Covid-19 (Health): Statements and Questions and Answers

We move now to the second round of statements. To clarify, there is a set time for this item, which is precisely 100 minutes for questions and answers. We will begin with the Government side. Deputies Carroll MacNeill and Alan Farrell have 15 minutes to make statements or pose questions. That time also includes the time for the Minister's reply, and that should be borne in mind. I will stop the speakers after 15 minutes.

I wish to speak again about clarity regarding the vaccines. We have reached the point in this pandemic where people are under stress like never before. At the beginning, we did not know what Covid-19 was and we did not know how bad a virus it was. Now, however, we do know that information. We all now know people who have contracted this virus, who have been seriously ill and who have been hospitalised. I believe also that everybody at this point now knows somebody who has sadly died. Pharmacists, front-line workers and GPs working throughout this pandemic have faced stress. That is nowhere more acute than with front-line workers, but I was thinking today about pharmacists who cannot triage people coming into their premises in the way GPs can. Those pharmacists and their staff have been suffering the stress of not knowing who is coming in, and the difficulty caused by that situation.

I still cannot answer the question posed to me by a pharmacist in Shankill today concerning what level she was at regarding her treatment of patients. Is she considered to have direct patient contact or is it potential patient contact? I cannot answer that question or other questions. I cannot answer the question that came from the mother of a four-year-old child with type 1 diabetes. She is a lone parent and the only carer for that child. Will she get the vaccine when he gets it? It seems logical that she would, and that the programme has that flexibility built into it. All that mother wants to know to mitigate her stress is the knowledge that she will get the vaccine.

I also cannot answer the question posed by the son of a 91-year-old lady who lives in my constituency. That man is not sure when his mother will get the vaccine. He appreciates that people in congregated settings and in the healthcare system have to get the vaccine before his mother, but the question is when will his mother will get it. The reason I cannot answer those questions or provide clarity in those cases is that we do not have any sort of pictorial graph or spreadsheet in the way that we have for other things in our documents regarding the vaccination implementation plan. I refer to page 19 of that plan, which contains a spreadsheet of activities for three months. I also point to a similar document from Denmark, which was highlighted by the Minister's party colleague, Barry Andrews, MEP, on social media today. That document also contains a schedule, albeit that being an indicative schedule and one with different levels of certainty regarding presentation. It is, however, a schedule.

We have heard the argument in response when these issues have been raised, and I understand why it is being made, that we cannot provide such a schedule because we do not know how many vaccines we will have. We can, however, provide a schedule based on the number of vaccines which we know we have. What would be the schedule based on the current vaccine which we know we will have available? If that schedule is then expedited, then that will be fantastic. If I were to go and tell somebody, based on our current vaccination plan, that it seems he or she will be vaccinated in June, perhaps the first or second week of that month, and it then turns out in reality that the vaccination takes place in the first week in May, that is misinformation I am happy to stand over and a clarification I am happy to make.

Can we do more in the context of providing clarity for people in order that we can try to retain the social solidarity that exists? The implementation plan and the associated communication strategy focuses on convincing people not convinced by vaccines at present. I do not think that is the problem we have in respect of communication. We must address those people willing to queue overnight in the snow to get this vaccine and to try to keep those people with us as we go through the next phases.

Those are my questions for the Minister. In particular, can we go back and examine the possibility of providing a spreadsheet which will give a visible representation to people concerning when they may get the vaccine, while recognising that the process may be expedited? Can I get clarity in respect of pharmacists? If the Minister will answer those questions for me, I will then come in again.

In answering the question, there is nothing that I or the HSE would like to do more than to be able to say "Here is our week-by-week allocation. Here is what is coming in, here is what is coming in month by month and here is how that feeds into all the various priority groups" and then to be able to put up a simple calculator or drop a document into homes which would give people, in light of their individual profiles and attributes, such as age, underlying conditions, etc., the date on which they are scheduled to be vaccinated. Most Deputies who have spoken referred to this matter. We are all being asked this question about the vaccination schedule. It is the biggest question on people's minds. There is nothing I would like more than to be able to come into the House and give an accurate answer to that question. We must be honest, however, about what we know so far.

What we know so far is that we have the prioritisation groups, and they are as recommended by the National Immunisation Advisory Committee, NIAC, endorsed by NPHET and agreed by the Government. We have that list. After that, we know two vaccines have been authorised by the European Medicines Agency, EMA. Those are the Pfizer-BioNTech and Moderna vaccines. We have a reasonably accurate delivery schedule to the end of February for the Pfizer-BioNTech vaccine and a provisional delivery schedule for the Moderna vaccine. The first doses of that vaccine arrived in Ireland just yesterday, initially at small volumes. For Ireland and every other EU member state, everything after that is informed speculation.

Having been in my seat, the Minister will appreciate how difficult time and the management of time is for backbenchers. If this situation is as the Minister has said, we still do have a certain amount of information. We can provide information to people on the basis of the information we do have. I prefaced my remarks by recognising that we would get more vaccines and not less, that we would get more speed and not less and that it would be a schedule which will be expediting over time. The Minister will have the opportunity to address that aspect further.

I have also had communications from senior staff in the Central Mental Hospital, who have yet to receive information regarding when they will receive vaccine doses for their long-term patients. We saw a report in The Irish Times today regarding the difficulties experienced at St. Vincent's Hospital yesterday and the day before, where people who were not in direct contact with patients were being vaccinated.

This is where that measure of flexibility comes in. It is difficult and understandable. Professor Karina Butler, the chair of the National Immunisation Advisory Committee, NIAC, commented that one does not want people who are not on the front line to leapfrog over others at greater risk but hospitals had to have a measure of flexibility and the vaccines that were taken out of cold storage had to be used within a certain period. That is totally understandable and I get that. However, the more that happens and the more that people like me cannot account for why that is happening, why this person is getting it and that person is not, why leapfrogging is going on even though it should not be and why flexibility works for this person but there is not flexibility for that person, the greater the risk. This is the only measure in this pandemic that we can foresee and over which we have some measure of control. As Members pointed out in the Dáil before Christmas, this is the biggest logistical exercise this State will face and the risk is that if we do not do this and we cannot provide that clearly, we will lose the solidarity we have. It is crucial we get our priority groups looked after.

I will try to continue in the vein that Deputy Carroll MacNeill has started. It is pretty much the same thing. I echo the comment made by Deputy Colm Burke earlier on. As a Member of this House for the past decade, I am getting information on Covid vaccinations from journalists. That should not be the case and I know the Minister, Deputy Stephen Donnelly, accepts that. That has to change dramatically and quickly.

The public is in need of a significant shot of hope and the vaccine roll-out is a great opportunity to do that. A number of constituents have been in contact with me over the past week or so who simply want to know. I got a text message late last night from a person who had completed the online predictor Deputy McAuliffe referenced earlier, wanting to know what the story was. Of course, it is not an official source and it is problematic but these are the sources of information and the lengths to which people will go to get information. I acknowledge the Minister knows this. I welcome his comments earlier on the provision of information from this weekend. I also welcome the comments of several colleagues, myself included, that the app should be used for the provision of this information on a daily basis. Along with the number of new cases and the number of unfortunate deaths, we should provide the number of vaccinations administered in that day or perhaps the day prior. That can be achieved and I would like the Minister's further commitment on that.

We know that when the Pfizer vaccine arrived, the training to administer it had not been completed. Will the Minister give a commitment that this will not occur with Moderna? Will he give a commitment regarding the number of vaccinators in the country? I believe 1,400 individuals have been trained and I have heard a figure of 2,000 being mooted for those who are in training. Can the Minister confirm that?

Can the Minister confirm the approximate number of total vaccinations he proposes to have within a given period, say, to the end of January or perhaps the end of February? This will give people the information and hope I believe they require in the coming weeks and months. The Minister has said repeatedly, and I accept the point, that one cannot make a plan without knowing precisely how many vaccines will arrive at any given period. However, he was in business prior to his role as a Member of this House and he is a practical person. I know he knows that people are looking for our best-case scenario. Perhaps the Members opposite will bash us over the head with it but I think the public will accept our bona fides in trying to present factual information based on what we believe will come in terms of vaccinations. That is the point my colleague and other colleagues have been making in the House throughout the afternoon. The best-case scenario is what we want to see. We want to know there will be 100,000 vaccines delivered in the next two weeks, or 200,000 or whatever it is. Let us tell people that. We know that somebody knows in the HSE. The provision of that sort of information is critical to providing the hope that the public requires.

On ICU capacity, there has been talk of 25% or thereabouts of the private healthcare provision being taken up as part of an arrangement. On the last occasion this happened, Members of the House on all sides were provided with the information. On this occasion, it happened over Christmas. I looked at my inbox, where there was no information. The only information I got was from cursory references to it by journalists. Last week, we were at the bottom of the pile. This week, we are in the middle of the pile. It shows the necessity for us to provide as much information as possible. I am a pragmatist, like Dr. Mike Ryan, who said something to the effect that perfect is the enemy of good. Somebody has to be first; somebody has to be last. I do not want to be in either of those positions but I would like to provide certainty to the people who have been kind enough to support me over the last decade in this House in my constituency and to give them the information they need. There are a few questions there, which I hope the Minister will cover in the time provided.

I thank the Deputies for the questions. I assure them that the vaccination task force and the HSE share the frustration behind the questions. Everyone here is representing their constituents and the questions people are asking them.

I will lay out for Deputy Farrell what we know. We know that on Sunday week, our target is to have vaccinated 140,000 people. That is split 50:50 between long-term residential care and front-line healthcare workers. In long-term residential care, it is the entire nursing home sector. That is 589 nursing homes, residents and staff. In mental health residential care and disability residential care, it is residents over the age of 65. In healthcare, colleagues have rightly raised the question of who are front-line workers and what are the protocols. The HSE has an agreed protocol for who front-line healthcare workers are, both in the hospital system and in the community. I will make sure that is made available straight away to colleagues. It will be 70,000 healthcare workers. On Sunday week, which is a week and a half's time, the first 140,000 people will be vaccinated. We are then cycling back immediately to start the second doses in the nursing homes and with healthcare workers who have had their first dose because that happens on day 22.

The figure I shared earlier with the House, which comes with many caveats around it, is our aim to have 700,000 people or thereabouts vaccinated - most with the first and second dose but some with only the first dose because the second dose would spill into April - in quarter 1, that is, by the end of March. Critically, that covers more or less the first three cohorts. That is the entire long-term residential care sector, staff and residents; about 150,000 healthcare workers in hospital and the community; and almost all of the population over 70 years of age. There are, as colleagues know well, other cohorts who are high risk but by the end of quarter 1, which is just 11 weeks away, those first three cohorts will have covered off a lot of those who are most at risk and those who take care of those most at risk.

Moving on to Sinn Féin, Deputy Cullinane is sharing with Deputy Patricia Ryan. They have ten minutes in total.

I have seven and a half minutes and there will be two and a half for my colleague. I want to go over and back as fluidly as I can with the Minister. I accept this is a difficult format.

I do not want to bash the Government over the head on the roll-out of the vaccine and I certainly do not want to bash over the head Dr. Colm Henry, Professor MacCraith and Professor Butler. They have difficult jobs and we all wish them well and want this to be a success. Everybody in this House wants the roll-out of the vaccine to be a success because it is vital in terms of eliminating this virus as best we can. Be under no illusions that this is the case.

There is a lot of hunger for information from the public. The Minister should draw on that as a positive because it shows people want to be vaccinated. We were having discussions even before a single dose arrived as to who would or would not get the vaccine. We can now see that people want it. People want information, clarity, certainty and honesty in relation to all of that.

The Minister stated that 700,000 people would be vaccinated by the end of March. Briefly, is that inclusive of the second dose?

For most people, that includes both doses, but the Deputy will appreciate that there will be a three-week gap. For those we start reaching in the last three weeks of March, their second doses will spill into weeks 1, 2 and 3 of April.

Of the 700,000, the most up-to-date information given to health spokespersons at the latest briefing by Professor MacCraith, his team and Dr. Colm Henry was that we would get 40,950 doses of the Pfizer vaccine weekly until the end of March, although that amount might increase when the additional procurement through the EU comes on stream. Has that position changed? Is the figure of 700,000 people vaccinated by the end of March based on the current flow of 40,950 Pfizer vaccine doses or is the AstraZeneca vaccine, which might be certified at the end of January, built into that?

Our assumptions might not all come to pass, but to give people a sense of what might be possible, we are assuming that the AstraZeneca vaccine will be authorised on 29 January and that we will begin to get amounts of it quickly. We are planning on several hundred thousand doses within quarter 1. Although it might not come to pass, we are also planning on the number of weekly Pfizer doses increasing, albeit not by vast amounts. This would include the additional opt-in.

The 700,000 is the best -case scenario and is based on including the AstraZeneca vaccine and the current number of Pfizer doses increasing. On the day we were briefed by Professor MacCraith, the news came through that 300 million more doses would be procured through the European Commission, of which we would be in line for 3 million doses. When are they likely to arrive? Where does Ireland lie in terms of priority? The US is in line for more and Germany has ordered more. Will they be ahead of us? When are the 40,950 doses of the Pfizer vaccine that are arriving weekly likely to increase? Has any timeframe for that been given to the Minister?

Of the 300 million, the EU has confirmed the first 200 million. Yesterday, the Cabinet agreed to buy into that. We will get 1.1% of it. It will be the third tranche, as it were. There was the original Pfizer amount under the advanced purchase agreement, APA, and we got an additional amount through an opt-in. What was agreed yesterday was a third amount. Under the schedule we have, that amount will begin to arrive in quarter 2. I will get the Deputy and other colleagues the breakdown of the amounts in quarters 2 and 3.

I accept that. I will ask my next question constructively, although I am not sure whether what I am asking for is possible. If the AstraZeneca vaccine receives certification at the end of January as anticipated, and given that AstraZeneca is one of the companies that has undertaken a great deal of advanced manufacturing, will it be possible to get shipments of the vaccine to the State before certification so that, when it is certified, the doses are in Ireland? Has the Minister asked the European Commission whether that is possible?

I have asked my Department to look into exactly that. The CMO and I had that conversation this week. It is what I want to see. The UK did it, including in Northern Ireland. The doses were in GPs' surgeries and they were able to start vaccinating the moment the vaccine was authorised. Since the vaccine is manufactured in the UK, we can get it into Ireland very quickly. As such, the additional time we would get to vaccinate would not be much, but I agree that if we can save a day here or there, we should do so. I have asked the Department to engage with the Commission and, critically, the pharmaceutical company to determine whether we can ship in doses ahead of time.

My colleague wants to contribute, so I will ask a final question on the vaccine before putting a question to the Minister about what is happening in our acute hospitals. We are all getting genuine queries from different cohorts of the population about where they will be in the roll-out of the vaccine. Carers and home helpers are two categories of people from whom we are getting many calls. Where do they come in the roll-out? The Minister stated that he would publish the priority list of front-line healthcare workers from which hospital managers were working. I asked for it last week but I still have not received it. It is important that it be published. When are carers and home helpers likely to receive the vaccine?

Regarding acute hospitals, and as I told the Minister, I am dealing with various representative groups and have met many of them. They are very worried about what they are dealing with and what they anticipate they will deal with next week and the week after, given the increasing number of hospitalisations. They are sore about the fact that investments in ICU and hospital capacity were not made to their satisfaction. There has been no rapid modular build to any great degree. We called for that in the summer. There are issues with public health specialists, who called off strike action and are now sore that that was not recognised by the Minister in a positive way. Hospital consultants have raised pay equality issues and student nurses and midwives have legitimate pay claims. They see all of these issues and the failure to deal with same as a failure to value the work they do. Will the Minister engage with the representative groups on these issues? Those on the front line are dealing with a dire situation and the seething anger they feel at these issues not being dealt with is genuine and palpable.

Will the Minister address my points in the short time available?

He has barely 15 seconds. I am sorry, but that is how it has worked out.

Will I write to the Deputy?

I will ask three questions quickly, since I am aware of the time. I will ask them constructively and respectfully and I hope the Minister will understand why.

When will the public inquiry into deaths in nursing homes due to Covid-19, as recommended in the final report of the Covid-19 committee, be established? Will the Minister provide funding to section 39 organisations to account for their inability to fundraise? I have been contacted by a family whose father received a cancer diagnosis before Christmas. They are unable to visit and comfort him and difficult conversations are being held in public wards over the phone. What can be done to ensure that dignity is maintained and our health services are kept open for screening and treatment?

Regarding the Deputy's first question, the pandemic has borne down hard on the older generation. The Minister and I are on record as saying that people need to receive answers, but we are in the middle of the third surge and our focus is on nursing homes and keeping our elderly generation safe. There will be time for a discussion on the matter in question. People need answers.

We built into the budget an extra €30 million to support section 39 organisations' workers and staff and to help them with the gap created by fundraising.

How will we keep screening and treatment open? Can we ensure that they will remain open and that there will be dignity for those undergoing treatment?

Will the Deputy clarify which screening services she is referencing?

I was contacted by a family whose father had received a cancer diagnosis, which was being discussed on a public ward via phone. There is no dignity in that. Can dignity be maintained and can we ensure that our health services are kept open for screening and treatment?

Urgent non-Covid care is being kept open, including referral clinics for urgent cancer care and urgent screening. The situation the Deputy described sounds distressing. I have no doubt that the clinicians involved would not want that to happen. Unfortunately, with the system under this level of pressure, they are probably having to make decisions that they normally would not. We need to encourage people to stay at home, continue reducing the number of cases and give the hospital system the space it needs.

Before asking my questions, I wish to say that my thoughts today are with the victims and survivors who passed through our mother and baby homes.

I will speak and leave the Minister with a few questions. The first matter of two that I wish to focus on is that of travel. The Minister knows how strongly I felt about a proper regime of testing and follow-up contacts in respect of people travelling to this country. The requirement for a PCR test within 72 hours in advance of travelling is a welcome step, but it is nowhere near enough. The Government has bottled this in a major way. One of our first interactions with the Minister was on this matter at a testy meeting of the Covid committee in early autumn. Along with others, I believed even then that we had lost so much time.

Even though many horses have bolted from many stables on this, will the Minister consider bulking up and providing a regime that includes quarantining in hotels and a follow-up test within a couple of days upon arrival? If we do that along with what the Minister has bought in, people will feel much safer and it will get us somewhere to where we need to be. I do not hold out much hope but the facility at Dublin Airport is a private testing facility in the long-term car park. According to anecdotal evidence from north county Dublin over the past number of weeks, it was used by as many locals as people travelling into this country. I tabled a parliamentary question seeking breakdown of who used it in terms of people who are travelling in and who are locals. That data are not available, which is really disappointing.

The second issue I wish to discuss is workers. Over recent weeks, as the spread of the virus has intensified, health workers have been left truly in the dark over how many of their colleagues have tested positive for Covid-19. The Health Protection Surveillance Centre, HPSC, has produced weekly reports to give health workers and their union representatives a fuller understanding of the infection rates. The last of these reports was published on 23 December. Since then, there has been a deafening silence.

We are in a crisis and these workers are going over and above. They are stretched beyond belief and at absolute capacity. The old saying comes to mind that when we look back on this - when we do is up for question but we will get through it - and think about what our health workers are going through right now we will need to remember, to borrow the phrase, that never in the field of the Irish health service will so many of us owe so much to so few because that is what it feels like in terms of how our health workers are operating at the moment. They are stretched and there is no data they can work off to know how many of their colleagues are sick. It was reported today that in the health service, close contacts of people in the who tested positive had to come into work to fill the gap.

This is a pandemic and a crisis; I understand that. Will the Minister, however, ask the HPSC to publish this data again regularly? Does he know how many staff have been affected in this latest wave and how many are out sick, or worse? Will he provide an update on the plan and promise in budget 2021 to hire 16,000 additional healthcare workers? Where is that at and how is it progressing?

I thank the Deputy. I acknowledge his strong and ongoing position on travel measures. As he will be aware, we had a full travel ban between Britain, South Africa and here. That has now been changed. There were two steps. The first was to bring in a mandatory requirement for a clear or negative PCR test up to 72 hours before travel. On top of that, critically, when a person travels here, all the same measures are still in place. It does not replace them. Therefore, a person coming from Britain and South Africa still must self-isolate for 14 days, get a day-five test and that is it. It is three days before a person travels with a PCR test and all of that.

Yesterday, the Cabinet went further and extended the mandatory three-day PCR test to every country. Everyone coming into the country now needs the PCR test and needs to be able to produce documentation of that. If they do not, it is an offence with a fine of up to €2,500 or six months in prison. We are taking it very seriously indeed and on top of that, a person still must restrict his or her movements for a full 14 days or take a second PCR test on day five.

Will the data be published?

I will contact the HPSC today on that, absolutely.

I wish everyone a happy new year. We are in worrying times and yesterday there were 46 additional deaths related to Covid-19. This is such a difficult time for families. My sympathy goes out to everyone who has lost a life through Covid-19. Today we will have more high numbers. We have 172 people in intensive care and 1,750 in hospital so it is a worrying sign for us all. GPs around the country are reporting that not only is there a marked increase in people presenting for tests, more people are sick. Dr. Liam Woods, the HSE's national director of acute operations, said that intensive care figure could increase to 300 by early next week. That is a concern. Our hospitals are straining. What is the Government's plan? Do we have a plan B? Will the Minister please come back to me on that?

Have there been cases of healthcare workers who are close contacts of a positive case being asked to return to work? What protections are there for them, the public and, of course, other staff? I was contacted recently by a constituent in County Carlow who told me that due to the increasing number of Covid-19 cases, she could not have a childminder in the house so had no-one available to mind her children. She and her husband are both front-line workers who work with Covid-19 patients. She is now working four days per week and they are trying to work opposite shifts because they cannot get childcare. Does the Minister feel that we are on brink of a burnout? It is getting to the stage where family members in one home are going from work to try to cover to make sure their childcare is there. This is hard. This healthcare worker is not alone in being unable to access childcare. Not every healthcare worker can form a support bubble with another household. I heard that 7,000 healthcare workers are in direct need of childcare assistance. What are the plans? What can we do to help these people?

It is welcome that an agreement has been reached in the past week between 16 private hospitals and the HSE, which is really good, to provide additional hospital capacity to deal with the surge in Covid-19 cases. Are there plans to roll out a full policy of care in their own homes for those who have Covid-19 and are very sick but can be monitored virtually from a healthcare setting? This is happening in some hospitals.

I have two more questions and then I will come back to the Minister. We will be getting 40,000 doses per week of the Pfizer-BioNTech vaccine. It is welcome. The Moderna vaccine arrived yesterday in Ireland but other speakers mentioned that the UK vaccine, AstraZeneca, is the main hope for us all in the fact it will provide for an easier roll-out and can be stored at room temperature. It is important that we communicate with the public. My phone has been ringing all over Christmas as people want to know what is happening with the vaccine, what is the roll-out strategy and communications strategy and when they can apply for it. Communication is the key. The Minister said he will not have an answer on that until the end of the month. I believe he was at a Zoom meeting this morning with some of the other European health ministers. He might come back to me on that. We need to roll the vaccine out quicker. I know many Deputies have been asking about that. More than 2,000 people have been trained to give the vaccine, however. Are we rolling out more resources now for when we have access to more vaccines? We need to vaccinate straight away the minute we get it.

I am also concerned about creating an online platform for people to register for the Covid-19 vaccine. Not everybody wants to go online. The Minister knows broadband access is a problem and, perhaps, people do not want to register. Have GPs and pharmacists been asked if they can assist in registering interest in giving the vaccine by phone or, perhaps, a drop-in service? Perhaps the Minister could come back to me. I have a few more questions.

I thank the Deputy. On critical care and ICUs, she is absolutely correct. The hospital system is under severe pressure. It will get worse before it gets better. We know it will get better because we are beginning to see the effect of the measures in place. We are beginning to see the cases go down but it is essential we maintain that at a tight level so that they go down as fast as possible. That is how we will help our healthcare workers the most.

Regarding the numbers in critical care, there were 255 critical care beds at the start of last year. That was brought up to 285 beds. They are not all being used but there are now approximately 305 critical care beds available and that can be scaled up to 350. As the Deputy said, we have an arrangement in place with the private hospitals where we can access their beds and their critical care units as well. A large number of nurses have had additional training in critical care. The HSE has done a lot of work to make sure it is in a good place regarding many of the real concerns we were all looking at carefully in the first wave, for example, around ventilators and PPE. The HSE now retains a three-month stock of oxygen and so forth.

The Deputy asked about healthcare workers and close contacts. There is a derogation in place, which the HSE uses sparingly. The derogation is that if somebody is non-symptomatic but is deemed a close contact, he or she can have a PCR test. If he or she tests negative and if it is deemed appropriate, he or she can come into work under the supervision of occupational health, in an appropriate way, in the hospital setting. That is the only place in which it is used.

Childcare for healthcare workers is something I am pushing hard on. There has been progress and I would like to see more progress. Preschool childcare is available for essential workers, including healthcare workers. I am working with the Minister, Deputy O'Gorman, on what more can be done for primary school children, which would help with a lot of those needing childcare. Then there is the remaining question of secondary school children. As the Deputy quite rightly says, there are many households in which there are two essential workers. They might be healthcare workers, gardaí or other essential workers. Their children are at home during the day and it can be really hard to find childcare. Even if childcare can be found, it can be really expensive. That is a real problem.

I spoke with the HSE about this just a few hours ago and the Deputy's figure of 7,000 is exactly right. The HSE's estimate from the first wave of the number of people who would be quite stuck was 7,000. I am working with the Minister, Deputy O'Gorman, at a Government level and we are working with the HSE. The HSE is putting in place flexibility wherever it can to facilitate it. The Deputy has explained it really well in asking if this will push some couples and households to a level which is incredibly hard. It will do so because we are seeing in some cases that healthcare workers are doing shifts and their partners then do another shift while they mind the kids. It is a really tough time for them and we have to do everything we can to facilitate them, particularly the households that might have a lone parent or where both parents are essential workers, be they healthcare workers or other essential workers. One of the additions that is worth mentioning is that households with essential workers in them can pair with another household outside of their bubble, specifically for the provision of childcare. That will not solve the problem for everybody so we have to keep working on it but it will help to some extent.

The Deputy asked how we can scale up the vaccination programme. We all hope that we get a vast number of vaccines into the country. We are watching AstraZeneca particularly carefully, for example. We can scale it up with the vaccination programmes we have, with the thousands of vaccinators who are trained up and in addition to that, with the GPs. There are thousands of GPs and many practice nurses, not to mention the pharmacies. We must create an army of vaccinators all across the country and I mention the vaccination centres as well. The real advantage of the pharmacists and GPs and of their staff is that they are in every town and many villages across the country.

I want to raise the concerns in Donegal about its major acute hospital, Letterkenny University Hospital. The Minister will be well aware that in recent days, approximately 170 staff were off work at the hospital for a variety of Covid-19-related reasons. Seven ambulances were backed up outside the hospital. That meant that half the capacity in the county was tied up, which caused great alarm. What assurances can the Minister give that additional resources can be deployed to Letterkenny University Hospital? What proactive efforts is the Minister making to appeal to those who may have retired as healthcare workers in Donegal to come and assist? I understand there is additional capacity at St. Joseph's Community Hospital, Stranorlar. Can that capacity be utilised? At present, there are more than 100 patients with Covid-19-related issues in the hospital.

I will take this opportunity to convey my utmost solidarity with front-line healthcare workers across the State who have done incredible work throughout this crisis, particularly in recent weeks. However, they need assurances that everything possible is being done to assist them in the incredible pressure they are under.

The other issue is the vaccinations. As the Minister knows, up until recent weeks Donegal had the highest numbers per 100,000 in the entire State. They were stubbornly high numbers and the hospital staff were carrying that responsibility. We would have expected that they would have been top of the list for vaccination but they were behind by a week and we are still getting reports from front-line nurses in the hospital that they have not received the vaccination.

My questions are around vaccinations for the staff in Letterkenny University Hospital, getting extra staff into the hospital and the issue of extra capacity being available at St. Joseph's Community Hospital in Stranorlar.

I join wholeheartedly with the Deputy in his support of the staff and healthcare professionals in Letterkenny University Hospital. They dealt with the serious pressure point they had and which we were all watching within a matter of hours. Donegal has done well. As the Deputy noted, the figures were right at the top of the county table recently. As for the figures I have been sent for today since we have been sitting here, the rate is now very slightly below the national average. It is now mid-table and coming down. The people of Donegal are clearly doing an awful lot of hard work to get that figure down and that should be recognised.

I will write to the Deputy and give him a longer answer but the short answer is that the vaccination programme for hospitals is being done hospital group by hospital group. There are about 150,000 front-line healthcare workers in cohort 2 and by Sunday week, 70,000 of them will have been vaccinated. That is the pace we are looking to get through on the first dose. I will revert to the Deputy in writing with the rest of the information.

As the Minister has heard from all sides of the House, there is a huge gap in information on vaccines and the public is crying out for that information. The quicker we can provide that information and the more clarity that can be brought, the better for everybody.

I want to ask the Minister if he will commit to providing a number of pieces of information on vaccines. I fully accept that it is a fluid situation but will the Minister set out the current expectation and then that can be amended on a week-to-week basis? Will the Minister set out a schedule for the expected delivery of all vaccines over the first and second quarters? Will the Minister set out a schedule for the expected administration of those vaccines and for what cohorts are expected to receive them? Will the Minister set out the weekly deliveries of vaccines into this country and the numbers of people vaccinated? When will details be available on the registration process for those cohorts coming after the first two groups?

On current expectation, I want to provide as much information as possible for the same reason that we all want that information. We only have two authorised vaccines. We are looking to put in place figures that are reasonable as quickly as possible. There are ongoing conversations with the pharmaceutical companies and figures are moving around a lot but I take the Deputy's point. On the different cohorts, I will provide Deputies with the numbers in each cohort this evening. On weekly figures for vaccinations and deliveries, this weekend we will be putting up the weekly vaccination figures on the data hub. That will be updated regularly and then I want to move fairly quickly to updating that daily. There is no problem at all with putting up the figures for the weekly deliveries that we get in.

What about registration?

Does the Deputy mean the portal where people will be able to sign up?

It is being worked on at present.

There are many different factors at play including GPs, pharmacists, local clinical judgment, the protocols etc.

Has the IT system been sorted out? Is that ready?

The IT system is active at present through the long-term residential care and with the front-line healthcare workers. There is another piece to it, which we do not need yet but we hope to need very quickly, which is the portal. That will be ready very soon and certainly well before it is needed when the vaccination schedules increase.

I look forward to getting that information.

In relation to healthcare staff, they are all under enormous pressure at present. They are doing incredible work in extraordinarily difficult circumstances. There are two particular areas where they need the Minister's support. The first is in relation to public health doctors. Traditionally, they have been very badly treated in this country. They have been campaigning and have been made promises that their status would be upgraded. It is the only specialty that does not have the status of consultant. There is no explanation for that. They have the same qualifications as all other consultants. The Minister gave a commitment to address this issue. It has not yet been done. The doctors had to threaten strike action and, because the virus situation was so bad, they withdrew that. When will the Minister sort this out? The Minister has been making promises since he came in to office and he made many promises before he came in to office. When will the Minister sort that out? When will the Minister upgrade specialists to a consultant grade?

I agree they have been treated as the poor cousins in public health. I want to see them having consultant status. It is moving quickly. There has been much work done between my Department and the Department of Public Expenditure and Reform. Obviously, these are contractual. It is a very significant increase in pay and, as the Deputy will be aware, these issues must be syndicated at a Government level.

I can assure the Deputy that the threat of strike action did not speed things up. We were already moving on this. I would love to have had it over the line by now. It is a top priority and I want it done quickly.

With all due respect, there is vast amounts of money going into call centres privatising elements of this service. It is the public health doctors who are the people who know how to do the proper tracing and who know how to manage staff in that regard. Can the Minister give us a date when those promises will be delivered on?

We have run out of time. If the Minister has a reply, he may go ahead.

I will revert in writing if the Leas-Cheann Comhairle wants.

I thank the Minister.

I welcome this opportunity and put on record my thanks to those who are putting in superhuman effort to deal with this crisis. I include in that Ministers and their advisers and senior public servants who are making very difficult decisions in the face of this virus.

One of the biggest problems, apart from the virus itself, is the fear and isolation that are taking a huge toll on many people and it is important that we seek to build public morale at this time.

I am pleased that this debate has not all been about a blame game and criticising the weakness of plans. I think there is a realisation across the House that we are facing a situation where there is no manual. There is no accurate model, as we have seen, to predict how this will work. There are no pathways that avoid a very painful impact for different sections of our community. There is no nailed-down supply chain for the vaccine for which we all hope. It is important that we cut our decision makers some slack at all levels - in the vaccine roll-out, in the HSE and at local level in making decisions - because what we need here is people with the sense of confidence to act imaginatively and compassionately to deal with the challenges that they are having to face without having to look over their shoulder continually. That does not mean there is not accountability but it must be accountability that encourages people's willingness to be innovative, to learn from what is happening and to evolve policy as we gather experience.

As other Deputies have said, it is important that we get the information flow right. The approach of establishing Professor Brian MacCraith's task force with expertise from IDA Ireland and from logistics from the sectors was an important initiative. I refer also to the National Immunisation Advisory Council led by Professor Karina Butler. These are important and they inspire public confidence. Could the Minister arrange that they would have the same sort of daily or weekly briefings so that difficult questions could be responded to by these people in whom I have great confidence because that has been one of the successful features of Dr. Nolan and Dr. Holohan's work, and, similar, would instill the same sort of confidence in people who have their fingers on the various elements? This is not all about politics. Politics should not be making decisions about who gets immunisation first. By and large, these are not political decisions. They are technical decisions based on evaluation of evidence. I wonder, and would be interested to hear from the immunisation council, is age the most reliable determinant. I am surprised that there is not an attempt to identify vulnerable people other than by the age category at an earlier date.

The second question I would put to the Minister is, does he agree that there is a need to have deeper analysis of the collateral damage that Covid is creating outside of the virus itself, in mental health and in education? One of the worrying features in the past week or ten days is the Government's correct instinct to protect special education. It could not be done in practice because deep thought had not been undertaken and fully explored as to how that would be done. We cannot afford that. We need to have more deep investigation of these issues so that we can as the opportunities arise deliver in mental health, in education but also in economic spheres as we seek to reopen sectors of our economy. We can create nuanced responses to allow limited opening for the most important elements as that evolves.

These are my final questions for the Minister. Do we need to think about local escalation because there are patterns that are different so that there would be different levels of protection in different areas? Where stands the private hospital beds and the access? When, how and where will those become available as we see the build up of stress? Can the advisory council be part of the briefings?

I also ask the Minister of State, Deputy Butler, if there is any contingency funding available for community groups. There is one in my constituency, called Doing The Best We Can, based in Raheny, trying to provide support for mental health. Are there any contingency funds available for such groups which are trying to respond on the hoof to real problems that we could see supported?

I will take the last question from Deputy Bruton. I agree wholeheartedly with the Deputy that there is no manual for this and there is no accurate model. Those are fair words.

In relation to the contingency funding, the best I can say is if an application is made to the Department we will have a look at it. In the budget for this year, there was an extra €15 million allocated for Covid responses. That is the best answer I can give the Deputy.

I thank Deputy Bruton for his questions. I will try and go through them quickly. The Deputy asked can we arrange briefings on the vaccination programme. Absolutely. We had two briefings last week for the Oireachtas. We had one for party leaders. We had another for Health spokespersons. I hope the Deputy has been getting the regular updates from me which I have been sending out to all TDs and Senators.

I mean along the lines of those of Dr. Holohan.

That is something we can look at.

The determinant is not only age. There is the underlying medical conditions group, which is quite a big group. That was the recommendation from National Immunisation Advisory Committee, NIAC, based on the principles it put together.

Obviously many people are asking similar questions and want to understand why one group and not another is dealt with. It is the kind of thing that could be addressed by the type of briefings about which the Deputy spoke.

Do we need a wider analysis of the damage? I could not agree more. We measure this in terms of cases and, tragically, in terms of deaths. We need to know, however, about mental health, economic damage, social isolation and loneliness, as well as long Covid. There is more evidence emerging, particularly for younger people, that there are potentially long-term changes and damage for those who get through Covid. We need to be aware of all of that.

In terms of local escalation, the Government framework can be done county by county or region by region. Obviously, given where it is at, it is a national effort. I will revert to the Deputy with a note on the private hospitals.

There is no doubt but that Covid has shone a bright light on the inefficiencies of the health service. Years of underinvestment and systemic mismanagement are there for all to see. Up to 21,000 children are waiting for occupational therapy, 9,000 children are waiting for psychology treatment and 4,000 children are waiting for an assessment of needs, while an astonishing 41,000 children are waiting for speech and language therapy. Successive Governments have failed these children. Children are being moved from list to list without getting the treatment they need. It is an old-fashioned three-card trick, a sleight of hand of Government policy. Children are missing out on lost opportunities while their developmental needs are not being met.

These waiting lists were here long before Covid. While it might not come under the Minister's remit, many of these children referred to are now not able now to access special needs education. These children are not only not getting their long-term developmental needs met but they are missing out on vital daily education and routines. We have heard from parents that some of these children are regressing instead of progressing.

I, like many others, was shocked to hear that some of the specialists providing the treatments in question were moved from delivering them to contact tracing and community swabbing. These children were again abandoned. Up to 72,000 people applied to Be On Call for Ireland. I was one of them. I wanted to volunteer my previous experience of working with those with mental health and addiction issues for the common good. I, like 72,000 others, was prepared to put my shoulder to the wheel and do my bit.

Out of these 72,000 applications, how many of these could have been or were used as contact tracers and community swabbers? Why was the decision made to use specialists who provide life-changing treatment for children instead of using the pool of applicants from the Be On Call for Ireland initiative? What other alternatives did the Government consider? Will the 75,000 children in question get the treatment they need any time soon?

Only several weeks ago I answered the same question. In my opening statement, I stated that, under level 5, assessments of needs will continue, whether it is face to face or whatever alternative measures are put in place. That does not just mean assessment of needs. It also means all other interventions as well. I have secured support on that from the Minister, Deputy Donnelly.

I am delighted the Deputy brought up the issue of special needs schools and classes. I have a real concern about the regression of those children who do not get the routine and the intervention they need daily. I am equally dismayed and shocked by the stance the unions have taken. Perhaps they might reflect over the coming days on their intervention and what has happened to these children. We need to look at a whole societal approach. While we need to protect the staff, we also need to look at what effect regression is having on the children and their families.

Last November, I questioned the Minister on the cost of private hospitals to the State. He was quite honest about it. He said things would be done differently if we all had hindsight. Last year, the State paid €115 million per month for private hospitals, the equivalent of one third of €1 billion. That is to Larry Goodman and Denis O'Brien.

The Irish Nurses and Midwives Organisation, INMO, stated today that all private hospitals should be nationalised immediately because of the emergency. There is a new agreement with private hospitals that up to 30% of their capacity will be taken. We should not be negotiating prices about private hospitals. Instead, we should be commandeering them for this public health emergency.

Does the Minister stand by what he said in November about private hospitals, namely, that there should be oversight and things done differently?

Yes, I absolutely do. The new deal reflects exactly that. I want to reiterate that while I felt last year the deal did not work for anybody, there was no criticism of those involved for doing it, given the level of the crisis. I have said that many times previously.

We did need to learn from that, however, and do it better. This deal works for patients first and foremost and for the State better. If and when the State needs to use the capacity, then we pay for it. We are avoiding exactly what the Deputy and I have discussed before, namely, these vast payments which essentially emptied out the hospitals with some hospitals left completely empty. That is not going to happen again.

The hospitals will continue using their capacity. The State will use the capacity for public patients as and when we need it. The VHI pricing for that, an established pricing mechanism, is being used. Critically, if we need over 30%, which we well may need, there is a clause in the contract whereby the amount the State uses can be expanded in agreement with the private hospitals.

Today we had 63 notified deaths, almost 2,000 people with Covid in our hospitals and 172 in ICU. The Minister now oversees the health service in the country with the worst rates of Covid infection in the entire world. It is worse than Trump's US and Johnson's Britain.

All of this was predicted. It is the direct consequence of the deadly mistake that the Minister made to ignore the public health advice that he got. Does the Minister accept responsibility for the terrible state of affairs in which we are? Will he learn the lessons from it?

I and the rest of the Government accept responsibility for the decisions we make. Every Government must accept responsibility for the decisions it makes. Was this predicted? Absolutely not. The worst-case scenario we saw was a R value of 1.8. Last week, the R rate was calculated at between 2.4 and 3. The Deputy is entirely wrong, however. When the Government decided to move from level 5 to level 3 on 1 December, it was in line with NPHET's advice. NPHET said to go to level 3 and keep hospitality closed but open up households. The Government said we are going to move to level 3 and do that the other way around. Accordingly, we had a 3A and a 3B level. Nobody knew about the variant. We found out about the variant on the Friday before Christmas.

That was when the UK Government said it had a very serious problem. We worked through that weekend and on the Monday, before NPHET met but in consultation with the Chief Medical Officer, CMO, the Cabinet Covid sub-committee met and agreed to move the country to level 5. These are the facts. I know it does not suit the Deputy's political narrative but-----

On a point of order-----

It is not a point of order. These are verifiable facts available to the Deputy and to everybody else.

On a point of order, the Minister is lying. He is telling bare-faced lies. The Government-----

I ask Deputy Paul Murphy to resume his seat.

I have a point of order. The Minister told bare-faced lies.

It is not a point of order. The Deputy has interrupted the Minister and accused him of telling lies. That is not acceptable and it is not a point of order. It is simply not. I ask the Deputy to withdraw the remark.

He did lie to the House.

The Deputy is repeating it and that is not acceptable. It is not a point of order. I will move on and leave the matter. The Deputy might reflect on his use of language.

May I get a correction on the record?

I have a number of questions to pose and I ask the Minister and Ministers of State to engage with me on an over-and-back basis. I commend the effort. Earlier, I spoke about the immense effort being undertaken by our front-line health services. I now want to speak about Covid vaccinations and the immense effort being made to roll them out. With regard to vaccinations for GPs, in Clare, we are watching how GPs in other counties are getting the all-important Covid jab. In recent days, I have seen how Bantry General Hospital in Cork was bringing in GPs from the local area to inject them with the Covid vaccine and put them safely back into the community. This is not happening in County Clare, where GPs are being told it could be February, perhaps even late February, before some of them will be vaccinated. Will the Minister update me a little on this?

Like the Deputy, I have been contacted by many GPs throughout the country very reasonably asking the same question as to when they will be vaccinated. Not only are they front-line workers, they will also be involved in the vaccination programme. There are 150,000 front-line healthcare workers in the second prioritisation cohort. They include GPs and many others who work in hospitals and throughout the community. As a result of this, some GP vaccination has already started and more will be starting in the coming days.

Where we are right now is that by Sunday week we will have vaccinated 140,000 people. This will include just over 70,000 individuals who are in long-term residential care and approximately 70,000 front-line healthcare workers. We will have got out almost all of the vaccine that has come into the country. We have reduced the buffer. At first, Ireland and most other countries decided to keep the second dose in reserve because there were questions about supply chains. That very quickly improved and we moved down to holding just one week's supply. As a result of the urgency and because of the very positive supply chain deliveries we have had, we are reducing the buffer to approximately 2.5 to three days. All front-line workers can know they are being prioritised. Half of the vaccinations are going to front-line workers, including GPs, and the number we are aiming for is 140,000 by Sunday week, which is approximately a week and a half from now. Specifically, which GPs in which towns, villages and counties will be vaccinated is an operational decision for each of the hospital groups.

We see other hospital groups, such as that in west Cork, bringing in GPs but it is not happening in Clare. They will have to wait an awfully long time. I know it is an operational issue but I ask the Minister to look at it. With regard to vaccinations reaching hospital groups, we were all delighted to see vaccinations been rolled out in Dublin in recent weeks but it took two and a half more weeks for it to come to the mid-west group of hospitals.

A nursing home in County Clare has a Covid outbreak. All of the patients there were tentatively waiting for a vaccination date but now it cannot happen. How will it be rejigged? Perhaps the Minister of State, Deputy Butler, will respond briefly.

I thank the Deputy for the question. The situation in respect of nursing homes is that we have 111 nursing homes with Covid outbreaks at present, with 72 of these occurring in the past seven days. It is very serious. With regard to vaccination in a nursing home, if there is a small outbreak that is very controllable it will continue but if there is a significant outbreak the best practice is not to continue. We cannot give the Pfizer-BioNTech vaccine to a person who has Covid. The person has to be clear of Covid for 28 days. If a situation arises whereby vaccination cannot proceed in a nursing home, it will go ahead when the staff and residents are able for it.

Has the Minister, the Taoiseach or anybody on behalf of the State been in contact with the CEOs of Moderna, Pfizer-BioNTech, AstraZeneca or Johnson & Johnson to acquire supplies additional to those being delivered via the EU scheme?

There is ongoing contact at the appropriate level, which is task force level, between the State and the pharmaceutical companies. However, let us be very clear. If Ireland went on its own and tried to secure volumes of vaccine, as a tiny country in a highly competitive global market right now, we would not do very well. What we are doing is working as part of the EU. The EU has supplied significant quantities and they are being distributed pro rata. Ireland gets 1.11%. The total amount we have now signed up to is a little in excess of 14 million doses of vaccine.

I will take that as a "No". The Minister indicated that there was contact at the appropriate level but then went on to say that the EU is doing a great job and we will be doing well. Earlier, he stated that there will be 50,000 vaccinations a week. If that is the limit we are tied to then, as I said earlier, it will take us two years to inoculate everyone. I respectfully suggest that the Minister or the Taoiseach lift the phone because that is what I would do. If the Minister decides that Ireland is a small country and will not get the vaccine anywhere else, then he will be right that we will not. I would lift the phone to Stéphane Bancel of Moderna, Albert Bourla of Pfizer, Pascal Soriot of AstraZeneca and Alex Gorsky of Johnson & Johnson and ask how much do they want because we are prepared to pay and that Ireland is putting Irish citizens first, just like Germany and Israel are doing as regards their citizens. As the Minister's party colleague, I appeal to him to shelve the good European line just for once. We will pay for whatever they give us but let us look for more for our people.

My next question is not related but it is very important. In the post-Brexit scenario, it seems that under the cross-border directive, pre-authorised patients in the Republic seeking various surgeries in the North for which they were preapproved are now being told by the relevant section of the HSE in Kilkenny that it is awaiting a policy decision from the Department of Health and that until it gets that decision, it can do nothing. The Minister is aware, as are all Ministers and anybody in the business of politics, that people have taken out credit union loans and borrowed from family to arrange their procedures in the North under the cross-border directive with pre-authorisation from the HSE. Now we are welching on it because we are waiting for a policy decision from the Department of Health. We all celebrated a Brexit deal. It would not look like much of a deal to me if I had booked into a clinic for a procedure for which the HSE was going to reimburse me and I borrowed from the credit union or family members to pay for it and now the HSE is saying it is waiting for a policy decision. Let us up the game, take the policy decision and ensure that patients are getting what we told them we would provide.

I thank the Deputy. Moving on-----

A Leas-Cheann Comhairle, two seconds.

I am sorry, Minister-----

No, sorry, a Leas-Cheann Comhairle. I am responding to this, with respect. It will be one sentence and I am responding. Deputy MacSharry-----

Minister, please, I have already taken one Deputy to task. You do not tell the Leas-Cheann Comhairle what you are doing. The ruling from me is that we are sticking to the time. If you seek permission by way of exception I might accede to that but I ask you to have a little respect for the Chair, not a finger-pointing exercise. I am giving you 20 seconds to answer.

Thank you, a Leas-Cheann Comhairle. I would note that when you were on the floor-----

Would you please reply?

-----you were given a lot more than 20 seconds.

I am going to stop now and move on because the Minister has not used his-----

I am sorry, Minister. I am moving on-----

On a point of order-----

What is the point of order?

I propose a very small amendment to the Order of Business to permit the Minister of the day to answer a question. I am sure we will get a seconder.

Would anyone like to second that? The idea that-----

Would the Deputy please resume his seat? I have been more-----

It makes a mockery of this House.

Deputy, could you please resume your seat?

(Interruptions).

As an outspoken Deputy-----

Deputy, would you please resume your seat?

(Interruptions).

That is not a point of order. I have been more than flexible in my time. I am now moving on. If at the end some Deputy decides not to use all of his or her time or if the Ministers are quicker there might be some time available. I call Deputy Darren O'Rourke.

In fairness, the Leas-Cheann Comhairle did provide the Minister with some time to respond but he did not use it. That was the way I saw it.

I want to focus my contribution on the issue of travel restrictions onto the island and into the State. At the outset I want to highlight that in our opinion the checks at our ports and airports today are wholly inadequate and have been since March. I welcome the announcement last night that a negative or not detected PCR test would be required for people arriving from all countries. That is an extremely late development but nevertheless it is an improvement.

Since last March Sinn Féin has been asking the Government to bring in strict checks and controls at our points of entry but successive Governments have resisted it at every opportunity. Month after month various spokespersons, myself included, have asked for airport testing, a robust passenger locator form and follow-up and it has not happened. As a result of that our points of entry have become a weak point in the national effort against Covid-19. We were forever getting lectures about the nature of testing, false negatives, false positives and the assessments that were being conducted of testing regimes but we had no action until we had 6,000 cases a day. That is a bad way to do policy.

The truth of the matter is that the measures announced last night should have been introduced a long time ago. If we were to listen to the European Centre for Disease Prevention and Control, ECDC, we should have introduced them when the numbers were low. That is when checks and controls at our ports and airports are increasingly effective and important. That said, while the new PCR testing requirement is extremely late in the day it is welcome but more needs to be done. Foreign travel must be restricted to only those cases that are essential at this time.

Sinn Féin firmly believes that testing post-arrival should be mandatory as the current voluntary system is insufficient. All the Minister has to do is listen to himself and his Government colleagues in respect of what he said about a pre-departure test. He said that a single negative PCR test, whether taken prior to travel or on arrival, does not exclude the presence of disease due to the incubation period. That was true then; it is true now. I appreciate that there are additional regulations in respect of quarantine but in truth they are not being implemented. We do not have a monitored quarantine or self-isolation regime. We do not have adequate follow-up on our passenger locator form. When I submitted to the transport committee that only 18% of people received a follow-up call for their passenger locator form NPHET queried it and I had to show it that it was the Minister's Department that confirmed those statistics. It is wholly inadequate. We need a post-arrival PCR test. We need monitored and rigorously tracked and traced follow-up of the passenger locator form or we will continue to have a weakness at our ports and airports.

Deputies have a choice whether to use their time for statements or questions. I do not mind. It is entirely up to them. The next speaker is Deputy Denis Naughten who has six and a half minutes.

Last June I wrote to the Minister's predecessor pointing out that Portiuncula University Hospital, Ballinasloe was in a desperate situation because it has lost 10% of its acute hospital capacity due to Covid-19 configuration. The hospital was very proactive. It put forward two very specific proposals. The first was to develop two separate modular buildings, one for an accident and emergency department that could segregate Covid and non-Covid patients. The second modular building was to take the outpatient department out of the acute hospital and convert the old outpatient department into 13 single rooms. Currently, Portiuncula hospital, which is one of the biggest acute hospitals servicing the midlands, has only 13 single rooms. It is down 10% in terms of its capacity. Last week the daily average of patients on trolleys overnight was 13.

While funding has been forthcoming for the modular building for the outpatient department no refurbishment work has taken place of the old outpatient department and no funding has been provided for the second modular building for the accident and emergency department. As a result of that, the hospital is operating at 10% less capacity today with just 13 single beds. It is not in a position to manage the pandemic and the challenges that currently exist. Will funding be provided to expedite the refurbishment of the old outpatient department? Will funding be provided to ensure that we have a modular building to deal with the chaotic situation we currently have within the emergency department?

I will revert to the Deputy with a note on exactly that. It is a very specific question around a very important capital build and capital refurbishment so I will revert to him with a note on it.

I thank the Minister. I turn to the vaccination issue. First, as he knows the Oxford-AstraZeneca vaccine is likely to be approved at the end of this month but we need to see that particular vaccine distributed in advance of the EU approval to GP surgeries so that the administration of the vaccine can take place the following day. Can the Minister assure me that that will happen? Second, by the end of February it is hoped we will have four vaccines in use. Three of them will require two shots but today we are still using a paper based system. When will we get the fully electronic system? When will the GP IT system be fully operational, which it has not been up to now? That is causing confusion and, importantly, good records are vital to identifying and tracking any adverse reactions that may arise in respect of any of these vaccines.

I thank the Deputy for the questions. The most important thing for all of us to understand, and I have asked the question myself on the IT system, is that a very complex IT system has been put in place that did not exist previously. Due to a lack of investment in public health in the past we did not have an existing national vaccination IT system and that has now been put in place in record time. Critically, none of the IT development is slowing down the vaccination programme. In some cases, as part of the data gathering, people are inputting on paper and that is then being entered into the IT system. It is not causing confusion to the best of my knowledge. It is requiring some data entry but, importantly, it is not slowing down the vaccination programme.

With regard to the GP system and the wider portal for the public, which will become very important, the system that is required for what we are doing now was delivered around 29 December - I cannot remember the exact date.

Additional functionality is being added but it is not needed yet. We are in a targeted phase of the programme, involving front-line healthcare workers, nursing homes and other long-term residential care facilities. The portal and other functionality are being put together and I am told they will be ready well in advance of when they are needed.

The fact is that we are using sheets of paper to record vital data that are needed to track adverse reactions. I took this issue up with a predecessor of the Minister, the current Taoiseach, 18 years ago and the Minister is telling me that we still do not have an IT system in place. When will we no longer be using pen and paper to record the numbers of patients being vaccinated? As the Minister knows, some of our hospitals complained in the past that they did not have enough bins available to them for PPE. There has not been capacity to manage the amount of PPE waste that is being created. With such a high rate of infection in the hospitals, this gives rise to significant concern if we are not able to manage the used PPE. At present, there is an industrial emissions licensing application with the Environmental Protection Agency, EPA, to ensure that a system can be put in place to deal with PPE on-site. If I provide the Minister with the detail after this debate, will he intervene with the EPA and plead with it, in the interests of the patients in hospitals across the country and the staff working in those hospitals, to approve this licence once and for all and allow us to protect people who are using our hospitals?

There has been a significant increase in the incidence of Covid-19 in nursing homes, in which tens of thousands of people live day-to-day. If the vaccination date is, for example, next Tuesday and there is an outbreak before then, what happens? The Minister said if there was a small outbreak, vaccinations could continue but there is a question mark over cases of large outbreaks. There needs to be absolute clarity. I ask the Minister to ensure that all residents are tested if there is an outbreak. Anybody who has a negative test should get the vaccine, with no ambiguity or doubt.

I welcome what the Minister of State, Deputy Butler, said, that nursing homes must continue to play their part in having robust contingency plans in place and dealing with issues related to infection control and so on. Is she satisfied that all nursing homes are taking all of the assistance and meeting all of the requirements that they are obliged to?

My last question may require a written reply. The St. John of God service has residential units in County Louth and some in County Monaghan. It has about 400 people, some over 65 and some under 65. The over-65s thankfully have a definite date by when they will be vaccinated but I do not have clarity about the under-65s or about the staff. Will the Minister examine that issue and respond?

I thank the Deputy for his questions and continued interest in the nursing home sector. I reiterate the plan is to vaccinate in all 585 nursing homes, with 70,000 staff members and residents, by Sunday week, with the first dose of the BioNTech vaccine. I spoke to Brian MacCraith, the HSE and the Department about this last week and we had a meeting which the Minister, Deputy Donnelly, was at last Friday. If there is a small outbreak, we will proceed as planned. However, if there is an outbreak among 50 residents, and more than 80% have Covid, a decision may then be taken with regard to health and safety. The decision will be taken by medical people and the HSE. The co-operation between Nursing Homes Ireland, which represents 80% of nursing homes in Ireland, and the voluntary and community sector is at an all-time high. Everything that can be done for nursing homes is being done. There are significant challenges regarding staff. Some 890 staff from the nursing home sector are currently out because of Covid, which is a significant challenge.

I do not have an answer about St. John of God. Perhaps we can come back to the Deputy in writing.

I accept that there may be public health issues and I acknowledge them. However, if people in a nursing home do not have Covid and their vaccination date is due, and one can be assured by testing that they do not have Covid, it is essential that they get that vaccination.

Another issue that arises is if a substantial proportion of the staff have Covid too. The main aim is to vaccinate everybody in the nursing homes as quickly as possible. We have some critical levels in nursing homes at present. If over 80% of staff and residents have Covid, it is hard to organise provision of the vaccine. The plan is to do it as quickly as possible and I agree with the Deputy.

On the roll-out of vaccines to GP practices, a number of GPs from my constituency in Limerick have contacted me in recent days. I have been in contact with the Minister's office. GPs in Cork and Kerry have got the vaccine, as have many GPs in Dublin. There appears to be significant inconsistency in the roll-out of vaccines to GPs. Who is responsible for the roll-out of vaccines to GPs? Is it community health services or University Hospital Limerick? Will the Minister look at having a national roll-out of the vaccine to GPs and their practices? They are on the front line. The people who refer people for Covid-19 tests are GPs. They are on the front line. It does not in any way take from other healthcare workers. Some 1,100 vaccines are coming into Limerick on Thursday. Only 300 of those are going to community health services. In our case, we have such a high rate of Covid that while I understand they have been dispersed based on population criteria, surely there should be an element related to risk too. That is a significant factor for GPs. Will there be a national roll-out for GPs, including in Limerick? Why are GPs in Cork and their staff vaccinated while GPs and their staff in Limerick are not?

The roll-out to front-line health is an operational decision which has been given to each of the hospital groups. Therefore there may be GPs vaccinated in one county or city in the same way that residents in one nursing home might be vaccinated a week or two before another, or that nurses and doctors might be vaccinated in one hospital before another, or indeed colleagues in the same hospital. There is a national roll-out programme. It has started. GPs are part of the front-line healthcare worker group, which is the second cohort. They are very high priority. There are approximately 150,000 front-line healthcare workers, including the GPs. The plan is to have vaccinated 70,000 of the 150,000 with the first dose by Sunday week. On day 22, the teams cycle back for the second dose.

The Minister has not answered my question. How can GPs in Cork all be vaccinated out of the South Infirmary and Bantry and people in nursing homes be vaccinated, while GPs and their staff on the front line in Limerick are not? The roll-out is inconsistent. Will the Minister look at putting in place a national roll-out specifically for GPs to ensure that there is consistency of treatment throughout the country?

That is of great importance. There were other questions I wished to ask. The vaccine programme is a ray of light. It will bring us out of this pandemic but there must be consistency of treatment throughout the country, particularly in respect of GPs and their staff. Once again, I ask the Minister to give consideration to a designated roll-out for GPs and their staff as part of the vaccine programme in order that there is consistency in the treatment of GPs and their staff nationally, including in Limerick city and county. I ask the Minister for a brief response.

The time has been used up. I am trying to be consistent. At the end I will offer the Minister a minute or two if he wishes to come back on a few of the issues. I am sticking to the time limit as best I can. If the Minister wants to give a "Yes" or "No" answer, he can. He is not in a position to do so.

I ask the Minister why he refused to seal the airports and ports. He knows from his previous meetings with our group that I, as leader, have been asking why the ports were not sealed. It is now being done from 16 January. The Minister is closing the stable door when the horse has bolted. I believe that 54,000 or 56,000 people arrived here from England over the Christmas period and none of them were asked to do anything. Now the Minister is proposing to prosecute the people and we have a mess.

On the issue of international travel into the country, Ireland signed up to the EU-wide approach, namely, the traffic light approach. In common with all the other member states, we implemented that approach. On airport testing, the consistent public health advice is that it is not the right way to proceed. It is not recommended by the WHO or the ECDC. The firm view of our public health experts is that it is not the right way to test. The current situation is that inbound travellers, whether at airports or ports, cannot come into the country without a clear PCR test done up to 72 hours before travel. If they arrive without that, they are subject to prosecution and face a fine of up to €2,500 or six months in prison or both. On top of having a clear PCR test, those coming into the country must restrict their movements for two weeks. They need a clear PCR test on Day 5 and if they get that, they can be released from the two-week movement restrictions. Therefore they need to provide the results of two PCR tests, done between five and eight days apart, both of which must be negative. The situation for Britain and South Africa is different, in that two weeks mandatory self-isolation is required, regardless of any tests.

It is fair to ask whether we put the travel measures into place quickly enough, particularly in light of the emergence of the UK variant. I will outline the timeline in this regard. On the Friday before Christmas, the UK Government issued a warning stating that there was a highly contagious variant present in the UK. We worked through the weekend. Our public health officials were in touch with their UK counterparts and I was in touch with mine. On the Monday, the Covid committee met and recommended an immediate ban on travel from Britain, which was then extended to South Africa, based on the emergence of the South African variant that has also been detected here.

I wish to raise the issue of St. Brigid's hospital in Carrick-on-Suir. It was commandeered by the last Government at the start of the last outbreak and was deemed to be fit to serve Covid step-down patients. I note that the Minister of State, Deputy Butler, is present. Why was the hospital closed in the middle of a pandemic? Why did the Minister of State refuse to meet her own colleague, Councillor Kieran Bourke from Tipperary, in relation to the issue of the closure of the hospital? It is a wonderful institution, as the Minister of State knows well. Why has the rug been pulled from underneath it? Why are people being denied the services they need? I do not want to hear anything about diabetic clinics. How was the hospital deemed suitable for treating Covid patients when it is not now deemed suitable for patients convalescing?

St. Brigid's hospital was built in 1837 in Carrick-on-Suir. It was a long-term residential care home that used to be home to between 16 and 18 residents. The care that was delivered there was always exceptional. I do not live far from the hospital. HIQA flagged issues with the hospital in 2018. These issues included the age of the building, the fact that there was only 76 cm between the beds on the two five-bed wards and the fact that there were no shower facilities on the men's ward.

I wish to make a point of order.

I would like to be able to answer the question.

That is not the question I asked. I said-----

The Deputy can come in if he lets the Minister for State finish.

HIQA determined that the facility would not receive registration going forward under infection prevention control and due to the fact that it could not guarantee patient safety. The decision was taken by the HSE that the facility would no longer be used as a residential centre but it is going to be recalibrated into a community healthcare network. Seven new jobs will be created and the building will be used as a facility for people with long-term conditions such as diabetes, asthma and chronic pain. Work has started to reconstruct the premises and the seven new jobs have been advertised.

Why did HIQA deem it to be suitable for step-down patients during the Covid pandemic and then decide that it was no longer suitable?

The Deputy is not making a point of order. While the Deputy may be unhappy that his question has not been answered, he did not make a point of order.

One of the key recommendations of the Covid committee, of which the Minister was a member, was that in the long term, we should move away from care and congregated settings to care in the community. Rightly, those in congregated settings are a high priority for the Government's vaccination programme. The Minister may correct me if I am wrong but I do not see any mention of those who are in receipt of home care. They have a vulnerability over and above elderly people generally, because two or three different carers are coming into their homes every day, and those carers are also visiting many other homes every day, by necessity. Will this group be prioritised in the roll-out of the vaccination programme? Deputy Michael Fitzmaurice also wants this question answered.

The Deputy has asked a very fair question. My own granny is about to turn 102 and has carers coming into her house. I want to know when she and her carers are going to be vaccinated. The key is to protect the vulnerable person in the home, more than the carers coming in and out. The key is to vaccinate people like my granny, quite frankly. The answer lies in the prioritisation. For example, the third cohort is those over the age of 70. Based on the schedule that I laid out before the House earlier today, the population over the age of 70 will be vaccinated within the next 11 weeks.

I am sorry to cut across the Minister. I accept that those over the age of 70, and those in nursing homes should be prioritised, and I agree with that. Will there be a prioritisation for persons who are in receipt of home care because of their unique vulnerability? It is a "Yes" or "No" answer.

I will ask a couple of other questions because of the propensity to develop a narrative. I do not disagree with that; it is just that my time is limited. Antigen testing is something that I have called for in the past. I am not saying that it should replace or supplant PCR testing but I am asking whether the Government will consider the roll out of more antigen testing for travellers and the general population, in order to ascertain whether they pose a risk. The European Commission has recommended it and we seem to be laggards in Europe in that regard.

I also want to raise the issue of blame generally. Like everyone else, I am hugely concerned about the Covid figures. There is a tendency to blame people, and that concerns me. I worry about the effect that will have on society. Where is the flu this year? A small minority of people behaved recklessly, and I do not condone that in any way. If the population or indeed, the Government behaved as recklessly as some would suggest, then where is the flu? Clearly the social distancing measures such as the wearing of masks etc. seem to be having an effect on the flu. Lastly, in the event that there is a flu pandemic this year, as there is every year, are we prepared?

I have put four questions to the Minister.

I have written down three and will do my very best to answer them. In regard to the situation of people in receipt of carer services, I am not trying to obfuscate. I am trying to make the point that it is not a question with a "Yes" or "No" answer. NIAC has given a prioritisation process and some people in receipt of carer services will be higher up or lower down that list. Being over the age of 70 will have a person in one group and having an underlying condition will put one in a different group. People can be in receipt of carer services and fit into neither of those categories, in which case they will be in a different group again.

Does that apply to people who have carers coming into their homes?

Yes. Is that not the question the Deputy was asking?

In terms of rapid antigen testing, I fully agree with the Deputy. I want to see more of it. It is already being deployed, including in Letterkenny and in healthcare settings. We are working on other places where it can be deployed. I note, for example, the very wide use of it in the UK and we are exploring how it can be deployed here. I agree wholeheartedly that it is not in a place where it would replace PCR testing. It is to be used in places where we would not otherwise use PCR testing.

What was the Deputy's third question?

What is the situation regarding the flu virus this year? Does the Minister anticipate that the flu will come here? If it is not here, why is that the case? Is it because people have behaved reasonably responsibly?

I do not know where the flu virus is. I do know that it is not here, which is fantastic, and that the position is the same in other European countries. I am not really qualified to answer the causality on this but my best guess would be a combination of, as the Deputy said, the use of masks, basic infection prevention and control and the biggest flu vaccination programme we have ever had. I would say it is a combination of things. Thank goodness it has not arrived here.

I said I would come back to the Minister if he needed a little leeway at the end.

I thank the Leas-Cheann Comhairle but I am fine.

Sin deireadh leis an seisúin seo.

The Dáil adjourned at 7.22 p.m. until 12 noon on Thursday, 14 January 2021.