Ceisteanna ó Cheannairí - Leaders' Questions

Yesterday was a critical day in our fight against Covid-19. The Taoiseach and I spoke yesterday afternoon as he considered the public health advice from the National Public Health Emergency Team, NPHET. I am glad the Taoiseach also spoke to Michelle O'Neill and Arlene Foster about strengthening the all-Ireland approach. There is no doubt that the decision facing Government yesterday was hugely challenging. It has decided not to implement the NPHET recommendation to move to level 5 and instead we will move to level 3 from midnight tonight. The truth is that a move to level 5 now would have proven catastrophic for workers, families and businesses. I say this because the Government has cut the supports and protections that they need simply to survive and get by. I was very alarmed by the aggressive approach taken by the Tánaiste on RTÉ last night. Governments ask for advice and, when given advice, they should accept it with some level of maturity and grace and then make their decision. The NPHET recommendation comes against a backdrop of very high levels of community transmission and, critically, very low capacity within our health service. NPHET is worried and it is right to be worried. Listening to the Tánaiste last night, one would never think he had been Minister for Health, much less that he and his party had been leading Government for the past decade or, indeed, that he joined with the Taoiseach in cutting supports like the pandemic unemployment payment, PUP, that people rely on.

The vulnerabilities that we now face are down to the Taoiseach and his partner in government, Deputy Varadkar. In 2009, we had 289 intensive care beds. More than a decade on, we have 280. We have fewer intensive care beds now than we had more than a decade ago. This represents a decade of failure from Fianna Fáil and Fine Gael. It is on them. Last night, as the Cabinet had come to its decision, there were only 39 adult intensive care beds available. That is the situation we face and it is a troubling one. Along with testing and tracing, capacity in our hospitals is perhaps the most important measure to protect us from going into very severe lockdowns. It is how we ensure that non-Covid care is not suspended again with the terrible impacts that has. It is how we will keep our schools, economy and society open during this pandemic. When we spoke yesterday, I asked the Taoiseach to provide assurances that we were winter ready, in other words, that we have the necessary supplies of personal protective equipment, PPE, testing kits, reagent, laboratory spaces and ventilators to deal with the second surge. He could not give me that assurance. I find that very worrying given the rate of infection in the community, the resurgence of the virus in nursing homes and the increase in people over the age of 65 contracting this virus.

It seems that the Government does not have its eye on the ball and does not have a grasp on what is needed to ensure people can live safely alongside the virus. This came across strongly in what the Tánaiste had to say last night. He expressed his concern about mental health, isolation and poverty. If the Government is really concerned about these things then take action next week in the budget.

Is the Taoiseach concerned at the lack of capacity in intensive care? Does he accept that we now need to urgently increase ICU capacity as we enter winter in this pandemic?

Unity of purpose on all fronts is essential in dealing with a pandemic of this scale and severity, including within this House. The Deputy has consistently sought in recent times to undermine not just the efforts of the Government but those of the HSE in the context of acute hospital care, testing capacity and so forth.

The Deputy has now misrepresented the telephone conversation she had with me yesterday when she said I could not give her assurances. That is not true and she has no right to misrepresent a phone call of that importance. I took her in good faith. The Deputy made clear to me that it would be catastrophic to move to level 5. She could not understand how we could move from level 2 to level 5 and I agreed with her on that.

I take seriously the advice from NPHET about the exponential growth of case numbers. The situation out there is serious in terms of the growth of cases. That is why we have moved to level 3 in accordance with the Government's graduated plan, which involved discussions with NPHET prior to its formulation and publication. I believe we have an obligation to the public and to industry, business and jobs. There is an expectation they should have a sense of knowing when we could move from level 2 to level 3, level 3 to level 4 and level 4 to level 5.

Given that the advice we received on Thursday was to basically stay at level 2 outside of counties Dublin and Donegal, to then move on Sunday to level 5 would have been an enormous shock to people and jobs. The Government must take wider issues into consideration. To be fair to NPHET and the Chief Medical Officer, CMO, they have to advise on public health grounds. We take that advice seriously and I have great respect for the CMO and NPHET. I have known the CMO for a long time and served with him during my time as Minister for Health. At that stage, he was deputy CMO and worked with me on the SARS-CoV-2 situation.

What must also be acknowledged, and I believe the CMO does, is simply that the impact of moving to level 5 would have been severe on the lives of many people. I spoke to him before the Cabinet decision because it is not something I recommended to the Cabinet or that the Cabinet decided upon lightly as one wants a common approach to this. We know from our analysis of the pandemic to date that lockdowns affect lower paid people, those in lower income groups and the marginalised more. When schools close, disadvantaged students lose out. Notwithstanding that we have provided for the continuation of education at level 5, there is no guarantee that would happen. One must foresee all eventualities. Disadvantaged children suffered most during the lockdown when schools were closed and, likewise, in terms of income streams, impact on employment, workers and young people. Young people do not have savings to fall back on and will suffer enormously in a level 5 scenario. These are serious and profound decisions with profound impacts on society and the economy.

The Deputy said the country was not ready because of cuts to services. That is not the case. It is the enormity of what a lockdown does. We are already looking at a budget next week when we will have a substantial deficit of well over €20 billion. We are projecting similar figures for the entirety of 2021. The intervention to support people has been unprecedented. At one stage, more than 1 million people were on the Government payroll during the lockdown. We are looking at hundreds of thousands of people being made unemployed once we get to level 5, so it is not unreasonable for Government to take stock before deciding to go to that level in one fell swoop knowing the implications it would have on economic sustainability in the longer term.

Already pandemic unemployment payments have cost about €3.6 billion which is fine. It is vital and just. It will move to €5.2 billion. Yesterday we decided at this stage not to move to level 5, but it is in all our hands collectively to avoid having to go to level 4 and level 5. The only way we can do that is by ensuring we contain the virus by our individual behaviours and our collective behaviour.

The Government cut the pandemic unemployment payment and the wage subsidy. That is the reality. For all of those in low paid work to whom the Taoiseach referred, and whom he correctly said are disproportionately affected by a very severe lockdown, let me tell him that the fact the Government cut these important supports looms large and is to the forefront of their thoughts when there is any talk of a complete lockdown, because those are the supports they rely on to pay their bills and to live.

The Taoiseach said the Government has to foresee all eventualities. I absolutely agree with him. More is the pity that back in 2009, when we had 289 intensive care beds and when we knew at that stage that that was grossly insufficient, he and others in government did not have the foresight to plan for proper capacity. The truth is this. We are now reaping the harvest of more than a decade of underinvestment in our public health system. The truth is that we do not have the necessary capacity to reassure the public and even to reassure NPHET that we can make it through the autumn and winter months. Does the Taoiseach accept that we need to increase intensive care capacity? What will he do now to make that happen?

First, Fianna Fáil was not in power for the last decade. The Deputy consistently says that even when we were at 20 seats. She equates 20 seats with being in power. That is just an aside. It is immaterial and irrelevant. She keeps on with the propaganda and, really, we do not need that now in the middle of a pandemic of this sort.

On intensive care unit, ICU, beds, there has been a 25% increase since March. There were 225 ICU beds in March; we now have 282 fully staffed beds, which is an extra 57 with a further 17 in the winter plan with the staff available for that. With the surge capacity that was achieved in the first phase it went to 370 ICU beds. The HSE says it has the capacity-----

That was with no other care in the system.

-----to deal with this. I do not know why the Deputy does not believe the leadership team in the HSE. She takes umbrage at other situations, but she seems to disagree consistently with the leadership team in the HSE which consistently says to me, because I make it my business to check if they have capacity to deal with the current situation, "Yes."

On testing, the supply at the moment is more than capable of meeting the demand. It is one of the few countries still in a position to meet demand and is exceeding demand right now. That includes all the serial testing. Significant progress has been made on testing over the last five or six months, but it never gets acknowledged by Deputy McDonald or by others. Of course, we can do better and can go further, but testing across the board has made a quantum leap forward in recent months.

An additional 810 general beds have been put into the system. By the time the winter plan, costing about €600 million, is implemented there will be a further 1,400 beds in total if the 800 beds are added to 590 beds that will be provided under the winter initiative. By any yardstick in such a short space of time that is significant progress. It gives us the capability and capacity not just to deal with the impact of Covid, but the non-Covid services as well, which was one of the factors in our decision yesterday. We did not want to shut down non-Covid services given the challenges they are currently facing.

I raise the issue of direct provision and quarantining in the Dundalk area. In the centre of Dundalk, the Carroll village apartment centre is currently used as a direct provision centre and has been since 2005. The number of asylum seekers it houses varies from around 50 to 80. It is known as an own-door-type accommodation and is self-contained accommodation. I understand that approximately half of the residents have been there for five years or more.

The building itself is on the old P.J. Carroll site at the northern end of the town and is very well known to locals. Last week, it was reported on local radio that 80 Covid tests were carried out on residents of the Carroll Village centre on 20 September and that those swabs were subsequently mislaid or lost. The Taoiseach can imagine that this has caused great concern locally and many questions are now being asked. I understand that subsequent tests have been carried out. We need to find out exactly how these tests could go missing. It is important we get answers and find out if this was an isolated, once-off case or if there were many more cases. We need clarification as to whether this was an isolated case.

The Carroll Village centre is situated on the main commercial street in Dundalk and people are asking if proper public health guidelines on self-isolation and quarantine are being adhered to should a resident test positive for Covid. On quarantine, a local hotel on the outskirts of Dundalk, not far from the Carroll Village centre, is being used as a quarantine centre. Again, my understanding is that those in direct provision who need to self-isolate or quarantine are being directed to this facility for a two-week isolation period. I believe the centre is housing people from all over the country for this purpose. As the Taoiseach can imagine, this is causing great concern for people locally. The local hotel in question has been used for this purpose since the beginning of September.

The Taoiseach can appreciate my many concerns about these centres. First, regarding the Carroll Village centre, can the Taoiseach confirm whether the original 80 test swabs were mislaid? Can he also confirm that replacement tests were carried out? Can he confirm that the proper public health guidelines are being observed should a resident test positive for Covid? On the quarantine centre, I have a very real concern about the means of transport those who need to use the centre are using. The facility is located approximately 2 km from Dundalk town centre and, as I said, it is accepting people from all over the country. Does the Department provide the necessary transport for those going to the facility or do the users avail of public transport, which would be a clear breach of public health guidelines? Furthermore, when a resident's period of self-isolation is completed, what methods of transport are being used to these facilities? These are real concerns that need to be urgently addressed. The people of Dundalk, like those of the rest of the country, have made tremendous sacrifice and effort to combat this virus. We need to ensure we all work together and follow the same guidelines so we can all get back to some form of normality.

I thank the Deputy for raising this important issue given the concerns locally. Protecting those living in direct provision accommodation centres from any Covid-19 outbreak has been an absolute priority of Government. A comprehensive programme of serial Covid-19 testing by the HSE has been completed across 66 accommodation centres. My understanding is about 3,300 tests have been undertaken in direct provision centres and about 18 positive tests have emerged from that testing programme. That is a positivity rate of 0.53% among residents and staff. I will endeavour to bring clarity to the points the Deputy raised in the context of local media highlighting these issues. The transfer of residents from Dublin to Dundalk has created some degree of confusion locally.

As the Deputy knows, there are two international protection accommodation services facilities in Dundalk, Carroll Village and the Carnbeg re-accommodation facility. Carroll Village independent living is a block of apartment-style independent living units housing mostly family groups. The Department of Justice and Equality has confirmed there has been no large-scale transfer of residents either in or out of this centre in recent months. Routine testing as part of the Covid-19 serial testing programme was completed recently at Carroll Village. As I said, this was one of the public health measures put in place by the HSE and the Department of Justice and Equality to safeguard residents and staff in direct provision centres since the beginning of this pandemic. The HSE's investigation into the specific incident the Deputy highlighted found there was an isolated logistics issue whereby swabs did not reach the laboratory within the required timeframe. As the swabs had expired, they had to be retaken in line with standard practice. The HSE has apologised for the inconvenience this caused to the residents concerned and it conducted on-site follow-up testing on Friday, 2 October to complete this serial testing and all results have now been communicated at this point.

The Carnbeg Hotel, which opened earlier this year, is used as emergency, temporary accommodation for people who willingly left their accommodation centre at the start of the pandemic and are now seeking to be re-accommodated by the International Protection Accommodation Service, IPAS.

To be clear, the Departments of Justice and Equality and Education have confirmed the Carnbeg Hotel was not affected by the retaking of tests in recent days. This facility is used for 14-day quarantine prior to re-accommodation in a dedicated accommodation centre. It has a regular turnover of temporary residents. These residents had been living in private accommodation located throughout the country prior to requesting re-accommodation from the Department. That is the situation as of now.

I thank the Taoiseach for his reply. As I have said already, the people of Dundalk and the rest of the country have put their shoulders to the wheel and it is very important that they get clarity. The one question the Taoiseach did not answer is with regard to transport and the people in Carroll Village and the Carnbeg Hotel. Will the Taoiseach guarantee that people who have tested positive are not walking the streets of Dundalk? How are they getting from Carroll Village to the Carnbeg Hotel? This is of major concern.

Last week, I raised in the Dáil the issue of moving the test centre from Dundalk to Ardee. In fairness, the HSE contacted me during the week and invited me to look at the facilities in Ardee. I have to say the facilities in Ardee are absolutely fantastic. I cannot complain. However, I am very concerned, and I ask the Taoiseach to answer my question please because I will be asked about this by the people in Dundalk. How are people travelling from Carroll Village? Earlier, the Taoiseach mentioned there were families involved. How are they getting to and from Carroll Village?

How are they getting from Carnbeg Hotel?

From Carroll Village and from the Carnbeg Hotel. Are they using public transport? If they are using public transport we have a serious problem. Will the Taoiseach please give clarity on how people are getting from A to B, whether from Carroll Village to the Carnbeg Hotel or from the Carnbeg Hotel to Carroll Village? It is a serious concern.

I visited the Ardee centre and spoke to Martina Ralph of the HSE. I was giving out about the test centre being located in Ardee but what is most important is that it can do 720 tests a day. The issue is the location. There is nothing wrong with the facilities in Ardee, which are excellent. It is about getting people to go from Omeath, Carlingford and Dundalk to Ardee. The facilities in Ardee are excellent.

I thank the Deputy for his very positive comments on the facilities in Ardee. Carroll Village is a block of apartment-style independent living units housing mostly family groups. There has been no large-scale transfer of residents either in or out of the centre in recent months and they are entitled to travel, like anybody else, in whatever format or mode they so desire.

It is also very important to point out that in the national serial testing programme, we are looking at a 0.53% detection rate, which is quite low. There have been 18 positives out of 3,300 tests. This has been a feature of most serial testing programmes, including those in nursing homes and meat plants. This suggests, with regard to the origin and source of the virus, that by and large, transmission is in the community but it can spread very quickly when it comes into congregated settings. When we do a serial testing programme at any point in time there may be a very low level of the virus in that congregated setting. This is why the serial testing programme is regular and consistent to try to keep an eye on these congregated settings.

With regard to the Carnbeg Hotel, which is emergency temporary accommodation, people come to it using a variety of transport modes. I do not have the specifics on this but I can check.

I want to concentrate on the many who suffer from massive pain in this country, whether it be from hip or knee, or the pain and worry of losing eyesight and being in need of a cataract operation. The cataract operation is a 20-minute procedure for which many people in Cork and Kerry have been waiting for five years. For many of these, the cross-border directive has been a game changer in their lives and it has got them out of excruciating pain or has given them back their eyesight when they knew they were being left to go blind. Deputy Danny Healy-Rae and I have organised taking 2,000 people from all over counties Cork and Kerry to Belfast in the past two years. Some of them were far into their 90s. They had no choice except to go blind at home or go to Kingsbridge Private Hospital, Belfast to save their sight. I truly welcome the recent announcement of the building of a new cataract theatre in Cork.

I hope in the coming years this happens and that it is not like the endoscopy unit, announced by the then Minister for Health, Deputy Harris, surrounded by a huge fanfare in Bantry hospital two years ago which, as of yet two years on, has not had a sod turned or a brick laid. The people who are losing their eyesight rapidly cannot wait two years for a clinic to open in Cork. Some cannot even wait two months.

In the next week and a half, I have men and women from Skibbereen, Durrus, Bandon, Baltimore, Ballineen, Carrigaline, Ballinlough, Ballyvolane, Dublin Hill, Kinsale, Goleen, Midleton, Kealkill, Tipperary, Clonakilty-----

It is not a laughing matter.

It is not a laughing matter. They are going blind on the Taoiseach's watch. That is the second time that he has laughed. People are not happy about that.

There are people from Dublin Hill, Cork, Kanturk, Macroom and all over parts of Kerry frantically heading to Belfast. One of these is a 36 year old woman, Maeve, from the Taoiseach's constituency. She has allowed me to use her name. She was rapidly going blind and attended the Taoiseach's constituency office, desperately hoping that he could get a cataract operation done in Cork for her. Like many more of us, the Taoiseach's constituency office failed to get this 20-minute procedure done in Cork or anywhere else in the Republic for her. The Taoiseach's office advised her to travel on our buses to Belfast. She did so four weeks ago. She had her eye surgery and is now due the second operation in the next week and a half. What the surgery has done for that woman is truly unreal and has transformed her life.

I am quite happy to help the Taoiseach's constituents, as I know he is a busy man. For me to do this, however, and for those who are in pain to find relief or save their sight, we will need a cross-border directive to continue after 31 December, deal or no-deal Brexit. I asked the Taoiseach three weeks ago would the cross-border directive continue for those who are desperately awaiting surgery in the South and he skirted over the answer. In the Dáil I questioned the Minister of Foreign Affairs, Deputy Coveney, about the cross-border directive continuing. He gave encouraging signs and said legislation is being put in place which may help in this matter.

On behalf of the thousands who are in pain or are in massive fear of losing their sight, many of whom are from the Taoiseach's constituency, who need a shining light in the dark and want a "Yes" or "No" answer, is the cross-border directive going to continue?

I thank the Deputy for his remarks. I also thank him for the seat on the bus for any constituent of mine. My emphasis, however, is to avoid people having to go on long journeys to get cataract operations. We should be increasing capacity locally. That is what I modestly announced last week. There was no fanfare. I simply said there would be a significant investment going into the South Infirmary-Victoria hospital, the largest centre in Munster for dealing with eye, ear and throat issues. In particular, it will develop capacity locally with a dedicated cataract surgery theatre in the South Infirmary-Victoria hospital. It will have a refitted designed area with two side-by-side ophthalmology operating theatres which will go to tender shortly and which will have a capacity of 2,000 cataract surgeries annually. One theatre will deal with the most complex ophthalmic cases while the second will serve as a dedicated cataract theatre.

The cost of all of what the Deputy has been at - I have no difficulty with it. It has been a gamechanger too for the Deputy electorally in terms of number of people on buses-----

That is not fair to say.

That is a snide old comment. That is beneath you, Taoiseach.

Come on. The lads need to relax a bit.


That is a reflection on the people who need to use this bus.

I was reliably informed that Deputy Michael Healy-Rae approached people outside a mass saying he could get them on the bus if they wanted a cataract operation.

And God bless him, if he did.

The woman concerned-----

You should take that back. You are a disgrace. You are only in the bottom of the barrel now coming out with that kind of a statement. Cop on a small bit, Taoiseach.

The Taoiseach should look after his constituents.

That is beneath you. For the Taoiseach of the country to make a statement like that-----

You do not tell me to sit down. The man who will tell me sit down is the Ceann Comhairle and not you.

I am not telling you to sit down-----

Can we all-----

God damn it, that is an awful thing to say.

That is the truth.

Smiling and laughing as if it is some sort of a joke. If somebody belonging to you was going blind, you would not like it.

Calm down, Deputy.

You are a disgrace.

The cross-border health directive is an EU directive. I explained that to the Deputy the last day. Britain is leaving the European Union. Deputy Michael Collins knows that. I have told him. What happens is the EU directive does not apply to the UK anymore and it is no longer obliged and we then have to develop a bilateral agreement with the United Kingdom, a similar scheme which we would have separately with the UK as we have had with the European Union. That is currently being considered and discussed with the UK authorities.

On top of that, as part of the common travel area, we have had a long-standing relationship with British health care services.

They have had the same with us in terms of their citizens availing of Irish healthcare services when they are living here and vice versa. As part of preparations for Brexit, we are devising and working up a memorandum of understanding, which will be legislated for to guarantee the type of ongoing provision of services to Irish citizens in Britain and British citizens in Ireland that were always part and parcel and to continue with a similar arrangement as applied under the cross-border directive.

I thank the Taoiseach. His time is up.

I apologise to Deputy Michael Healy-Rae if there was any offence. I meant it in good faith.

The Taoiseach is a downright disgrace.

It was said to me, by the way, by a clinician. The Deputy may not have realised who was who but that is fine. That is evidence of the degree of energy he applies to the scheme, making sure to inform people who do not know that they can avail of the trip to Belfast.

It is our job to take care of people.


If the Taoiseach was half as worried about people, he might be a lot better off.

The Taoiseach does nothing for them. He would let them go blind.

In any event, the most effective way of dealing with this is to build capacity locally and in the region in order that we do not spend excessive amounts on people having to travel outside of the jurisdiction.

I thank the Taoiseach, even though some of his reply was a mockery to the people who are struggling with pains and are going blind. The Taoiseach must be well aware of the benefit of the cross-border scheme, as it was on the Fianna Fáil pre-election video, showing what a great benefit it was and how Fianna Fáil got operations for its constituents. Maybe the Taoiseach was outside the church at mass advising them and, if he was, he should be proud to think he looked after his constituents and did the like of it and not be one bit ashamed to say he did it, wherever he stood to help them. I spoke to the Taoiseach about the constituent who went to his constituency office and was advised to go to me to look after her. I saved her eyesight and the Taoiseach failed to do so.

Surely, just a few months into his leadership, the Taoiseach is not intending to get rid of the scheme which helped thousands who were on the waiting lists for procedures. They used this cross-Border scheme and not the National Treatment Purchase Fund, NTPF, or any other scheme. I am delighted if there is anything that will increase the capacity of surgeries in the south of Ireland. I am all for it and, of course, that is where this should be happening but that may not happen for a year or two. Until it does, will the cross-border scheme, which gives people the opportunity to get surgery in Kingsbridge Private Hospital or any other private hospital in Belfast, continue in order that people have somewhere to go rather than go blind on the Taoiseach's watch?

Does the Deputy understand that Brexit is happening?

It is happening on 1 January. Does he understand that EU directives will not apply to Britain from then on? Does he understand that? What does that mean?

It means that other directives and legislation should be put in place already.

Through the Chair-----

The Taoiseach asked me a question and I gave an answer.

-----it means that as the European Union directive will no longer apply to Britain, we have to do a separate agreement with Britain in relation to that.

The Deputy has not paid for any one of these cataract operations. The taxpayer pays for them. Let us all be clear about that. Anybody in this country is entitled to utilise the directive in any EU member state right now. Some Deputies can assist people to get on buses and hire buses and so on but it is the taxpayer who pays for it.

Who said anything else?

I am not saying it is not. We have failed the people.

The State is ensuring that people do not go blind through------

We have failed them. There are 90-year-olds having to go to Northern Ireland.

The NTPF paid €10 million for ophthalmology procedures in 2018. The Government and the State are not resiling from underpinning this financially. The NTPF is paying about €1,450 per cataract operation. That is outsourced to private hospitals here or in the North. Since I became Taoiseach, I have been anxious that we build up capacity in our own centres in order that people in west Cork, Cork city, Kerry, Limerick or anywhere do not have to go to Belfast or outside the jurisdiction to get cataract surgery done. That is my objective. It is more cost effective and better for the patient to have that approach and system. That is all I am saying. I commend the Deputy on the work he is doing but the taxpayer is paying for it.

Are you going to let them go blind in the meantime?

It is not happening.

NPHET met last Thursday and decided that, while concerned with the trends and the increase in infections, it did not see a reason to move to level 3 nationally. Three days later, it recommended a move to level 5 nationally, in effect reinstating the lockdown from the spring and early summer. NPHET has pointed to an increase in the 14-day incidence rate in over-65s and 31 outbreaks in nursing homes, seven of which were reported in the last week.

There are 25 open outbreaks among vulnerable groups, with ten in direct provision centres, seven in homeless settings and another seven in Traveller communities. NPHET also made a point about increasing admissions to hospital and ICU beds, with 243 of 281 critical care beds now occupied.

Why are we in this situation? The Taoiseach and the Government had months over the summer to prepare for the inevitable second wave. Why are there still only 38 high-dependency beds in the public system? We all knew the perilous state our public health system was in when this pandemic struck in February and March. We were overly reliant on acute hospitals, emergency departments, EDs, with a bed-occupancy rate of 95% and a severe shortage of ICU beds. Germany, for example, has 37 ICU beds per 100,000 of its population whereas we have 6.5 ICU beds per 100,000.

It was only last week that we had a discussion in this Chamber about the proposed HSE winter plan. Serious questions have been raised by organisations representing nurses, doctors and consultants about our ability to deliver on the plan, particularly the increase in qualified staff that would be necessary to deliver on it.

I must also raise the issue of track and trace. I note that in the winter plan it is only by November that the necessary levels of staff dedicated to providing track and trace will be reached, allowing HSE personnel currently operating in the system to return to their normal duties. Can we continue to meet the level of 100,000 tests and traces per week?

Having flattened the curve due to the lockdown in the early part of the year, there was an opportunity to prepare that was not taken. We can contrast that with how quickly the Government moved to end the bans on evictions and rent increases and cut the pandemic unemployment payment, PUP, and temporary wage subsidy scheme. The move to level 3 nationally will put thousands of jobs at risk, particularly in the hospitality sector. The Restaurants Association of Ireland is warning that 180,000 jobs are at risk. It is entirely possible that the Government will be forced into a turn in the next couple of weeks and will move to level 5. Such a move would have catastrophic effects on jobs and livelihoods, as the Taoiseach has said. He has also made the point that those on the lowest pay are most affected by the restrictions under level 3 and would be most affected by the restrictions at level 5. Will the Taoiseach make a statement that in next week's budget, the Government will restore the PUP and the wage subsidy scheme to their previous levels? Will he introduce a ban on evictions and rent increases?

The Deputy is correct to say that we received advice on Thursday and Sunday. A lot has been done in public service and about capacity in acute services since the first lockdown in March. What is increasingly happening is that non-Covid-19 issues are being dealt with. That is why quite a substantial number of ICU beds are being used - they are predominantly being used for non-Covid purposes. That is the reality. With the winter initiative included, we are looking at a 30% increase in ICU capacity. ICU is not just about the provision of a bed, it obviously also comes with a large complement of staff.

There will also be substantial increases in the numbers of general hospital beds. Including the measures in the winter initiative, an additional 1,400 beds will have been created in our general hospital system. I think it has been overstated that the system is run down, although it has challenges. The health system managed the first phase of the pandemic well within its capacity. The HSE is clear that it has the capacity to deal with the current situation. It will obviously have to watch the growth in positive cases, hospital admissions and admissions to ICU. There are many hospitals around the country that have no Covid patients in their ICUs at the moment. That is true of many hospitals around the country and must be factored in. Quite a lot of counties will be aggrieved that they are at level 3 because people there will feel they ought to have stayed at level 2, given their numbers. We decided to take on board the advice from NPHET that there was a growth trajectory that needed to be arrested. People in counties such as Tipperary, Waterford, Mayo and Kerry will be looking at their numbers of infection and wondering why are they going to level 3. I understand that. It is a severe hit for the hospitality sector in those counties and parts of others.

Moving to level 3 has very significant implications and impacts for the hospitality, tourism, arts and culture sectors in the counties that up to now were not at level 3 - those outside Dublin and Donegal. Could one imagine what it would be like if we had moved to level 5 by midnight tonight in terms of the economic impact, the impact on jobs and so on? We have to take the broader picture into consideration. I will not pre-empt the budget but in the budget we will look to see if we can do something more specific for people in certain categories of work or sectors. The pandemic unemployment payment was originally designed as a 12-week scheme and was rushed into this House, and everybody agreed with it in the context of it being a temporary scheme. It is now being extended to April, along with the wage subsidy scheme. By April, €5.2 billion will have been spent on the pandemic unemployment payment. That is an enormous sum of money for just one social welfare payment. Social welfare spending overall will go well beyond €30 billion by next April. We have to consider the financial and economic impacts well beyond April 2021 and we are now factoring in what the situation will be to the end of 2021 in terms of the economic and fiscal impacts of Covid-19.

Many people in Dublin and Donegal have lost their jobs over the past few weeks. They are in receipt of €203 per week because of public health advice and for public health reasons. This did not happen of their own volition; they did not lose their jobs in normal circumstances. Rather, they were forced out of their workplaces.

We are facing into the winter. People have to pay rents of €1,800 and mortgages. Electricity and fuel bills go up during the winter. Families are trying to feed their children while living on €203 or €250 a week, but they earned more when employed. I ask the Taoiseach to reinstate the previous levels of the pandemic unemployment payment and the employment subsidy scheme and reintroduce legislation to protect people from evictions and rent increases. If we do not do that, as the Taoiseach said, a cohort of low-paid workers will be left in a very vulnerable situation. We need to address that and reinforce that we are all in this together rather than hanging apart.

Those in receipt of the pandemic unemployment payment will be in a better position, relatively speaking. Obviously losing a job puts people in a very difficult position. We did not want to increase the number of people losing their jobs this week. That is one of the factors that fed into the Government's decision yesterday not to move to level 5. Quite a number of businesses may not be closed on a temporary basis, but may close long-term resulting in longer-term sustained unemployment.

Prior to the pandemic, there were roughly 213,000 people in receipt of jobseeker's allowance of €203 per week. Many people employed before the pandemic never got the pandemic unemployment payment. We have to be fair to those people, as well as those in receipt of carer's allowance and other social protection payments who are in receipt of basic social protection payments.

It will not be possible to raise everybody's payment to €350 per week. There are limits to what the Oireachtas and the State will be in a position to do.

People have to be able to live, not just survive.

That is why we have to try to manage the situation in the most fair and sustainable way we possibly can. The implications of the pandemic for people will now go beyond April 2021. Therefore, we also have to spend money on creating jobs and work for people in areas such as construction and other projects, such as retrofitting, where we can create meaningful opportunities for young people in particular.

On a point of order, the Ceann Comhairle could consider reminding Members of the public health advice in respect of wearing masks and that the main purpose of wearing a mask is to protect other people. I think some people need to be reminded of that.

Thank you very much. We will conclude Leaders' Questions on that and move to the Order of Business.