy, it now seems to be completely relegated to some point in the future. Can the Minister provide any explanation for this? Is he aware of this? Did he sign off on it? If this has been kicked into 2022 or later, all momentum is going to be lost and public healthcare in this country will be set back years and years. It is really disappointing.

The other matter I wish to raise relates to the policy document that was launched this morning, Sharing the Vision. We waited for some time for that review of A Vision for Change. The document is full of undertakings and aspirations for building capacity in order to provide access and take us to a much more progressive place where the whole issue of mental health would finally get the kind of attention and priority it needs. Of course, it is a subset of the overall health system, Sláintecare and the public health service. Therefore, if Sláintecare is not being funded, how can we have any confidence that Sharing the Vision is going to be funded as well? I would very much welcome the Minister's views on both those matters.

First, I acknowledge Deputy Shortall's work on Sláintecare. I do not say this for any reason other than sincerity, but if I had put money on who would have been Minister for Health after the general election, I would have had her in contention and I am disappointed that we never had the opportunity to engage fully on the importance of Sláintecare. I welcome the fact that there is a commitment to accelerating it in the programme for Government. I was reading about this yesterday and my understanding is that it was always in the document, although another document had been uploaded. Acceleration is key. The Deputy will expect me to make this point, but I genuinely believe that many elements of Sláintecare are already funded. We can debate on another occasion when there is more time the matter of capital being a huge part of the electronic record, the GP contracts and the various capacity projects. Perhaps this is always the way with programmes for Government, and people may criticise that, but there are not very many areas of the programme for Government which have a commitment for additional funding and Sláintecare is one of them. I hope the Deputy will acknowledge some of the key reforms we have managed to get into the agreement.

We have different views on Sláintecare consultant contracts. That has been included, along with regional areas and elective hospitals.

The Deputy made the point in respect of the review of A Vision for Change in that it was key to have it published in advance of the new Government being formed. It has been published and there is a key implementation plan. The new Government will have to be held to that in terms of delivering on the actions outlined in it. As the Deputy also knows, the individual budgetary process decides every year how much money is allocated to each Department.

It is a complete and utter contradiction to say that the new Government will accelerate the implementation of Sláintecare and at the same time that the only financial commitment to it is to examine the period post-2022. That is entirely disingenuous and feeds into the view that the outgoing Government party, supported by Fianna Fáil, was never really serious about having a proper universal public healthcare system. That is deeply disappointing.

I want to raise a few other matters. There is a general consensus, and it was said by Professor Phillip Nolan, that a second wave of the virus is probable. We all hope and keep our fingers crossed that will not happen, but it is highly likely and has happened in other countries. There is concern that we are not prepared for a second wave. I listened to Professor Jack Lambert, a consultant in infectious diseases, speaking on the radio yesterday. He said we are particularly unprepared in the nursing home sector because it is so under-resourced and so many people working in it are in precarious employment without any kind of security at all. They come and go and, as has been mentioned, have no sick pay. What is the view of the Minister on the level of preparedness for a second wave in the nursing home sector where so many of the fatalities occurred? Is there a document to support that?

I hope the Deputy does not believe I am being disingenuous in regard to our commitment to Sláintecare and I can assure her if a new Government is formed it will be the case that, as I have heard her say, it will be about reform alongside funding. Whichever party is in the new Government will need to show real contractual reform in terms of the consultants' contract and regional areas, something we can come back to another day.

The Deputy is right about the second wave. The current advice, accepting that these things evolve and are dynamic, is that it is likely that this is going to be a virus that will be with us for a while and will come in waves. We all wish to keep the size of such waves as low as possible and that is why we need to continue with the public health measures. That is why I believe there is going to be a need for the ongoing involvement of NPHET and the various structures we have in place.

On the nursing home sector, it will require constant vigilance. I did two things recently to prepare for any potential future wave. One is the establishment of the expert panel chaired by Professor Cecily Kelleher, which is due to produce its first document on what more actions need to be taken, how it believes we are prepared now with the measures we have in place and what other countries are doing that we could learn from. That to-do list for all parts of the health service in respect of nursing homes will be published at the end of June. The second thing I did was to meet HIQA last week. I told it very clearly that if it believes it needs any additional regulatory powers, I could ask the board to formally consider that question and revert to me. There are ongoing actions, but this area will require constant vigilance.

We have had yet another week without a roadmap for the reopening of the health service. We are coming to the end of a very expensive deal with private hospitals. In recent weeks, I urged the Minister to ensure that all of that additional capacity was used to make progress with the public hospital waiting lists because we are paying very dearly for that extra capacity. The other area of extra capacity is in Citywest, where we are paying €25 million for a 1,000-bed facility which is being completely underused. We are spending money but are wasting time in terms of tackling waiting lists. Can the Minister tell us when we will see the roadmap?

In fairness, last week I said in the House that the roadmap would be considered by the HSE board on Wednesday of this week, which is today. My understanding is that the board is considering the matter today. It is a fair point to say that many non-Covid activities have recommenced, and we are seeing evidence of that. The number of Covid-19 patients and vacant beds in hospitals are dramatically decreasing.

I spoke to the HSE about Citywest yesterday. It is acceptable that it has been so little used up to now because it was effectively an insurance policy against a surge that thankfully did not materialise. That will not be acceptable for much longer so it needs to come up with a very clear plan as to whether it believes the agreement needs to be extended beyond the limited period that is left, and if it does why that is the case and if it does not what it intends to do with it between now and the remaining period of time in the agreement. I believe that is also being considered by the HSE board today.

Deputy Kenny is sharing time with Deputy Barry.

The Minister has accepted that we need changes in our public health service and the Covid-19 public health emergency has shown the cracks in our system, such as bed capacity and staffing shortages. The running down of our public health service over the past number of decades has been hugely detrimental to all citizens in this country. The new programme for Government states that it will examine new ways to utilise community settings and create partnerships with our private hospitals to avoid placing increased pressure on our public health services, a statement I found deeply depressing. That is going backwards rather than forwards. There is no recognition of the thousands of beds that were taken out of our health service or staff shortages. Will it be the old way, the new way or another way?

We cannot get ahead of ourselves. A draft programme for Government has been agreed by three political parties and has to go through a process. If a Government is formed its members will be held to account by the House in terms of the implementation of the programme and questions arising from it. The Deputy still raises a fair point on the need not to return to the old way. Every time I meet anybody from the health sector, be it from a union, management or anybody else, I know they, like everybody else in the country, wants to go back to a degree of business as usual. In the health service we cannot do that. Some good learning has come out of Covid-19, despite it being a very difficult and traumatic time for our country. People are working together in a new and different way. Stakeholders are being engaged with in a better way. I meet disability organisations which say they have never had so much contact and engagement.

More capacity is required, and we can debate the programme for Government's commitments on that another day. The future will also be about doing things differently, and I will give the Deputy an example. Almost 50% of outpatient appointment clinics in the month of April were done virtually. The Deputy and I had a virtual Zoom meeting the other day about an important issue. The use of technology means that more can be done through the use of teamworking. There will be reform coupled with capacity. As I said to Deputy Pringle in the House last week, this will require investment and there is no cheap or easy way of doing this.

On countless occasions over the past four years I have raised the issue of the medical cannabis access programme. This time last year the Minister announced that the programme would be functional. That was underpinned for, I understand, the first time in medical history by a statutory instrument which allowed people to access medical cannabis legally. The Minister said he expected people to be prescribed medical cannabis by the autumn. Does he know how many people have been prescribed medical cannabis under the programme? The answer is not one person.

Not a week goes by without parents of very vulnerable children ringing me to ask how they can get access to medical cannabis because their children are in desperate situations. I have run out of things to say to these parents. I can only say so much. They return to their doctors who tell them they do not know anything about the programme. Access has been four years in the making. It is referenced in the programme for Government, which is welcome, but the Minister has to give a commitment to parents and patients on getting access to medical cannabis under the programme. Can he give a commitment on this in his last couple of weeks as Minister for Health?

While we might not agree on everything, Deputy Kenny's sincerity and work rate on this is something I fully respect. He did a massive amount of work on this in the last Dáil and I know he will continue that in this Dáil.

While I might not have gone as far as he would like, the Deputy certainly helped change and influence my position by introducing me to a number of people to whom this was very important. While he is right in the context of the compassionate access programme, we do need it open and I will give him a commitment to return to him with a written update on that within a week. There were a number of different elements and a number of people were repositioned during the Covid crisis. In my final days as a member of this Government, I would like to get the Deputy a written update and try to progress that.

I say to the parents the Deputy is referencing that the ministerial licence scheme is available. While I know it is not ideal for everyone, I am signing them regularly - I think I signed two last week. In addition to that avenue, we have also come to funding support arrangements for a number of people under that. I want to get the compassionate access programme and I will get the Deputy a detailed written update this week.

Front-line workers in the health service have been selfless and have made big sacrifices. At the end of May it was reported that 8,000 health service personnel had contracted the Covid-19 virus with 9% of them having contracted it in the workplace, which underlines the point about the selfless work that has been done here.

Throughout society, it has become commonplace to applaud the work of health service workers. Ministers have joined in doing that. However, it is not right that health service workers would be applauded one month and denied their entitlements the next. Nurses, ambulance personnel, hospital workers and others are among the 330,000 public service workers who are due a 2% pay increase under the current pay agreement in October. The proposed programme for Government is silent on this. It contains an aspiration to have a new public service pay deal, but is silent on the issue of honouring the agreement that was made with these workers. The Minister for Finance, Deputy Donohoe, has said that it is an issue for the new Government, which I understand and accept. I also understand that, strictly speaking, it is in the remit of his Department and not that of the Department of Health, but Deputy Harris has been Minister for Health during the Covid crisis and he has seen at first hand the work done and sacrifices made by our health service workers. Is he prepared to join us in saying that these workers fully deserve to have that commitment followed through on and that the pay increase due to them in October should be honoured? I ask him to outline his position on that.

I do not mean to get in any way narky, but it gets under my skin when people criticise other people for applauding front-line workers. No political tradition owns front-line workers. They are our husbands, wives, mothers, brothers, sisters and fathers. We all know them and we are all immensely proud of them. We will applaud them and stand with them. We will do a lot more than applaud them, which I think is the Deputy's point. I regularly engage with unions on matters that come within my remit. I have excellent engagement with the INMO, including three meetings in the past ten days on a range of issues. I have also met SIPTU to discuss a number of matters. I am proud to engage with them. We need to continue to work with them and we could not have got through this without them.

I note that there is only one proposed programme for Government. It is open to anybody in this House who elects a Taoiseach to produce an alternative programme for Government and an alternative candidate for Taoiseach. That is how democracy works. I would love the read the Deputy's and see. He can produce an alternative programme for Government. As we know, there are no faits accomplis in the political world. However, I am pleased that the programme for Government contains a commitment to a public sector pay deal. For what it is worth, it is my clear view that all agreements reached by the State should be honoured by the State. That is a very important part of reaching an agreement - both sides have to honour their word.

I think the Minister has said what I want him to say.

I ask the Deputy not to tell anybody else.

I will leave it at that.

Normal people would be speechless, Deputy Barry.

I offer my sincere condolences to the families and friends of those who have passed away in the last week due to the Covid-19 pandemic. I again give my full support to all the front-line heroes who are keeping us safe during this most critical time. I am particularly pleased to note that there have been no new cases in my constituency of Louth since last Friday which is a testament to the efforts, commitment and resilience of the people of the constituency.

If anything, this Covid-19 crisis has shown us the value of our health service. We have seen how the health service has reacted to the pandemic and how it is keeping our country safe. I have no doubt that people will see our front-line staff in a different manner. They now see the heroic efforts of these wonderful people. However, we must now realise that in order for the health service to not only reach its full potential but also reward the front-line heroes in that service, we must now take a different approach.

There is likely to be a new Government in place in the coming weeks. I feel that we now have the opportunity to make real changes, particularly in the health service. It is clear that the health policies pursued in recent years are simply not working. I give an example in my constituency. Louth County Hospital in Dundalk is a prime example. It has traditionally served the people of Louth and its surrounding areas for over 60 years. The hospital has always had a tremendous reputation. Previous governments, in their wisdom, decided that it was appropriate to downgrade the hospital, which was a major mistake. We were told that Our Lady of Lourdes Hospital in Drogheda was to be the main acute hospital in the north east, which was also a mistake. It is clear that the downgrading of Louth County Hospital was not only wrong, but has also cost lives. People in Dundalk and the surrounding areas are clear that Louth County Hospital must have its services reinstated. I have spoken at length on this topic during my term in Dáil Éireann. My strong and only belief is that we must reinstate all services at Louth County Hospital.

While I am not going to scaremonger, how many lives could have been saved over the past decade if only we had a fully functioning hospital in Dundalk? The infrastructure is there, the staff are there and more importantly the population is there. During this Covid pandemic, Louth County Hospital has offered strong support to its counterpart in Drogheda, Our Lady of Lourdes Hospital. While I welcome the support it gave, it is now time for the full services to be reinstated and for Louth County Hospital to stand alone. This is what the people of Louth and east Meath demand and it is the least they deserve.

Over the coming days, the three parties hoping to form a Government will no doubt be seeking the support of Independents. I want to put on record and be very clear on this. Unless the proposed Government supports me in my call for the reinstatement of full services to Louth County Hospital, I will not support it. The people in the Louth and east Meath area have made it clear that this hospital must have its services restored and I will stand by them.

The Minister visited Louth County Hospital in 2018 and the minor injury unit can now treat patients as young as five. The people of Dundalk, Louth and the surrounding area thought this was the first step in the right direction. On 27 June 2010, Louth County Hospital emergency department closed, which was a major shock. The only good thing was that it was continuing to do the day surgeries, day medical services, outpatient services, and also operating the minor injuries unit. Louth County Hospital has medical wards and plenty of space to expand. In recent months we have spent millions of euro to use the facilities of private hospitals. The buzzword is ICUs. Louth County Hospital is willing and able to step into the breach. This is very important. I put on record again that if the Government is looking for my support, I am looking for the Minister's support. Will he help me and call for the services to return to Louth County Hospital?

In recent weeks I have called for a public inquiry into the many deaths that occurred in the Dealgan nursing home as a result of Covid-19. What is the status of this inquiry? It is important that we get to the bottom of exactly what went wrong so that we can learn what procedures and protocols can be implemented to ensure we do not have this issue in the future.

Where do we stand on testing and tracing? Many experts predict a second spike in Covid-19 and the common consensus is that we need a stable and robust test and tracing system in place. Has such a system been put in place now?

Over the past couple of months, I have spoken on the record about the 2 m social distancing requirement. I was led to believe that we were following the advice of the World Health Organization.

It categorically states that the safe social distance is 1 m, yet we are insisting on 2 m. We need complete clarity on whether we are following the WHO guidelines or not. If we are to follow the guidelines set out by WHO, then we should be operating a 1 m social distancing rule. This could be a game changer for many businesses in the State that badly need to reopen. They are being starved of business and unfortunately the longer this goes on the greater the chance that some businesses will not reopen. We must avoid this at all costs. Will the Minister confirm to the House what guidelines we are following and can he see a situation whereby a 1 m social distancing rule could be implemented?

I will conclude by summarising the issues I would like the Minister to address. If he does not have enough time to reply perhaps he can reply in writing. Will the Minister support me in my calls to have full services reinstated at Louth County Hospital? Will the Minister give the House an update on the progress of a full public inquiry into the set of circumstances around the many deaths due to the Covid-19 pandemic? Will the Minister update the house on the testing and tracing system currently in place and does the Minister believe this to be robust enough should we suffer a second surge of the virus? Will the Minister update the House on whether we will adopt the guidelines of the World Health Organization in implementing a social distance rule of 1 m, as opposed to 2 m?

I thank Deputy Fitzpatrick for the questions. My own leader, the Taoiseach, will be watching on the monitor to make sure I am not negotiating arrangements with Independents. That is certainly above my pay grade.

I take very seriously the issues raised by the Deputy. We got much work done on investment in the healthcare services in Louth. I recall visiting Our Lady of Lourdes Hospital with Deputy Fitzpatrick when I was first appointed as the Minister for Health. I remember it as a very overcrowded hospital. We have seen significant improvements there with regard to much additional bed capacity and a really good management team and staff, to whom I pay tribute. I also visited the Louth County Hospital in Dundalk with the Deputy. I was struck by the dedication, especially to the rehabilitation work that goes on there, and in respect of the Deputy's campaign on the minor injury unit age-appropriate usage, which we were able to reduce to the age of five. It is a brilliant hospital. The policy is to make all hospitals able to provide the full range of services that are appropriate for it. As the Deputy already pointed out, the Drogheda and Dundalk hospitals have been working together during this pandemic. It is about identifying what more hospitals such as the Louth County Hospital can do, and to invest in them to do that. I am more than happy to talk about that in more detail at some time.

I will write to the Deputy on the Dealgan nursing home. I understand HIQA was due to carry out an inspection there. I had said I was going to await the outcome of the HIQA report to decide what further actions are needed. I know it has been a very difficult and traumatic time for people with regard to the Dealgan nursing home. I will keep in touch with the Deputy on that.

Deputy Fitzpatrick raised the issue of testing and tracing. Significant progress is being made. We now see that in some 90% of cases the turnaround time from referral to completion of contact tracing is three days or less. I recognise the HSE's hard work to achieve the target it set itself in its testing and tracing roadmap, which was published last month. Encouragingly, we now see a positivity rate of only 0.8%. This means that almost 99% of people who have had a test are negative. This is a good sign. On Monday of this week, a zero prevalence study commenced in Ireland using the antibody testing. This study will measure the exposure to Covid-19 infection in a representative sample of the population in Dublin, where we have seen a high level of cases, and in Sligo where we have seen a low level of cases. We expect initial results from this study in late August. This will provide us with an overall national estimate of infection in the Irish population. NPHET has recommended that all healthcare workers in nursing homes be tested weekly for the next four weeks. All close contacts are now being tested and negative results are delivered by text message. The median and average number of close contacts per case over April and May has been very steady also. I am satisfied there is capacity now in place to do 15,000 tests a day. There has been good progress, but it is an area that requires constant vigilance.

On the 2 m versus 1 m distance, the clear view is that 2 m is safer than 1 m. The public health advice we follow is the 2 m rule. I heard the WHO representative, through video link in this Chamber, saying that 2 m is safer than 1 m. I have also made the point that we will need to provide bespoke solutions for some sectors, for example, 2 m and 1 m was not going to work in childcare. I have said very clearly that we need to get our kids back to school. We need a bespoke solution to reopen our schools that is safe and grounded in public health advice. The Deputy will be aware that we have also had the discussion about new guidance being drawn up for the hospitality sector.

I am glad to get the opportunity to talk about certain issues regarding health. I put it to the Minister that the testing is not yet satisfactory. If the Minister does not have time to respond to me verbally perhaps he will respond in writing. I ask the Minister to confirm or deny that there is just one laboratory doing the testing for all the country. Is the Minister aware there are other companies supplying test kits? Even Abbott is supposed to have supplied much of its product to the United States of America. Its test kits perform the test and give a result in 15 minutes. Why can we not have something like that? We are all very thankful that the figures are down but surely if they were to rise even factionally it would be very important to test people as soon as possible and follow up with contact tracing to confine any cases that may arise and to keep it to a minimum.

People who have other health problems are having serious difficulties in accessing their consultants and doctors. It is constant. We are on our phones every day trying to get people their appointments with their consultants, but it is not happening. These are people with coronary and cancer problems. They are patients looking to get hip and knee operations and who are in serious pain. People are losing their sight and going blind due to needing cataract operations. Indeed, I was told recently that when Covid-19 was beginning two patients were not seen by their consultant and were told to "Take this" or "Take that". Both of them died within a couple of days. I put it to the Minister that this is not satisfactory. This happened at the height of the virus. People who had other health problems and who tried to see their consultant were put off and it did not happen. That is very serious. We do not want any more of that to happen.

As an elected representative many people raise issues with me and I have to raise them in here. Many people regret what happened with the Italians when they came here. If the teams had been allowed to play but the supporters had not allowed to come it may have been as bad. People feel that we exposed ourselves then. There is also the issue of people who were returning from Cheltenham. There were no checks and people regret that also. We give praise where it is due, which I have done, but I must express the disappointment of so many people who regret that those things happened and exposed so many people to the virus. The Italians had it then.

I ask the Minister to do whatever it takes to open things up and get the consultants to see people, to see what the blockage is, which is serious, and to make sure people are not being denied assistance in their hour of need. Stage 2 very quickly becomes stage 3, and stage 3 very quickly becomes stage 4. That is then the end of the line. I appeal to the Minister in this regard.

I have two and a half minutes of questions and I ask the Minister to afford me two and a half minutes of answers. I ask him to forward in writing any answers he cannot provide now. Three weeks ago, I asked him about congregated settings and Bantry General Hospital. I thank him for the answers which were furnished to me this morning.

A little bit of clarity is needed on congregated settings. Was a risk assessment on infection control carried out before the statutory instrument was signed in July 2016? If so, will he supply that assessment to me? The Minister failed to answer my question on whether all community hospitals, such as Clonakilty Community Hospital, will be brought up to standard by the extended date of January 2021. Will the deadline in that regard be met? In the context of Covid-19, does the Minister accept that the statutory instrument which resulted in the date for community hospitals to be brought up to standard being pushed out has cost lives? I am asking that question in light of answers I received from representatives of HIQA at the Special Committee on Covid-19 Response.

On Bantry General Hospital, I am still awaiting answers to questions I asked on the last occasion I spoke to the Minister. If someone in Bantry or elsewhere in west Cork suffers a trauma, is there a policy whereby an ambulance will only take that person to Cork University Hospital, CUH? Are ambulances bypassing Bantry General Hospital? I indicated that may be the case on the previous occasion I spoke to the Minister. I told him about an 89 year old lady from Bantry who had a broken pelvis and whose family, when they contacted the ambulance service, were told that she had to go to CUH at 10 a.m. However, the family refused and instead took her directly to Bantry General Hospital. Thankfully, she is being well cared for and looked after there. The Minister told me he would provide an answer to that question. I would appreciate receiving it.

Are there plans to replace the current anaesthetist at the hospital, who is due to retire within the next year, and recruit a second full-time anaesthetist to ensure the hospital will remain a strong and viable general hospital which plays a very important role for the large rural population of well over 80,000 people whom it serves? If the Minister tells me that anaesthetist will be hired, I will know the future of the hospital is secure.

I have always encouraged the provision of new services at Bantry General Hospital. I invite the Minister to prove his intent to keep the excellent services that exist there and add to them. For some time now, the staff of the hospital have been expressing the need for a fracture clinic. This orthopaedic facility would be invaluable for the people of west Cork. What are the plans for such a clinic in Bantry?

Has the Government sourced PPE production units in Ireland, as well as additional laboratories for Covid tests, to be used in the event of a second wave of Covid? When will CervicalCheck services be reinstated?

I will try to answer as many of the Deputy's questions as I can in the two minutes remaining. I wish to see CervicalCheck screening back as soon as possible. Obviously, that must be done in a way that is safe for staff and women. I will meet the National Screening Service again tomorrow. It is due to provide restart dates for all four screening programmes by the end of this month. The restart date and a plan for how it intends to recommence will be shared with all Deputies and, most important, service users, women and men, by the end of this month.

On PPE, I am constantly in discussions with the HSE on this issue. Obviously, it needs to ensure we have enough PPE equipment not just for now, but for any second wave that may come. It has done a very good job of securing a supply line, something that, sadly, not every country managed to do. We are now looking at how we can ramp up domestic production where appropriate and are using our State agencies to assist in that regard.

I will revert to the Deputy on the plans to hire an anaesthetist for Bantry General Hospital. It sounds to me like a very sensible and important thing to do, but it is a matter for the HSE and I will discuss the matter with it.

I apologise that nobody reverted to the Deputy regarding the National Ambulance Service and his 89 year old constituent. Last week, he told me about the proposal to bring her to CUH rather than Bantry and the family involvement thereafter. I will make sure he receives a written response on that issue.

I was pleased to write to the Deputy regarding congregated settings in Bantry. He has asked two specific questions regarding the risk assessment and whether the extended date deadline will be met. I will provide answers in writing to those questions.

On the loss of life in nursing homes, there is a sad multitude of reasons for this. In the middle of the pandemic, it is, perhaps, too soon to be able to identify fully those reasons. We have seen a distressing pattern across the world and there are clearly lessons to be learned.

I am sure Deputy Danny Healy-Rae is very pleased that Kerry has not had a new Covid case for 28 days. Obviously, we need to keep that going. On testing, my understanding is that there are more than 40 laboratories involved in testing. We are always looking for new testing methodologies. The Deputy referred to such a test. HIQA carries out our health technology assessments. We are always interested in the identification of new and better tests.

I take seriously the point made by the Deputy on reopening the health service. The HSE board is considering its non-Covid care plan. I will write to the Deputy to provide details in that regard. We intend to ramp up non-Covid care in the coming days and weeks.

Deputy Pringle is sharing time with Deputy Harkin.

I will take five minutes and Deputy Harkin will take the remaining time. The Minister may be aware that a fire in Letterkenny on 15 June affected HSE stores of PPE, as well as aids and appliances, such as wheelchairs and so on. Is the Department aware of that fire? What role will it take to ensure that equipment is replaced? Obviously, it will be of vital importance in the ongoing fight against Covid in County Donegal. It is of vital importance that it be replaced and that there will be no interruption to supply in the county. I ask the Minister to address that issue.

On alcohol and alcohol sales during lockdown, it was distressing for me to read of sales of alcohol having increased because pubs have been closed. It is a bit horrific, particularly when one considers that there are 88 alcohol-related deaths per month and that more than 200,000 children live in homes where parental alcohol misuse is a problem. A national campaign was started by the alcohol forum in Donegal and the Irish community action on alcohol network is entitled "Deliver change on drink deliveries". Interestingly, there has been a 15% increase in online sales of alcohol during the pandemic. Will the Minister support the aims of that campaign and change the process for the online purchase of alcohol? There are protections for people who buy alcohol over the counter but what is happening in respect of people who buy alcohol online and have it delivered to their home?

I am aware of the fire in Letterkenny. I thank the Deputy for highlighting that it caused loss of PPE and aids and appliances that I am sure are crucial and important for many people. I will speak to the HSE directly through my Department to ensure that the equipment is replaced without any interruption to supply. I will confirm that in writing to the Deputy or ask that the HSE does so.

I thank the Deputy for raising the important issue of alcohol use. There has been a lot of talk about Covid-19 and it is very important that it is discussed. However, just beneath the surface there is much hidden pain and additional impact. Alcohol use is one of the causes of that pain. We all are or were being asked to stay at home, and home is a safe place for many of us, but some people, including many children, are not in a safe environment when they close the hall door. We know that may be the case in homes where there is an alcohol or other addiction. I very much welcome the work of the alcohol forum in Donegal and would be very pleased to hear from it and support its work in any way I can. There were 1,000 days of stalling before we managed to pass the Public Health (Alcohol) Act through the Houses. Its passage was hard won. In fairness, we listened and made improvements to it to try to get it right. It was the first time in the history of the State for public health legislation dealing with alcohol to be passed. The only thing this House had previously ever done in the context of alcohol was to stick a levy on it or decide on budget day how much excise to put on it. We had never used public health legislation for alcohol and I am very proud that we did so in the previous Oireachtas. One of the disappointments is that we could not deal effectively with the online piece. There were many debates in the Dáil and Seanad on the matter, as well matters relating to Europe and so on. I would set this new Oireachtas the challenge of dealing with that issue, perhaps working with the Department of Communications, Climate Action and Environment and at a European level. There is a vulnerability because the protections we put in place in the context of offline alcohol sales are not yet in place online. I would welcome the views of Deputy Harkin, as a former MEP, on how we can work on this issue at European level. That is a challenge for us.

Carers employed by the HSE are literally running around the country, spending 30 minutes in one house, perhaps getting somebody up and dressed and preparing breakfast, and are then out the door and off to another house etc. The service has been cut to the bone. It is care on speed.

Those carers are being asked to don PPE and take it off, put on face masks, practise hand hygiene and so on. All I am asking is that some extra time would be provided to those workers to allow them to give quality care without any diminution of services.

The second issue concerns the new document published by the HSE, the Framework for the Resumption of Adult Disability Day Services. We would all accept that family carers of adults with disabilities were abandoned from 16 March. While I am not apportioning blame, we recognise that people were left basically locked in their own homes and we have to ensure that does not happen again. If I were the parent of a person with a disability and I read this document, which I have, I would be absolutely devastated. As one carer said to me less than two hours ago, "Everything we fought for over the last 30 years is disappearing in front of our eyes". Upfront, this document states: "... the resumption of services will result in service users receiving a reduced quantum of service supports", and it describes this as the "new normality". It goes on to say that the reduction in the quantum of service will lead to greater reliance on service users' families and carers. In simple language, the HSE is saying: "We are cutting back front-line services and it will fall back on families - get used to it."

This is in direct contradiction of what is in the proposed new programme for Government, which, on page 79, under the heading Day Services and Supports, states:

We will:

- [commit] to expand adult day services and supports ...

- Deliver increased home support and Personal Assistance hours.

Has anybody told the HSE about this? Has anybody told the HSE that its plan contradicts another commitment in the programme for Government, namely, the implementation of the United Nations Convention on the Rights of Persons with Disabilities, Article 24 of which refers to the rights of persons with disabilities to education at all levels and lifelong learning?

If schools and crèches can reopen, why not day centres for people with disabilities? If shopping centres, hotels and pubs can reopen, why not day centres for people with disabilities? I am not saying this is simple because it is not. If the HSE had said resumption of services would be somewhat reduced at the start but that it would use all means at its disposal to increase day services, or if it had consulted with family carers before it announced its decision, which incidentally, is another commitment listed on page 78 of the proposed new programme for Government, then there would be the inclusive approach it speaks of in its document, but it did not do so.

The HSE document states: "The Government’s plan for reopening the country sets out phases which indicate a very gradual lessening of restrictions over the coming months." That is not factually correct. We started out with five phases and now there are four. We are in phase 2-plus. The third phase will run from 29 June and the fourth from 20 July. Part of the basis for the HSE decision is factually flawed.

I do not normally use up all the speaking time but I feel very strongly about this matter. The HSE document refers to the use of technology, such as Zoom and video. What about those who do not have access to the Internet, those who are non-verbal or have language disability, those who have a visual disability, or those whose attention span will not allow them to participate and who will take one look at the screen and walk away? As one carer said to me, what about the nitty-gritty everyday challenges that parents face in the context of toileting and what we euphemistically refer to as challenging behaviours?

I have two asks. First, I ask that it is explicitly stated that this is not the new normal but a temporary adjustment until the levels of service can be reinstated and expanded, as promised, and that there is a timeframe. Second, I ask that the extra supports that carers need will be put in place at the same time that services are reduced, so as not to have carers begging for them forever. I would appreciate a written answer.

I am sure the Minister will correspond with the Deputy.

I will correspond with Deputy Harkin in detail. However, while I am conscious of the time, she has raised such an important issue that I will give a brief reply now. The way the Deputy has outlined the issue is exactly how this should be viewed. This is a starting point to get these services back up and running. These people and their families have been left largely on their own due to this pandemic and we need to get the services back up and running. Not all day centres are the same, nor are all service users the same. There should not be one crude document that fits all. It will require engagement and I will make sure there is real meaningful engagement with the associations and directly with people with disabilities.

Sitting suspended at 4.35 p.m. and resumed at 4.55 p.m.