Covid-19 (Health): Statements

We now have statements and questions and answers on Covid-19. The Minister for Health has 15 minutes.

I will share time with the Ministers of State, Deputies Butler, Feighan and Rabbitte. I thank the Ceann Comhairle for the opportunity to update the House on the national response to the ongoing Covid-19 pandemic. Deputies will all be aware of the significant decisions taken by Government in the past few weeks regarding the new measures put in place to combat Covid-19. I would like to share with the House why these decisions were made.

The epidemiological situation has deteriorated substantially in recent weeks. The level of infection has increased rapidly and our 14-day incident rate is now 1,410 cases per 100,000 population. In addition, the R-nought number was estimated last week to be between 2.4 and 3 for the entire country. The incidence rates are high across all age groups, especially young adults, and across every part of the country. Incidence rates in those aged 65 and older remain high and are a cause for concern. The numbers in hospital and in critical care are increasing and putting enormous strain on our hospital system. Our thoughts and prayers are very much with those in critical care right now and with their families and friends. We know that most people who get the virus will have mild symptoms that resolve themselves but we also know we can expect to see a proportion of people infected with the virus who require hospitalisation. We know a smaller percentage of them will require intensive care and there is a percentage as well, tragically, who will die. I extend my heartfelt sympathies to the families and friends of those who have lost their lives so far to this awful disease.

The prevalence of a new Covid-19 variant is also a considerable concern. The highly transmissible variant first identified in the United Kingdom highlights the importance of strict adherence to public health guidance. It is now more important than ever for everyone to stay at home and avoid social contacts and for us to double down on our efforts to suppress this virus. In tandem with our efforts to limit person-to-person transmission, we must continue to identify the disease in our community. Testing and contact tracing continue to be essential in how we fight this virus.

While what is going on right now is really difficult for people, there is hope. In recent weeks, two vaccines have received regulatory approval from the European Medicines Agency, EMA, and a third will be decided on before the end of the month. Ireland's Covid-19 vaccination programme is now well and truly under way. As Deputies will be aware, the programme has been further accelerated to deliver the first dose of vaccinations to all nursing home residents and staff by Sunday week, that is, 24 January, and to all residents over 65 years of age in residential disability and residential mental health settings and approximately 70,000 front-line healthcare workers both in hospitals and in the community.

Colleagues in the House and people all over Ireland are understandably asking which priority groups will be vaccinated and by when. People want to know when they, their loved ones and those most vulnerable will be vaccinated. To date, only two of several possible vaccines have been authorised and neither Ireland nor any other EU member state has accurate delivery schedules for any vaccines except the two that are authorised, namely, those produced by Pfizer and Moderna. As a result of this, it is not possible for Ireland or other member states to accurately predict vaccination deliveries and, therefore, vaccination levels past approximately the end of February. Nonetheless, I will provide the House with at least some provisional numbers. We are planning on receiving enough vaccines to be able to inoculate 700,000 people by the end of March. Critically, this will vaccinate the top three groups on the prioritisation list, that is, those in long-term residential care - namely, staff and residents - front-line healthcare workers and people over 70 years of age. We are further planning to be able to vaccinate more than 1.5 million people in quarter 2 and more than that again in quarter 3. At these levels, people most at risk of Covid-19 will be fully vaccinated by the summer. I stress that I am providing this information to colleagues in an effort to give some sense of where we are moving to and at what speed, but these numbers are highly provisional. They include estimates for delivery schedules for vaccines that are still be approved. I hope colleagues will treat the numbers and the forecasts in that context.

Work is ongoing to ensure that people have easy access to vaccination details, including the numbers who have been vaccinated. I know there is much interest in this. Updated figures, which I am delighted to be able to share, will be available on the Covid-19 data hub from this weekend and regular updates will, of course, follow. Work is also under way to add vaccine numbers administered to the Covid-19 tracker app as soon as possible.

I will finish by making two points. The first is that I want to thank once more everyone working across Ireland’s health care system for continuing to step up at our country's time of crisis from those in our hospitals to community health teams to those working in GP practices, pharmacies, voluntary organisations, nursing homes and everybody in between. Second, I reiterate just how serious the situation is right now. The UK variant, which is far more contagious than anything we have dealt with so far, now accounts for in excess of half of all new cases. The way we support our healthcare workers and keep each other safe right now is to follow the public health guidelines and to stay at home.

Covid-19 has posed significant challenges including isolation, bereavement, anxiety and loss of income and work for many. As a nation, we continue to rise to this huge challenge but some of us will need additional support as we face this difficult time. Since the pandemic started, mental health services have responded rapidly, continuing to deliver supports for people in the safest possible way. Some services have been reconfigured while others, like telehealth, have been significantly enhanced with our NGO partners. This has ensured the delivery of the best possible service to some of our most vulnerable citizens in sometimes extremely difficult circumstances. I thank all mental health staff and commend them on their hard work and dedication.

A continuity plan has been finalised for the current outbreak. Experience from the initial outbreak and associated restrictions have ensured enhanced preparedness. Throughout the pandemic, specialist mental health services have operated at 85% to 90% of pre-Covid levels and this level of capacity is expected to continue throughout this current surge. Residential facilities continue to operate as usual with some adaptations and restrictions. Day services will prioritise high-risk individuals with service user and staff safety of paramount importance. Telehealth services are fully established including yourmentalhealth.ie, the information line 1800-111-888, the crisis text line 50808 and NGO online supports.

Use of these services has increased significantly during Covid-19. Mental health services and supports are available at all levels to children, young people and adults who need them. Recent trends in nursing homes are concerning, with provisional data including 62 new outbreaks in the last week and active outbreaks are three times the number that existed in mid-December.

Some positive news is the approval at European level of vaccines and the start of the roll-out here. The vaccination programme has accelerated to deliver the first dose of vaccinations to all staff and residents of long-term residential care facilities, including nursing homes, mental health and disability residential centres, by 24 January. Vaccinating our older and vulnerable population and those who care for them is our priority.

The HSE continues to provide personal protective equipment, PPE, and other necessary supports to help prevent and control outbreaks of Covid-19. I ask residents and families for their understanding at this difficult time, to work with nursing homes on visiting arrangements and to please support the dedicated staff to ensure a safe and effective roll-out of the vaccine, as it offers hope for better days in the near future.

I welcome this opportunity to update the House on the vital public health policy areas falling within my remit. While physical and mental well-being have always been important, the Covid-19 pandemic has put public health and well-being centre stage in both Government policymaking and in citizens’ lives.

Empowering people and communities to keep well and shifting focus further towards prevention are key elements of Sláintecare, delivered through Healthy Ireland, our national action plan to help people live healthier and longer lives. Healthy Ireland is being implemented through a suite of action plans and policies, which aim to reduce obesity, increase activity levels, improve health and awareness and help more people to reduce excessive alcohol consumption, illegal drug use and to quit smoking. Since 2018, a core component of Healthy Ireland has been our national communications and citizen engagement campaign, which raises public awareness of supports under three key themes, namely, healthy eating, physical activity and mental well-being. This campaign has been repurposed since the arrival of the pandemic.

In the spring, we supported health and well-being through the In This Together campaign. Last November, recognising that this winter may be one of the most challenging faced in living memory, the campaign was adapted to focus on building resilience, with the theme of keeping well. More details and specific supports are available on gov.ie/healthyireland. Some €7 million in funding has been provided to support a range of initiatives and services under the five main themes. These are: keeping active; staying connected; switching off and being creative; eating well; and minding your mood.

Covid-19 poses a major threat for people with drug and alcohol addiction. In response, drug and alcohol services have adapted new ways of working to continue to support people affected by substance misuse during the pandemic. HSE addiction services have put in place procedures to ensure the delivery of opioid substitution treatment for almost 11,000 service users, including addressing the risk of overdose during Covid-19 by providing increased availability of naloxone.

I could go on and I have a lot more to say but I just want to send my condolences to the families and friends of all those who have passed away and to thank all those who are working to try to reduce this awful problem during this pandemic.

As my colleagues have pointed out, this new wave of the virus has not spared any sector of society and unfortunately, that is also true for people with disabilities as well. I have been granted three minutes, which is only time to give the House a high-level overview of the significant work that is ongoing.

Last week, in light of the increased levels of Covid-19 transmission rates in the community, the HSE issued revised guidance measures for the disability services. The revised guidance reflects the Government's intention that disability services will remain open at each level of the resilience and recovery framework, subject to evolving public health guidance. I am keenly aware of the need for these services to remain open as they are a crucial support for service users and their families. It is also important to acknowledge the great work of the service providers in striking the balance between protecting service users and staff. Service providers have been asked not to take unilateral action on the provision of services and to ensure that robust communication plans are put in place. This ensures that each service user and his or her family has a clear understanding of how services may be impacted during the current restrictions. Residential home support and personal assistant services continue to be prioritised and delivered, subject to a revised risk assessment, public health guidance and direction.

On respite services, I can confirm that those with complex medical and clinical needs are to remain at home, while every effort will be made to provide home support where possible, subject to risk assessments and prioritisation. Therapy services for children with disabilities will continue to be provided, either remotely or face to face, as appropriate. The provision of assessment of needs continues to be a priority and each community healthcare organisation will continue to evaluate its plans on an ongoing basis. Since the start of this pandemic, a level of service continues to be provided for adults and paediatric referrals to each speech and language, occupational therapy, physiotherapy and other therapy service for those referrals that were considered to be a priority.

Extra funding has been provided to build capacity in the adult day services and to extra staff. This will ensure that the maximum service will continue to be provided at a scale that can be provided safely to those most in need. Day services continue to be prioritised and delivered, subject to a risk assessment, public health guidance and direction. Those with complex medical and clinical related needs are to remain at home. Providers have been in contact with the families and one of the recurring themes that I would like to bring up is that I have been working closely with the Minister, Deputy Stephen Donnelly, in respect of the vaccination. We have talked at a high level with the HSE and Dr. Kelleher on this and it is being continuously reviewed.

I want to start by wishing the Ceann Comhairle and all of my colleagues a happy new year. Hopefully we will get through this year as best we can.

We are facing into the worst phase of the pandemic on this island. As of this morning, in this jurisdiction, there were 1,750 people in hospital with this deadly virus and more than 170 in intensive care. The HSE forecasted that the best-case scenario for the end of this week was that we would have 1,500 hospitalisations. We have exceeded that. The most pessimistic scenario was for 3,000 hospitalisations and we are edging closer to that. The most optimistic projection for ICU capacity was that we would have 220 patients in ICU and the most pessimistic projection was that we would have 450 patients in ICU, putting real and serious pressure on our front-line healthcare services.

The numbers are not good, as the Minister acknowledged. We have the fastest growing rate of the virus of anywhere in Europe, if not in the world. The Minister might remember, that in December we had a debate in this Chamber before the Government eased the restrictions. I told the Taoiseach at that time, as did others, that we needed to break the cycle of lockdowns. We also said that we could find ourselves in a tough situation if the right decisions were not made. We said that the Government should not put the cart before the horse and that a decision should not be made before the public health advice was given. On the Monday of that week, announcements were made by the Taoiseach and the Tánaiste that we would be moving out of lockdown. On the Tuesday, we stood in Leinster House debating that decision. On the Wednesday, the Committee on Health was to engage with NPHET and that was cancelled, I suspect, at the behest of the Government. That move limited our access to information on the spread of the virus. It also limited our ability to interrogate the Government’s decision and the advice from NPHET. The Government said that it based the decision on its own data that it commissioned on opening up hospitality and retail. We were never given that opportunity.

I sincerely hope, therefore, that the Government and its members have learned from the experience of the last few weeks. It is never good to push back, undermine or move ahead of the public health advice. The consequences are real, including rising hospitalisations, an increasing number of healthcare staff out sick with Covid-19 and a real crisis in our acute hospitals. It is not that this was not forecast. The extreme situation in which we find ourselves may not have been predicted but a serious surge in cases was. We always knew this virus could get away from us if we did not get the basics and fundamentals right.

Let us be clear. We have to be factual about what has happened in recent months. The Minister and the Government never got testing and tracing right. It was never used effectively to hunt down the virus. We never got testing and checks at airports right and there is still no enforcement of mandatory quarantine. We never got the all-island aspects right. While sometimes the Minister and the Government want to shift the blame to Sinn Féin on this, we have always been absolutely supportive of any and every measure that can be used to ensure that we have appropriate all-island responses. Responsibility for dealing with this matter falls on the Executive in the North and the Government in the South, and we have never got that right either.

I have also stated previously that we wasted the summer months. We did not put into ICUs the capacity that should have been put in place. We did not build up the necessary capacity in the area of healthcare. I published a plan in the summer months and called for the provision of additional capacity - 100 extra ICU beds - to enable us to be better equipped in January to deal with whatever crisis arose. That did not happen. The healthcare unions and I called for modular rapid-build units to be put in place to increase hospital capacity. That did not happen. In terms of beds and staffing, what we are getting is promise after promise but it is not materialising into anything real for people on the front line.

In recent days I have engaged with the Irish Medical Organisation and the Irish Hospital Consultants Association. Tomorrow I will be meeting representatives from the Irish Nurses and Midwives Organisation tomorrow and the SIPTU health division. They all say the same thing, namely, that front-line healthcare staff are not getting close to exhaustion, they are already exhausted. These people are at breaking point and they are sick and tired of hearing promises from the Minister and the Government. We still have not had any movement in respect of the pay for public health specialists. There has been no movement to deal with the two-tier pay issue relating to hospital consultants. There was a slap in the face for student nurses and midwives who were offered a paltry €100 a week. This fell far short of their expectations and, I believe, what was necessary. As they say to me, they do not have the capacity in the hospitals that they should have to ensure that they can provide a safe service. They know they are facing into a very difficult period because they have to deal with this current surge. There is considerable fear among hospital staff regarding what might be coming at them over the next week as they see the numbers increasing. They also know that significant levels of catch-up care will have to be offered, probably during the summer months.

There will be no let up whatsoever for the front-line staff to whom I refer. Praise is not enough. A clap on the back is not enough. We have to support them in every way we can. I have given the Minister any number of examples of instances where he and the Government failed these people. I appeal to him to meet with the Irish Medical Organisation, the Irish Nurses and Midwives Organisation and the Irish Hospital Consultants Association and listen to what they are saying and to their descriptions of what the position is really like in any of the acute hospitals across this State. The people they represent are at breaking point and they do not believe that the Government has done enough to support them.

We all welcome the fact that the vaccine is beginning to be rolled out. Like other Deputies, I informed the Minister prior to Christmas that I want to get behind a programme or plan that works but that this must be resourced and there has to be maximum transparency. I welcome some of the information that has been provided here. However, a number of us were briefed recently on the vaccine and I have say the information on mass vaccination centres was sketchy. The information relating to staffing and to the number of vaccinators we will have when we get to rolling out he vaccine out into the community was sketchy. At that point, the engagement with GPs and pharmacies had not happened. It has happened since.

People want as much information as possible. They want to know that when we get to a point where it is vaccines in, it will also be vaccines out. The Minister stated that we will vaccinate 700,000 people by the end of March. We are still being told that there is no change in the context of the 40,950 vaccines arriving each week. Has the number changed? Has it increased? We will get to that in the question-and-answer session, but it is information that people want.

If there is not maximum transparency and we are not getting the information that we need, the vacuum that is left will be filled by misinformation. I do not want that. It is the Minister's responsibility to ensure that we get as much information as possible. In the context of the vaccine roll-out, there are many examples of where that simply has not happened. We need an all-hands-on-deck approach. Much more needs to be done.

I have raised the issue of University Hospital Limerick with the Minister on a number of occasions. I raised it in the previous Dáil at every opportunity. Unfortunately, there is an ongoing trolley crisis at the hospital, with 66 patients on trolleys there as we speak. In light of the alarming rise in Covid cases in my home city of Limerick, I am again really concerned about University Hospital Limerick. I am eager to hear from the Minister about the plans he and his Department have to manage the Covid and overcrowding issues at University Hospital Limerick. As the Minister will be aware, the 14-day incidence rate in Limerick has surpassed 2,000 per 100,000 of population, that is, one in every 50 people having Covid-19. Nearly 4,000 cases have been reported in Limerick since Christmas. These are startling numbers. Regrettably, some of these people contracted the virus and ended up in ICUs. Some of them will need access to ventilators.

I fear for the amazing staff of the University Hospital Limerick. As my colleague stated, they are exhausted. They tell me this every day I speak to them. They are already working under conditions of great strain. We already do not have enough beds for those who need them. In the first week of January, 254 patients were treated on trolleys - the highest number in the State - at the hospital. As already stated, there are 66 patients on trolleys in the hospital today. People being treated on trolleys is never acceptable but during a pandemic, it is dangerous. Overcrowding is exposing patients and staff to potential infections.

I have to ask the question that I asked in the previous Dáil. Is there a particular issue with the management of or what is going on in University Hospital Limerick because it consistently has the highest number of people on trolleys? We delivered the long-awaited 60-bed modular unit but it has not made an impact in the way we would have hoped. There is a plan to develop a 96-bed unit but that is only at the design stage. I ask the Minister to get his finger out and deliver that unit. I ask him to stop talking about this matter and to cut through whatever red tape is in the way. This unit needs to be built. It is not fair that people in Limerick will have to go through this hospital trolley crisis for years. The plan the Minister has in respect of the 96-bed unit will mean that the crisis will continue for a long number of years. I ask him to personally intervene in this matter. We are in the middle of a pandemic but our hospital in Limerick seems to be getting the worst of it.

We are in an unprecedented situation. I will raise a few issues with the Minister and his colleagues in the short time available.

I drove up from Tipperary today. We may have become neutralised to the message that people should stay at home. The figures for close contacts, etc., are going in a certain direction but there was quite an amount of traffic on the roads. We and the Government need to re-emphasise the message in this regard. I make a special plea to employers. We need to go back to them. There are many people who are being asked to go into work or who are being told they have to go into work who could work from home. I ask the Minister to re-emphasise this. Obviously, sick pay or the lack thereof, a matter in respect of which we have advocated, is a real issue.

We also must improve dramatically on communications. Forgetting about the personalities, I have said my bit as regards having one person in charge of the vaccination roll-out. I will not repeat it all here. Communications need to be tight. We cannot have multiple Ministers coming out on national radio and making statements that are diametrically opposed. It is not good enough. I do not know why the Minister is shaking his head. The Minister for Justice, Deputy McEntee, did it. Numerous others also did it. The information being provided has to be consistent. We are either going to have confidence in our vaccination roll-out and the figures the Minister is providing or we are not. If a member of the Government is going on national radio or television, can the Minister ensure that what that person says is consistent with what he is saying? There was information going out recently - I do not know whether it is accurate - to the effect that people who had Covid would no longer be a priority as regards vaccination. If that is a myth, the Minister should get someone to dismiss it.

The private hospitals deal is a disaster. It is not what we need. The Irish Nurses and Midwives Organisation has come out in support of what I had been saying for many years prior to the arrival of Covid, namely, that we need access to whatever we need access to.

This is a national emergency. The idea that there is a hospital not signing up to this is scandalous. I do not know why it took so long. I suppose there will be a look-back on this at some time.

There is an inconsistency in the approach of some hospitals with high-risk staff being told to come into hospital settings instead of working from home. Will the Minister talk to the Rotunda and some other hospitals where pregnant staff members have been asked to turn up for work? There is an inconsistency with regard to occupational health advice.

Will the Minister honour the commitment he made to hire 8,500 staff for our health service by the end of last year and 12,500 by the end of April this year? Will he give us the updated figures? We must be a long way on the road to that. Will the Minister tell us where we are at with this?

I will not stand here claiming the Minister can work miracles with the vaccine roll-out because he does not have the vaccine. We are part of the European agreement and I hope that European solidarity holds. If it does not hold, then that is a different matter.

I have a serious issue, however, whereby my local hospital in Nenagh has several wards with Covid patients but the nurses and doctors there have not been vaccinated. I know of other locations where people who are not on the front line dealing with Covid patients have been vaccinated. The nurses and doctors in Nenagh deal with Covid patients, in particular those coming out of University Hospital Limerick, but they are not vaccinated. They are as front-line worker as one can be. I am raising it not just because it is my local hospital but the one on which I have got the most representations. While I accept we have a limited amount of vaccine stock, can we prioritise the nurses and doctors who deal with Covid patients? Obviously, it has to be rolled out to pharmacists, GPs and those with disabilities. I understand the pressures. I am not going to say that it is possible for the Minister to do absolutely everything immediately. Surely, however, we can do that.

Several months ago, I spoke here about antigen testing. I did a number of antigen tests myself on my family over the Christmas period to ensure we were protected. Why are we not following the European Commission on this? We know the limitations of this testing. However, considering the situation with this pandemic, in certain settings there must be a role for antigen testing. Can we just deal with that for once? People agree with me on this. If we put antigen testing into certain locations, it will help combat the spread of the virus.

A higher grade of PPE is required for those working on the front line with Covid. With childcare provision, we need to be more innovative. If one looks at the staffing figures, some hospitals will fall over in the coming weeks, even days, if we do not deal with all staffing issues. Childcare is now an issue as we run out of staff.

Will the Government, collectively, at least set a date in the next week or so to make a decision on what will happen on 1 February? We cannot leave this up to the very end. There are too many decisions that must be made. This will fundamentally have an impact on the health service but it will have an indirect impact for schools and a range of other services. If we can make decisions on these early enough, hopefully it will help staffing for our health services and so forth. I cannot see how we will be opening substantially in early February. Accordingly, will the Government make the decision on this as quickly as possible?

This is an important debate at a difficult time in our fight against Covid, not just here in Ireland but right across the world. We heard today of the potential overrunning of the ICU system in the United Kingdom, a new variant to the virus from Brazil and challenges left, right and centre. The biggest challenge we have here, however, is to look after our older people and to meet the requirements of their needs. I welcome all the support given and progress in this regard.

Older people, particularly those over 70 and those in nursing homes, are extremely vulnerable. In the first wave, 61% of deaths were among nursing home residents. In the second wave, thankfully, it was reduced to 41%. Now there are worrying signs right across the country. The Minister of State, Deputy Butler, acknowledged this is a serious issue with a number of nursing homes getting new and significant incursions of Covid.

Families of those in nursing homes are extremely worried about it. Holding people accountable is important when all this is done. What is most important now for older people, particularly those in nursing homes, however, is a 24-7 vaccination programme, if at all possible. I know we are limited by the amount of vaccine we have. The demand and need is there, however. The families of those affected are concerned and their hearts would be broken if they were to lose their family members at this most difficult time. I know this because people are on to me about it, talking about their worries and concerns. We need passion and more commitment from the Government. We need the Government to see and hear these people. We need it to talk about them as real people as we know them. There is a need to make sure that the information and supports are there.

It came to my attention from a piece in The Irish Times that there was a question about a vaccination team which had to stop at lunch hour yesterday and that it could not continue to do the work as it did not have a programme in place. That is entirely unacceptable. The only impediment to appropriate and proper vaccination is that supply of vaccine. All engines should be on go and the 24-7 needs are always there. My local hospital, Our Lady of Lourdes Hospital, Drogheda, did its best with vaccinating many of its staff. It still must vaccinate many more, a point about which people are worried. Staff have written to me about this. One of their key points is childcare. Front-line workers, medical care workers, nurses and nursing assistants, cannot go to work if they do not have childcare for their children. It is absolutely essential to concentrate on this issue and put a 100% effort into making sure that all front-line workers have appropriate childcare where necessary.

The St. John of God care services in County Louth have a significant number of residents who were moved out of congregated settings. They are worried and want to know more about the plans for vaccination. I am getting representations from dentists, dental nurses and other workers in dental care. They are one of the most highly vulnerable groups in society. They are concerned because of the processes and procedures they have to carry out every day.

We must pull out all the stops and make sure people in our nursing homes are really looked after. I welcome the significant supports the Minister of State has introduced to support those families. I do not doubt her integrity or her commitment to it. However, we are facing an appalling situation, not just in Ireland but across the world. Those in nursing homes are the most vulnerable and the weakest. We need to do more. We need to pull out all the stops, put aside all the divisions and let everybody step forward as they are. We must fully support the healthcare and nursing home workers and staff. Now is the greatest hour of need for all of these people. Now is the time for action. I would support further and appropriate supports for older people.

I am having some difficulties, in so far as we have not been supplied by the Government side with a list of Government speakers. There are Members indicating all over the place. I have already seen Deputies MacSharry and Colm Burke indicate for the remainder of this slot.

To be helpful, I can email the Ceann Comhairle the list.

I understood I was to have four minutes. Is that the case?

There are only two minutes left. Is there anyone here who wants two minutes?

I was advised I had eight minutes.

It would be very useful if the people advising the Deputies advised us here so that we could include them in the list. Otherwise we-----

Are you cutting me out then?

I would be the last person on earth, Deputy MacSharry, to cut out you or anyone else.

What is the story? Do I speak?

The story is the people whose responsibility it is to provide the names to us should be doing their job.

No clock came up when Deputy O'Dowd rose.

I had no clock.

He knew he had four minutes and I knew he had four minutes. We had discussed it with our respective Whips. Is it within the bounds of possibility that we could consider a very mild amendment to allow the extra few minutes so we can get in line? We can get the list to the Ceann Comhairle now.

We will be flexible but will the Deputies go and work out their lists and give them to us because we are not divinely inspired?

Can we start with four minutes now and we will all be on route?

How long was the slot to be?

It was to be nine minutes.

There was no clock for-----

The first Government slot, which is what we are on now, is nine minutes. The next Government slot is eight minutes and then there are a further two Government slots of eight minutes each.

As a point of information, there was no clock on for five minutes and then a further seven minutes were given.

For the sake of eight or ten minutes can we start with four minutes now?

Yes, go ahead.

I thank the Ceann Comhairle for this opportunity. The Taoiseach uttered a very important line earlier with which I very much agree, although as a nation we are exceptionally poor at it. He stated it is the duty of the Republic to hold itself to account. We never do that, to be honest, until we are dragged, kicking and screaming. Normally we deny, delay and defend, circle the wagons, and dress up mediocrity as efficiency. That is what we do. It gives me no pleasure to say that vaccination preparation and roll-out in a European context has been an abject disaster and a disgrace. The one thing we had some level of certainty around is the fact that vaccines were coming. We needed to prepare for them and prepare the macro environment for their roll-out in a local and national context and we did not do this. The EU failed miserably in securing adequate supplies for member states. I did not know countries were able to do side deals such as Germany did. If they are, when we get to questions later I will ask what we have done in Ireland about doing side deals of our own to supplement our supplies. I listened to the Minister on Newstalk this morning. He said our target this week was, hopefully, going to be 50,000 vaccinations. If that is to be replicated without some visibility on certainty of supplies at whatever cost to the taxpayer, because remember we are spending €500 million a week or thereabouts on Covid-related costs and expenditure, he should get those side deals done. The Irish people are entitled to the vaccinations of which other countries are enjoying the benefits.

As somebody who lives near a Border county it is certainly not lost on me that quite a number of people in the North of Ireland have been vaccinated already and some of them are not in nursing homes or healthcare professionals. Down here, we are slapping each other on the back saying how great the job we are doing is and taking pictures of a handful of vaccines coming in off a plane and stating we are well on the way, when the reality is we did not prepare when we had time to prepare. Preparing the macro environment means providing for consent and speaking to GPs and pharmacists and preparing the ground so we can roll it out, and not telling the nation that it is such a vast undertaking of scale. Honestly, we have been vaccinating people since the 1950s against polio, TB, and even H1N1 ten years ago. We were not organised. We have this defence in the vaccination plan that describes unknown variants. This covers all the mediocrity. We did not prepare. That is where we are. We are going around looking for consent. We are trying to figure things out. Some hospitals are bringing in local GPs and others are not. Some are giving it to administrators and some are not. Some are giving it to management and not people on the front line and some are not. There is no criticism here of our front-line healthcare professionals.

We are supposed to be leading this. We knew the vaccine was coming. It was not sprung upon us as a surprise. It was not shoved down our throats but we were not ready. Israel is leading the charge globally. Why can we not be like them? Even if we paid €60 per dose to Pfizer or whoever, the cost of two for every person in the country comes in at approximately €630 million, which is less than two weeks' expenditure on Covid, and we are entitled to it. At the Minister's 50,000 vaccinations a week, in 98 weeks or two years, we will be vaccine-free, with all of the associated delay in other clinical care, all of the erosion of all of our mental health, all of the job losses and the cost to the Exchequer in trying to keep people in social supports.

I thank the Deputy.

As the Taoiseach rightly said earlier, it is our duty to hold ourselves to account. The Government should up its game, get with the programme, have some tangible goals and start doing side deals, just like the Germans and everybody else. If the Germans can get it, I want it for the people of Ireland too.

I compliment the Sinn Féin Whip for making sure the Ceann Comhairle had the correct list of names and I suggest Fianna Fáil get its ship in action and do it properly.

When the first lockdown and restrictions were introduced last year, they caused concern and increased people's worries and anxiety levels. People who had a history of mental health problems were adversely affected. A proportion of the population also experienced mental health problems for the first time. This resulted in a significant increase in demand for mental health services, be they HSE, NGO, charity or voluntary mental health services. We heard at the Covid committee from stakeholders that Ireland was on the brink of a tsunami of mental health issues and that Ireland's mental health services are out of date and not fit for purpose. This is a damning indictment of years of systemic failures by successive Governments in failing to prioritise mental health provision in the State.

One of the highlights of a very difficult year was how communities rallied around each other. They looked out for our most vulnerable. It was like a throwback to my youth in north Clondalkin, where people had little but gave what they had. This time it is different. People are worn out and tired. There was a sense then that we are all in this together and we are all in the same storm. We might all be in the same storm but we are definitely not all in the same boat.

I have listened to the debate and I have heard from others in the Opposition that the Government failed to prepare adequately between lockdowns in the provision of health services. With regard to mental health, the Government not only failed to prepare but it also decreased the percentage of funding for mental health provision. During a global pandemic that has significantly impacted on people's mental health, the Government reduced proportionate funding. The percentage of the overall health budget allocated to mental health services has fallen by 1% to 6% despite the growing demand for such services at every level. This reduction is outrageous and highlights the lack of understanding the Government has of the inadequacy of current services. This reduction comes despite Sláintecare recommending that 10% of the overall health budget should be allocated to mental health, which is still below international recommendations. Currently, Ireland is at 6%. Ireland is now a first world country with a third world mental health system. Urgent action is needed. We need to start providing 24-7 emergency access to mental health supports so people can access the care they need, when they need it and where they need it.

Free universal GP referral to counselling would be a positive step forward. GP organisations that I have met have indicated that their members would be willing to host these services on-site - a one-stop-shop, so to speak, for physical and mental health services - but what we need now is a plan. We need a roadmap and we need it to be resourced and put into action, particularly during this pandemic. As I said earlier, we might all be in the same storm but we are all not in the same boat. I would go further and say that some people have been thrown overboard and left to fend for themselves because of the lack of access to mental health supports.

As we all know, the situation in the hospitals is on a knife-edge. We also know that we have currently got exceptionally high daily case numbers. It is very important that there is a recognition of the reason we have got to this point. There has to be a recognition that many of the decisions that were taken in the lead-up to Christmas were high-risk decisions that have put the country at serious risk because unless we do that, we will not learn from those mistakes.

We had a situation where the Government was claiming in Christmas week that the reason things were so bad was as a result of the new UK variant. That simply was not the case. NPHET, the Chief Medical Officer and, in the last couple of days, the WHO have told us that. The Minister will not be able to bring the public with him unless he is absolutely frank and candid. I ask him to please learn from those mistakes.

We were also told about a meaningful Christmas in spite of the fact that we knew that at the point of early December when level 5 restrictions were being lifted the numbers were dangerously high. The whole purpose of level 5 was to bring the numbers down to between 50 and 100 cases per day. At the point when the level 5 restrictions were lifted, we had an average of 330 cases per day in that first week in December. By 18 December, when the decision was taken to resume household visits, we had case numbers of 582 cases per day. Decisions have to based on the reality of the situation and the science. Wishful thinking about Christmas has done a lot of damage and we are paying a very high price for that.

I also believe a mistake was made in talking up the vaccines. It is fantastic that there are vaccines now. It is a wonderful breakthrough but the reality is that the Minister and other Government representatives spent a lot of time in December talking up the vaccines. That, combined with the talk of a meaningful Christmas and the lifting of the restrictions, certainly gave people a false sense of security. I repeat that we are now paying an exceptionally high price for that.

The figures seem to be plateauing somewhat even though they are still extremely high but we have to remember that the impact of the new variants is only starting to come through in the daily figures. There is no guarantee that we will continue on the downward trajectory of the daily case numbers. Rather than talking about restrictions for five weeks, a month or whatever, the target should be a fixed number of daily cases. We should have restrictions until we reach what is regarded as a safe number of daily cases. I ask the Minister to please consider taking that approach rather than a particular point in time.

I have a number of serious concerns in respect of the vaccines. We have no delivery forecast even though we were told that the EU had got a delivery forecast for the Pfizer vaccine last week. Can the Minister share that with us? There is a need to be absolutely transparent in respect of the roll-out of vaccines. There is a lot of concern that there is some queue-jumping going on. What exactly is the position with regard to GPs? What exactly is the position with regard to practice nurses? All of these matters need to be clarified. For example, who are the staff that will roll out the vaccines when we are into big numbers? What about the registration system? How do people go about registering? Has the IT system been sorted out yet? These are critical issues and the Minister needs to be upfront and clear with people to encourage confidence in the system but when there is vagueness in that regard, it causes concern.

One of the biggest gaps in the response to Covid-19 has been in respect of international travel. At no point have we been serious about having proper monitoring and oversight of restrictions. The latest announcement is that travellers coming into this country from every other country will be required to have had a polymerase chain reaction, PCR, test prior to travel. That is not enough. Will the Minister please stop telling people that that is sufficient? The public health advice is that one must have two PCR tests at least five days apart to give an assurance that a person is not infectious. I ask the Minister to clarify that and to stop giving out inaccurate information.

At the outset, I wish to offer my sincere condolences to the families of those people who passed away during the entire course of this pandemic but particularly to those whose family members died over the past few days and weeks when the numbers escalated.

I take this opportunity to thank the front-line staff who are fighting the fight of their lives against this pandemic to save lives. What they are doing is incredible. In my constituency in west Cork, from the GP clinics to the community hospitals and the general hospital in Bantry, what the front-line staff members are doing is incredible and I want to thank them. They are putting themselves at risk to save others. Unfortunately, they are dealing with a serious outbreak in Bantry. They have lost staff who contracted Covid and have not been able to attend work but they are still bravely fighting the fight. Thankfully, there was good news in Bantry on Monday with the arrival of a batch of 500 vaccines, which have been administered since Monday afternoon. That came as a huge sigh of relief to the staff but, unfortunately, they still have a bleak few days ahead of them.

I refer to the winter plan which was put in place before December. We are seeing the benefits of the investment in that. The health system is under severe pressure from Covid case numbers at the moment but I can tell the Minister it would be under much more pressure if it was not for that investment pre-Christmas. That has to be acknowledged.

I welcome the recent announcement about the requirement for PCR tests from Saturday in terms of those travelling here from abroad.

I join other Deputies in referring to the need for urgency in the vaccine roll-out. The largest volume of telephone calls to my office and to those of many Deputies, is about looking for information and clarity on the vaccine roll-out. There are guidelines on the HSE website but we need more information and clarity. I appreciate that the logistics in this regard are incredibly difficult and that it is not an easy job but the more information we get, the better. As I said prior to Christmas, we cannot be seen to be the laggards of Europe. I know that we are increasing the rate and are moving up that European table but because of the sacrifices that businesses and the Irish people have made in previous lockdowns, it is very important that we are at the top of the table when it comes to the roll-out of the vaccine. Getting the vaccine is what is on people's minds. They are trying to find out where they come in terms of priority, the location of vaccination centres and where they can get information. Not everybody is able to go online and, unfortunately, not everybody is finding it easy to get access to information so printed documents and information must be got out to all sectors of society.

The fewer questions that people have, the more certainty and confidence they will have that this vaccine programme will work.

We need a review of vulnerable groups. I refer specifically to adults and children with special needs. There is much uncertainty as to where they will come. In fairness to the Minister of State, Deputy Rabbitte, she mentioned that there is a review and work is ongoing to get as much information as possible about that sector. We need to provide certainty for service users, the parents and the guardians about when children and adults with special needs will receive the vaccine.

We talked about the speed and urgency of the vaccine. Many factors are involved. The most important one is that we will save lives if we roll out the vaccine faster. There are a couple of other factors. We will save regional economies. A place such as west Cork, where I am from, relies heavily on hospitality and tourism. We cannot go through another summer of severe restrictions. Businesses simply will not survive. The sooner we can roll out a vaccine and open up regions such as west Cork, the sooner people can come back and enjoy what west Cork has to offer.

The entertainment industry needs to be supported too. The faster we get a vaccine, the better it will be for the entertainment industry. I ask the Government to look at its suggestion about helping with the roll-out of the vaccine. The event production industry Covid-19 working group, EPIC, has made a fantastic suggestion and it needs to be looked at.

I too pay tribute to the many people working in our front-line health services at this time. All that has been said by senior management in the HSE in the last few days indicates just how stark this battle is. This is not all about vaccinations. It is about people playing their role by staying at home, staying safe and keeping out of harm's way, and making that mammoth task a little easier for those at the front line of our health services. I offer my sincere condolences to families who have lost loved ones over the last weeks. This is about saving lives and ensuring that far fewer families have to go through that awful grieving process at a time when grieving is so difficult.

Regarding the AstraZeneca-Oxford vaccine, I note that the European Medicines Agency anticipates that it may sanction that vaccine for full roll-out across EU member states on 29 January. We cannot have this soon enough. I have been reading with great interest in recent days that this is the vaccine that can be rolled out at pharmacy level. It adds an extra tier of rolling out the vaccine, gets it deeper into the community and allows it to be accelerated. As a member state of the European Union, we need to look at every way possible to fast-track that. In any other calendar year, 29 January would be quite soon, but in this calendar year, in the darkest days of this crisis, that date cannot come quickly enough.

I welcome the announcement that from Saturday onwards, all air passengers coming into Ireland will have to have a clear PCR test 72 hours in advance of their arrival. That is welcome and I think it will bring some confidence and certainty to people that those people who need to travel into our country do so Covid-free and are not putting our country at added or heightened risk. When we get beyond this peak period of Covid phase 3, we need to look at PCR testing in the context of aviation. I have noticed that there is significant variance across Europe with regard to the price of a test in a private capacity. In North Macedonia, for example, a PCR test costs €40 to take privately. In Ireland, it costs between €120 and €150 depending on the region in which one undertakes that private test. The manufacturing cost of a test unit is €12. There is significant variance and this will be a stifling factor when we get beyond peak Covid. When we are trying to have aviation and other types of international travel recover, we will need to make it possible and feasible, not prohibitive, for someone to get a Covid test and happen safely. That is for another day but it is a debate that should be happening in the background of the Department in conjunction with those in the travel sector. We also should be looking at antigen testing at points of arrival. They cost about €5 each and it takes minutes to generate a result, as opposed to hours for a PCR test.

Our priority listing for the vaccine roll-out is quite good. I make a pitch that we look again at our teachers, special needs assistants and all those who work in education. We hope that in February, the conditions in our country will be right and safe for them to return to work. They need to be bumped up from category 6 to a higher level.

I note that in 2020, when we looked at how hospitals were impacted, University Limerick Hospitals Group was under the most pressure, with 9,483 cumulatively on trolleys over the year. Some 75 people were on trolleys in the week before Christmas. Much was done for hospitals in the winter plan and much is being done to grapple with the Covid crisis. The solution to the problems in University Hospital Limerick lies in Ennis Hospital, Nenagh and St. John's. I hope that the Department will look at unlocking some of that.

I thank front-line workers for their service in difficult circumstances since this pandemic landed on our shores almost 11 months ago. The definition of a front-line worker has rightly expanded to include all workers who kept vital services going, not just hospital workers. We are grateful for their efforts. Bad as things have been, they could have been much worse had it not been for the workers' sacrifices. Their roles are too many to list and, at the risk of leaving anyone out, I will not do so. The people of Ireland are appreciative and it is time for the Government to show its appreciation. Applauding their efforts is welcome but it does not pay the bills. We need to pay our student nurses. There should be no more token gestures but a fair day's wage for a fair day's work.

We need to ensure that we learn the lessons that this pandemic has taught us. Our workers deserve better. We need to work towards having a living wage. We need affordable housing and healthcare. There is no point in achieving a living wage if the cost of living erodes it. We also need to look at the quality of life and climate action lessons that Covid has taught us. A shorter working week and working from home for those who can do it are ideas that need further exploration. With more opportunities for exercise, we need to ensure that the necessary infrastructure is in place in order that it can be done safely.

Older people bore the brunt of the pandemic in its early stages and many are still bearing it. They were disproportionately affected and many died needlessly. A public inquiry must be established to investigate and report on all circumstances relating to each individual death from Covid-19. We need to develop a network of publicly owned and operated nursing homes. Experience has shown that our over-reliance on the private sector has been ill-judged, which does not just apply to nursing homes. We also need to support older people who wish and are able to live in their own homes or the homes of family members. I do not mean throwing a pittance to family carers and leaving them to it. I know what that is like since I was a family carer and I can tell the Ceann Comhairle that €219 per week does not cut it. We need a proper support network for older people and their carers, a holistic approach to their mental and physical health and greater support for public health nurses to assist people and for social workers to assist older people in getting what they are entitled to.

I express the concerns of section 39 organisations. They provide vital services in our communities and are reliant on fundraising to ensure the viability of this service. With no opportunities for fundraising, we need to increase funding to them to ensure that these services survive. I feel that they deserve nothing less.

I wish the Leas-Cheann Comhairle and all the staff who operate the building a happy new year. They have been stalwart last year and this year, and I wish them well. A month ago, Ireland had one of the lowest rates of Covid-19 in Europe. That has utterly changed. Ireland now has one of the highest infection rates in the world. As the Chief Medical Officer has said, the pandemic is out of control. I argue that this stems from decisions made in early December to open the economy and lift restrictions. That has come back to haunt the Government.

It has put our health service, members of the public and our healthcare workers at enormous risk in their workplaces. Mandatory quarantine has never even been proposed by this Government. Those coming into the country were not even tested until two weeks ago, and nobody was quarantined. There are, therefore, huge question marks over the living with Covid strategy. The yo-yo effect of constant lockdowns will demoralise and break people financially, physically and mentally. The zero-Covid strategy, which isolates this terrible virus, is a better approach than the living with Covid strategy. We have paid the price for the constant lockdowns and the living with Covid strategy. We have the vaccine, and that has given a huge amount of hope to everybody facing this pandemic. However, I return to the issues of policy and the decisions that this Government has made over the past nine months. Of course this pandemic is difficult. No government in the world could have been prepared for the ravages of it but the policy and strategy, particularly putting the interests of business before those of public health, has come back to haunt this Government. This Government will have to face up to that legacy and soul searching must be done. The living with Covid strategy and the constant yo-yoing do not work.

The Government was full of praise for itself when Ireland had one of the lowest rates of infection in Europe before Christmas. Now it is trying to dodge responsibility when Ireland has the highest rate of Covid infection in the world. The Taoiseach went on the Claire Byrne show and tried to put the lion's share of the blame on the UK variant. He did not comment yesterday when Mike Ryan stated at a press conference that the variant is not the driver behind the new transmission rate. It is a factor but not the key factor. The key factor was the reopening of the economy, including the restaurants, gastropubs and big retail, and the decisions made by the Government before Christmas against public health advice.

Yesterday, Fórsa spoke about macho managers in the public service. There are not just macho managers in the public service; there are plenty of them in the private sector. Fórsa made the point that there are more public sector workers at work now, at a time it is more dangerous, than there were in the first wave in March, April and May. The same applies in the private sector. Hundreds of thousands of private sector employees are going to work. No section of the economy should be open, apart from those that are vitally necessary in the fight against the virus, namely, the health service and so on. That should be the policy of the State. If the State does not adopt such a policy, the workers and the workers' movement should adopt that policy. There should be a de facto general strike to close down the remainder of the economy and it should remain closed until such time as it is safe to reopen.

The next two or three weeks will be unprecedented in the history of our health service. I salute our front line staff, and I want to mention a cohort of them, namely, the student nurses. A total of 1,500 fourth years went into the hospitals on Sunday and they are being paid less than the minimum wage. They will now be followed by thousands of their first, second and third year colleagues. There is a recommendation on the Minister's desk that they should be paid €100 per week. That is less than €3 per hour for people going to work in hospitals with a pandemic raging all around them. Is he seriously considering that proposal? I invite him to take up the opposite position, rip up that proposal, state that it is outrageous and pay the student nurses at the level they demand, namely, the healthcare assistant rate

It is important, and I join with colleagues, to acknowledge the work of all of our front-line staff in our hospitals, nursing homes and all congregated settings. The past ten or eleven months have been a huge challenge for all of them. The commitment of each and every one of them has been tremendous during that time. It is also important to talk about the people who are not assisting the present scenario. For instance, over Christmas, a friend of mine contacted me. He had been contacted by someone who had tested positive, who was more or less boasting about the fact that they had to contact 52 people to tell them that they were at risk. I do not believe that that person clearly understood the challenges that our front-line workers have to face because of this pandemic. I am talking in particular about those working in ICUs. They are burnt out from the workload they have had to deal with and the care that they have to provide. It is a huge commitment, yet there are people who do not want to appear to acknowledge that. Everyone has a part to play in dealing with this pandemic, no matter what their role or job is. We all have a part to play and we need to put out a much stronger message about the responsibility that each and every one of us has in this matter.

My colleagues have referred to the current Covid figures, namely, 1,750 now in hospital with Covid and 158 in ICU. I am sure that in another half hour, the figures will be worse. Our health service is facing a real challenge over the next three weeks. We all need to put our shoulders to the wheel, therefore, to help those who are dealing with this healthcare pandemic.

It is important to highlight one of the more positive aspects. The South Infirmary Victoria University Hospital in Cork opened a special vaccine clinic last weekend. The clinic opened at 8 a.m. on Saturday, and over the weekend, 1,200 people received vaccinations. This included hospital staff, paramedics and those working for the National Ambulance Service, GPs, GP support staff and public health nurses. This work was done by people who volunteered to give their weekend to provide this service. It is a clear indication that there are people who want to make a positive contribution. The important issue now is about making sure that the vaccine is available.

I spoke to the head of the Nursing Homes Ireland earlier and he advised me that there has been a 90% take-up of the vaccine in nursing homes. We face a major challenge in this area because there are more than 70,000 people in nursing homes and congregated settings. I very much welcome the fact that the target date for reaching all of those people has been brought forward. It is important that we try to fast track every effort to get the vaccine out there. There is one group that I am particularly concerned about, namely, those who provide home care throughout the country. They call to four, five or six houses every day. These home helps and carers must be vaccinated at an early stage, because they are calling on vulnerable people. Many of them are living alone and have no other contact with people. Some of them may have two or three different home helps calling to them every day. Home helps and home carers, therefore, must be prioritised in the roll-out of the vaccination programme.

Those providing any kind of home care for the elderly must also be given priority. That is where GPs can play a significant part in making the vaccine available. I have another concern. In some areas of the country, for example, Cork and Kerry, many GPs have been able to avail of the vaccine. It has been made available in the hospitals, such as the South Infirmary Victoria University Hospital and the Kerry University Hospital, but in other parts of the country, GPs have not been able to access it. All front-line healthcare workers must be given priority and must have access to the vaccine at the earliest possible date, because they are the people we will be relying on to give the vaccine.

I understand that 46,000 doses of the Pfizer vaccine are coming into the country every week. It is not clear what volume of the Moderna vaccine will be coming in each week. The Minister might clarify that. Colleagues referred to the Oxford-AstraZeneca vaccine, which it is hoped will be approved by the end of January. Again, we need to ensure we can get that vaccine in at the earliest possible date. We can deal with this pandemic. We can deal with it by each and every one of us making a contribution in following the guidelines that are in place. As public representatives, we need to get out the message that we can come out at the other end of this pandemic in a positive light but we cannot afford to take any risks from now on. I ask the Minister to increase the amount of information available to the public and the amount given to us, as public representatives. In many cases, we are getting more information on Twitter and Facebook and in the media than is being forwarded to us by the Department. That is regrettable.

We can help to give a positive message but we need the information. We can deliver the message about the numbers of people who can get vaccinated and that it can be done at an early date. In the meantime, we all have a part to play in making sure that people follow the guidelines and that each one us, as individuals, do not put anyone else at risk by our behaviour. I acknowledge and thank our healthcare staff for their work and also the people in Departments who are assisting them in their efforts. We have a short period in which, we hope, we can make sure that the smallest possible number of people are infected over the coming weeks and months and the fewest possible die as a result of this pandemic.

During the first lockdown in April, The Irish Times reported that take-home alcohol sales increased by 40%, with €158 million being spent on alcohol to be consumed in the home. It is vitally important that we have a conversation about alcohol misuse in the light of the serious mental health concerns raised by my party colleague, Deputy Ward, and me, as a result of the Covid-19 pandemic. Social isolation, depression and anxiety are all triggers for harmful alcohol consumption, yet the Government does not seem to be too pushed to address the harm alcohol is causing to individuals, families and communities.

This week saw the implementation of further measures under the Public Health (Alcohol) Act 2018. People were quick to pat themselves on the back about this and everybody said, "Well done, lads". It took two years for that legislation to be only partially implemented. Local and regional drugs and alcohol task forces get no specific funding to support the establishment of alcohol misuse services. In fact, in the 2021 budget, there was no funding whatsoever in respect of harmful alcohol misuse. There was also no funding for alcohol-related brain injuries. When treated properly, there can be a 70% recovery rate from such injuries and it is estimated that 2.4% of the country's population is affected. We have no complete figures because the only treatment programme in the State does not get proper funding and cannot be expanded. There is no funding for the Irish Community Action on Alcohol Network, which has localised, evidence-based plans that work. In my area in Cork city, Cork Community Action on Alcohol Northside can attest to the success of those plans. Despite repeated calls to the Minister for Justice, dial-a-drink services continue to deliver alcohol 24 hours a day, seven days a week to vulnerable people. Nothing is being done about that. Alcohol can be harmful and is a real issue. We have all seen it destroy the lives of members of our community, friends or family members. We need action to address the problem now.

As the Sinn Féin spokesperson on addiction recovery and well-being, I am proud to advocate for all of those who are in addiction and in recovery. The Department of Health needs to abolish its drugs policy unit and establish an addiction and recovery unit. Until that is done, gambling addiction will continue to fall under the remit of the Minister for Justice and people in gambling addiction will be treated the same as those with mental health problems. There are no supports for people with gambling addictions and the Extern Problem Gambling Project, which provides counselling for those with such an addiction, receives no Government funding. I contacted five Departments before Christmas, namely, the Departments of Justice, Health, Children and Youth Affairs, Rural and Community Development, and Education, and each came back with the response that no funding was available. A representative of the Extern Problem Gambling Project told me today that if the Government does not step in now, it will close in six weeks' time due to a lack of funding. We need to act now to support people who are in gambling addiction.

For many months now, at various stages of the coronavirus pandemic, the Government, the Department of Heath and the HSE have continually been asked what is the plan. It is fair to say that the master plan often appears to be hidden and the perception is that Government health policy and leadership have been reacting to events. One recent decision that could be so described is the announced pending appointment of a new Secretary General of the Department of Health. The decision to award an almost 50% salary hike for this position appears to be both reactionary and rushed. A Government backbencher told me the reason for the decision is that the Department of Health management is dysfunctional.

I have sympathy for this narrative having seen at first hand. I refer, for instance, to the Department's influence in the development of a national cardiac care standard, as set out in the Herity report. This is a clinical standard that exists nowhere else in the world and one that describes travel times between two hospital centres for the treatment of emergency coronary blockage. This is a meaningless clinical measurement. Effective coronary unblocking treatment depends directly on the time envelope between the onset of symptoms and a patient's arrival into a cardiac catheterisation suite. I point also to the funding approval that was delayed by the Department of Health for 14 years to build a new mortuary at University Hospital Waterford, UHW. That funding was only secured in the end because of journalistic endeavour which highlighted the corpses decaying in the unit because of a lack of refrigerator space and capacity. Let us not mention the four-year calendar schedule, which is elapsing, for the delivery of a build tender award for a new catheterisation ward at UHW.

I can indeed believe that dysfunction in the Department of Health may be a reality. If it is, rather than just changing personnel, does it not indicate a need for a real strategic and structural change in the Department? During the banking crisis, it was recognised that the scale, complexity and oversight of the Department of Finance had become too large to be managed by the existing Civil Service structure. As a result, a new Department, the Department of Public Expenditure and Reform, was created. Given the significant scale and wide remit of the Department of Health today, surely now is the opportunity to look at strategic restructuring and a separation of responsibilities, such as the hospital and acute care sector being separated from social and family care services. What about reform within the HSE structure and its remit?

Instead of any strategic review of our health governance, it appears the Government has again taken the decision that an overwrought situation can be solved by a new appointment and a 50% pay hike. It is ironic that the preferred candidate for the position has been leading the Department of Public Expenditure and Reform for many years and, one presumes, has supported the policy to oppose increased appointments and pay increases across medical, nursing and allied grades during the Covid crisis. One might also ask whether this ambition extends to the Civil Service structure.

As a Covid-19 response strategy, there are a number of aspects to this appointment that require clarification. What evaluation has taken place on the need to provide a 50% pay rise to the salary scale of the existing Secretary General position? The appointment decision appears to favour a possible panel interview, yet how can that be the case for a fair interview process when the candidate is holding the position on offer, conferring significant advantage in final selection? What discussions, if any, were had regarding the waiving of future pension entitlements on the additional salary proposed, considering that this position attracts the top level Civil Service pension plan? The pay rise by my calculations, and I stand to be corrected on this, is a liability in excess of €1 million to the State. Was any discussion had as to the candidate agreeing to waive the benefits of this salary increase in respect of pension roll-up? If not, given the total employment costs involved, should the Government not have considered a move to create a contract role with the possibility of allowing private sector health management professionals to apply? It appears also that other Cabinet members were not made aware of the additional salary increases to be offered and neither was cognisance given to the pressure that this will cause in promoting further payouts across the Civil Service and public service at a time when so many private businesses and employees are facing potential ruin.

My personal disquiet on this issue has led me to write to the Comptroller and Auditor General and the Committee of Public Accounts to have this matter reviewed. At a time when Covid-19 mitigation strategy forces hard-pressed taxpaying businesses and individuals to close down and to depend on State subsistence - which for many is completely inadequate to cover their needs - Government leadership should be seen not to be reacting to individual crisis points nor to creating inflationary precedents, but should be, rather, planning strategically based on known deficits that can be overcome.

Regarding the high rates of Covid-19 infection at present in Ireland, which continue to rise and may potentially rise further given the new variant, I also point the Department to the risks around the oxygen supply and I highlight that we are dependent on the UK for the importation of medical grade oxygen. I have written to the Department on this point.

Can the Minister at some point also clarify what is happening with the vaccinators? We have a panel of up to 2,000 additional vaccinators made up of community medics, nurses and retired healthcare people. Will they be trained and when will this happen? The Pfizer vaccine requires 30 hours of online training. If that is the case, have these vaccinators begun this process yet?

There is no doubt that we are now in the throes of a third and probably the most significant wave of Covid-19 and we need every single hand at the pump.

Glaoim ar an Teachta McAuliffe, atá ag roinnt a chuid ama leis an Teachta Lahart.

On previous occasions I have started my contribution by offering my condolences to those who have passed away. Over the next few days we know that there will be families laying to rest their loved ones who have suffered the fatal consequences of this virus. They do so in the cruellest of circumstances, limited in numbers to ten mourners, often with a closed coffin, and without the support of their wider family or community. Tomorrow, I and my family will do that with my grandmother, Patricia McAuliffe, who was a very gentle lady who, thankfully, passed away gently on Sunday night in her care home, surrounded not by her family but by those who have become her family during lockdown. I imagine that she will be included in the nightly numbers, but as Deputy O’Dowd has said, it is important that we know that there are people behind those numbers. I only wish that I knew the names of the other 46 people that were mentioned last night, or indeed the 3,894 other people on this island who have passed away. There will be time for commemoration.

For now we must continue to do what we know we must do, which is to wash our hands, stay at home and to keep one’s distance. These directions may ring hollow but they work and we need them to work.

There are a number of issues which I will raise with the Minister, one of which concerns the vaccination. Yesterday I started to see the circulation of a website online called omnicalculator.com. It appears to be owned by a Polish company and purports to be able to predict where Irish people will be in the vaccination programme. It is not a HSE website and has misleading information. I encourage people not to use or share it. It highlights, however, a thirst for information which many people have to know where they might be in the vaccination programme. A similar platform might be useful if adopted by the HSE when the vaccine programme gets into full swing. In reality, the reason the vaccination programme is not in full swing is not limited by logistics but by the availability of vaccine. We are not rolling out but are still rationing. The application of the AstraZeneca vaccine with the European Medicines Agency yesterday will be a key changer in that regard because it is the vaccine that allows the least number of restrictions in a roll-out programme. I look forward to that vaccine being approved and made available to us.

It is also important to know that the priority order is not about who is most deserving. When the National Immunisation Advisory Committee, NIAC, established the priority order it did so on the basis of the vaccine itself, knowing as we do, that it prevents death but does not necessarily prevent transmission. Communicating why the NIAC outlined the priority in this way is important and it is deserving that we revisit and communicate this message to people.

Equally, on the question of restrictions, it appears that these will be extended in other countries until March and even into April. Should we now look at our date of 31 January and assess what the likely date will be for these restrictions and make decisions now around examinations, education and business? There are many challenges for us ahead but for the sake of those 3,800 people who have passed away on this island, we must redouble our efforts to ensure that vaccination and reduction are our two priorities.

I offer condolences to my colleague on the passing of his grandmother and to those other families who have lost loved ones to Covid-19 in the last number of months. I wish the Minister well in the arduous work he has ahead and extend that wish to his officials and to the members of the vaccination task force and NPHET, who have done sterling work and who I am sure must be at the point of exhaustion at this stage.

I must still convey to the Minister the questions that are on the minds of my constituents and of people in Ireland. In one sense a nation is holding its breath, to use that phrase, which I know the Minister is aware of. The public has only one question on its mind now which is when will it receive the vaccine. The private sector has been seen internationally to have rolled out the vaccine at incredible speed. It has moved mountains to ensure that the vaccine has been rolled out. Now there is an expectation that governments and the public sector will do likewise across Europe. There is a degree of incredulity at the European response and I wish to echo the comments made by previous speakers.

My questions include the following. We have been told that there will be an abundant supply from March 1 onwards. That is two long months away. What are the plans for the roll-out of this abundant supply? Is the ICT infrastructure built and operating? The public has clearly moved from pre-Christmas-mode vaccine anxiety to vaccine hunger. There is a great appetite for the vaccine. What is the latest information on 24-hour vaccination centres? We have seen these operating in other jurisdictions but have not heard anything about them here. What is the latest information on mass vaccination centres and when will they be located? What is the latest information on vaccines outside of office hours and when will that become available? Has a deal been done between GPs and the Government with regard to vaccine roll-out in surgeries when that is possible with the Oxford-AstraZeneca vaccine? We have the vaccines and the question now arises as to whether we have the personnel and the infrastructure to roll them out and when the personnel will be in place. How many people, if any, have received both doses at this stage? By my calculation we need approximately 1.1 million doses of vaccines to reduce deaths and hospitalisations by approximately 85%. If that was done, society could lead a good life at these levels and the awful hospital burden would not exist or be nowhere near as acute as it is now.

We saw yesterday, because we get so much news from the UK, that the UK Government rolled out 250,000 vaccines in one day. Therefore, there needs to be a system that allows no delay between the arrival of the vaccine and its rolling out. I welcome the roll-out of the Moderna vaccine but we do not know when we will be in a position to receive it. This lack of hard information is causing a lot of anxiety.

There are questions over whether there are people trained to administer the Moderna vaccine. People of my age are asking when they will receive the vaccine and how they will be informed. How will older people be informed about when they might receive the vaccine? I have a constituent who is over 100 years of age. There cannot be many such people in Ireland. When will such people receive the vaccine? How will they be prioritised? When will carers and the vulnerable get access to the vaccine? When are people who give home care to special needs adults and children, for whom testing for Covid, contracting Covid and isolation are traumatic, to receive the vaccine? When will the special needs adults and children being cared for at home be treated the same as those with special needs in institutions? When will children with special needs at home receive the vaccine? When will ambulance crews be vaccinated?

I have about 20 more questions I could ask but I have limited time. The message is not getting through. There is a hunger for information that will be replaced by anger very quickly if answers are not forthcoming and if the public is not given a calendar and certainty as to when they can receive the vaccine.

I wish to add my voice to the call for vaccines and vaccination as soon as possible for each and every person on our island. All patients and front-line staff in public homes that house those with physical and mental disabilities, such as the Cheshire home, Deer Lodge and Cherryfield House in Killarney, should be vaccinated sooner rather than later. The workers who are doing such great work should be vaccinated as soon as possible. Home helps and carers who are in and out of the homes of the elderly and who do great work day in, day out, to ensure the elderly and those with disabilities can remain in their own homes for as long as possible should receive the utmost attention and the vaccine as soon as possible.

What does the Minister know about the new pneumonia virus that we hear has arrived in Wuhan? Will all our own people be vaccinated here before this new virus comes from there? What does the Minister know about it? He needs to let people know about it.

I am glad that, at last, after my calling for it for months, the Government is now asking that people who intend to come to this country by air be tested within the three days prior to flying. I have been asking for this for so long. It is not that I am against people coming home because that is not the way I want it; I want people to come home but everyone needs to have a test before coming here. How much of the Citywest Hotel is being used? Are we still paying for it? There is an anomaly whereby people are flying into Belfast and coming down here without any test. The same story applies here in that people using Dublin Airport are saying they are going to Belfast, yet they are coming into the Twenty-six Counties. Something has to be done about these things.

There have been more cases of Covid-19 per million people in Ireland over the past seven days than anywhere else in the world. There is a complete lack of focus on some factors that have not been addressed. Experts, including Professor Anthony Staines, believe the following four factors apply. The Government decided not to test adequately for Covid-19. In fact, Ireland was one of the only western countries that was neither carrying out testing at airports nor requiring incoming passengers to have a clear PCR Covid test within 72 hours of boarding a flight to Ireland. We now know circumstances have changed. For many, I fear it is too late. I have been calling for rapid testing at airports nearly since the start of the pandemic but my calls fell on deaf ears. The overall testing regime lacked any strategy and planning and it was not of the scale required. There was an utter lack of meaningful implementation in respect of compelling individuals entering the country to self-isolate for 14 days. The overall plan is akin to flying blind. There is no strategy and there is no proper plan; instead, it is a complete case of making it up as one goes along. The Government's overall approach has been all over the place and extremely confusing. For example, we do not know whether the 54,000 people who flew into Dublin over the Christmas period quarantined properly because the Government put no proper measures in place. The UK variant of Covid-19 that arrived in Ireland was almost certainly brought by someone who flew into Dublin and did not quarantine adequately.

There are many more reasons I would like to read out but I must mention the student nurses and the way they have been treated throughout the pandemic. They are now being offered €100. It is an absolute disgrace even to consider offering that to people working at the front line. I even hear the pay of fourth-year students earning €14 per hour is now to be reduced to €10.60 per hour because it is said that the pandemic is under control. It is not under control in any manner.

I commend hospitals such as Bantry General Hospital, which has had to operate under extreme pressure. I commend the staff and all concerned.

Staff providing ambulance and home help services are looking for the vaccine. They are going from door to door so we need to have the vaccine rolled out properly. There are some rumours that it is being rolled out properly up the country but that is certainly not the case regarding the west Cork home helps. The Taoiseach, Tánaiste and other members of the Government took credit on 8 December when Ireland was at the bottom of the Covid-19 case table. Equally, they must now take full responsibility for the fact that, in four weeks, Ireland went from the best in Europe to the worst in the world where cases of Covid-19 per head of population are concerned. Ireland's dramatic surge in Covid-19 cases has made headlines all over the world. The words "too little, too late" come to mind.

Gaslighting is the process of causing someone to doubt their own thoughts, beliefs and perceptions. We have reached a stage of Government gaslighting where people are quote-tweeting news headlines correcting the information that is being falsely peddled by the Government. The Government did not listen to NPHET advice in the run-up to Christmas and instead went along with what its lobbyist friends wanted. In the last week or so, the Taoiseach, Tánaiste and Minister for Health have been doing interviews and completely contradicting themselves, refusing to accept responsibility for the fact that Ireland is now the worst in the world regarding the Covid resurgence.

I was dismayed to see that Letterkenny University Hospital has been so badly impacted by the latest wave of Covid. Earlier this week, staff were called to come in urgently so extra beds could be opened up. Patients were being seen and triaged in ambulances in the carpark. Owing to the high Covid numbers and the level of community transmission, we have a staffing crisis. Reportedly, around 170 staff from Letterkenny University Hospital are unavailable to work due to Covid. Staff in Letterkenny and other settings are working extra shifts to try to help in the effort to increase capacity. While the Government reopened the economy to let businesses boost their profits, those on the front line of our health services have had absolutely no let-up since early last year. They have made huge sacrifices in the fight against Covid and the Government has let them all down.

This morning, it was reported that health staff who were self-isolating due to their having been in close contact with people who tested positive for Covid have been called back in to work. I refer to those who are asymptomatic. Such is the crisis in the staffing of our health service that we are bringing potentially contagious staff back into settings with sick and vulnerable people and health staff, putting them all at risk. This is what happened in Letterkenny University Hospital last week. Staff were called back into work despite being identified as close contacts of people with Covid.

Today, there are just 24 available ICU beds in public hospitals across the country and 14 acute adult hospitals have no ICU beds available. The Minister's media appearances are not doing anything to reassure the public about the competency of the Government in handling this pandemic. If the Government could just give an honest, straight answer, take accountability for wrong decisions and clearly communicate how to make things better, there would be more buy-in. Yes, there is Covid fatigue but mainly there is Government spin fatigue. The Irish electorate are not stupid and do not like to be taken for fools.

Numbers in Donegal and other Border counties have been consistently high, as we have waited to see what belated action would be taken in the North. Months ago, I submitted freedom of information requests regarding the level of co-operation and forward planning taking place between the North and the South concerning Covid restrictions and management. I received responses from the CMO and the HSE basically stating that no contacts had been happening. I only received a reply yesterday from the Taoiseach's Department, which released one document from the 33 requested and that basically says nothing. That is the height of the co-operation taking place.

Yesterday, I attended the online meeting of the Oireachtas Disability Group at which we heard from organisations that work with people with disabilities. In the first wave in the UK, six in ten of all Covid deaths related to people with disabilities. Thankfully, we managed to avoid such a terrible fate here but there are serious concerns about this wave and what is happening now. Support organisations have staffing issues due to the high rates of Covid infection, and there are no details available regarding the vaccination of people with disabilities who are under 65 years of age. Will staff in section 38 and 39 organisations be treated as equally essential in respect of receiving vaccinations?

At the start of the pandemic, disability organisations were included on the NPHET Covid-19 vulnerable people subgroup, but that subgroup was disbanded last year. Why? Advocates say they are noticing the acute gap caused by not having this subgroup in place and have called for its urgent reinstatement. Surely, with Covid numbers as high as they are and have been, vulnerable people should be represented. How many women are in the room with the decision makers? How can we be protecting all of society, if we are only hearing from male and pale voices? That is not to be disparaging about NPHET, but we must make an effort to ensure that diverse and representative voices are present at the tables at which decisions are being made.

A final point I will make in the brief time available concerns high-risk groups whose pandemic unemployment payments have been reduced to €203 per week. Members of the Oireachtas Disability Group mentioned this aspect also. There are some people who are high risk but whose workplaces remain open. With uncompromising employers and-or without the possibility of working from home, there are instances where people are being forced to go to their workplaces, despite their high-risk vulnerability. This needs to be investigated. The Minister, the Government and its lobbyists always focus on employees, but Covid has given an opportunity for exploitative employers to be uncovered and penalised, if the Government wishes to do that. It will be interesting to see if it will. Sadly, we are almost a year into this crisis and what is obvious is that all the Government is interested in is publicity and publicity stunts. It has learned nothing. More gaslighting is all we are getting.