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Dáil Éireann debate -
Tuesday, 13 Jul 2021

Vol. 1010 No. 4

Ceisteanna ar Sonraíodh Uain Dóibh - Priority Questions

The Minister for Health will make a brief statement for the information for the House.

I thank the Ceann Comhairle for allowing me to update the House on my Department's processing of parliamentary questions since the cyberattack on 13 May. Parliamentary questions are a core part of how democratically-elected representatives seek information from Ministers on behalf of the people of Ireland. The cyberattack caused severe disruption to my Department's parliamentary question process and I fully understand that this situation has been very frustrating for Deputies. I wish to assure colleagues that we are determined to get everything back on track as soon as possible. I thank colleagues for their ongoing support and patience as we continue to work towards this goal. It is important to note that my Department is routinely assigned the highest number of all parliamentary questions tabled. The Department of Health, for example, received 25% of the 30,000 parliamentary questions tabled in the first half of this year. To put that into context, the Department of Education came second with 9%.

As colleagues will be aware, a significant proportion of parliamentary questions assigned to my Department are referred to the HSE for direct reply. Following the attack, the HSE shut down all of its ICT systems, including email and its ICT links with the Department. As a result, HSE systems were not able to receive or process referred parliamentary questions. The HSE has advised that while the restoration of HSE staff email, which is critical to responding to parliamentary questions, is taking place on a phased basis, problems still remain in some areas. Furthermore, discussions are ongoing between my Department, the HSE and the Office of the Government Chief Information Officer in order that links can be safely restored between the Department and HSE ICT and parliamentary questions can be securely processed and answered by the HSE. I am informed that good progress is being been made and anticipate that connectivity will be in place shortly.

As parliamentary questions continued to be submitted immediately after the cyberattack, a backlog has developed, which my Department is working to tackle. As soon as it became possible to transfer parliamentary questions to the Department, which was two weeks ago, the Oireachtas Questions Office transferred batches of 100 to 150 per sitting day. This will increase to 200 per day from next week. As it stands, because of all this, there are approximately 1,400 parliamentary questions on hand, which the Department is in the process of answering. While steady progress is being made, as Deputies will understand it will take some time to process responses to these questions. I ask Deputies for their continued understanding and forbearance in this regard.

I thank the Minister. We now proceed to Priority Question No. 33 in the name of Deputy Cullinane.

Hospital Overcrowding

David Cullinane


33. Deputy David Cullinane asked the Minister for Health the level of overcrowding in hospitals; his plans to expand hospital capacity in the coming months; and if he will make a statement on the matter. [37545/21]

My question is about overcrowding in acute hospitals. I am sure the Minister will have seen the repeated warnings from healthcare trade unions over the past number of weeks to the effect that hospital overcrowding is very close to being back at pre-pandemic levels, which is unacceptable.

We know overcrowding in hospitals is a symptom of a wider problem with regard to a lack of capacity. What are the levels of overcrowding in hospitals? What is the Minister going to do to increase capacity in our public systems to reduce overcrowding on one hand but also reduce unacceptably high wait times?

I thank the Deputy for raising this very important issue. I acknowledge that our hospital system is facing challenges and has been close to full capacity in recent weeks.

It is very important to acknowledge this has caused distress for patients, their families, and of course for our frontline healthcare workers who are working in very challenging conditions.

Attendances at emergency departments, EDs, have increased steadily since the beginning of the year and were almost back to 2019 levels, for the same time that year, just before the ransomware attack occurred in May. The last year with which reasonable comparisons can be made is 2019 due to the unusual attendance patterns in 2020. The HSE has estimated that for the week ending 4 July attendances were up 12% on the same time in 2019. There are a number of reasons for this, including the opening up of society as Covid-19 restrictions are lifted and additional GP referrals due to issues accessing diagnostics arising from the ransomware attack. The increased attendances, Covid-19-related patient safety protocols, and manual workarounds and reduced access to diagnostics due to the ransomware attack, have all been contributing to slower progress of patients through the system. The Government has funded significant initiatives across the health service to expand capacity, including, as Deputy Cullinane and I have discussed before, the €600 million invested in the last winter plan. It is worth noting that in spite of all the pressures Covid brought to bear over the winter, thanks to this very significant investment and extraordinary work right across our healthcare system, the ED attendances for the winter, which arguably should have been the highest on record, were the lowest on record. I credit everyone in our healthcare system who contributed to that. I have more I can share with the Deputy in the follow-up.

It is the case that overcrowding is becoming a problem in hospitals again. That was always going to be the case as we came out of a very difficult time for those who work on the front line. I acknowledge that, as the Minister said, it a has been a very difficult year for those on the front line because of Covid on the one hand, which led to the cancellation of much non-essential healthcare and a slowing down at times of essential healthcare and then on the other we had the cyberattack. However, the waiting lists were a problem long before the pandemic and overcrowding was a problem long before the pandemic. While the Government did make substantial additional investment available to the healthcare system last year in the budget, if one tries to find out how many of the beds were delivered, be they acute beds or community ones, it is very difficult to get the answers. Maybe that is down to the cyberattack but I would like it if the Minister was able to share that information with us.

For the Minister's information, next week I will be launching a document myself on how we can reduce waiting lists. The Government often asks where the Opposition's solutions are. I have some of those solutions in the document. I will ensure the Minister gets a copy of this and would like to see him bring forward his plan for how we are going to reduce waiting lists in the time ahead.

I thank the Deputy. I look forward to seeing the document. Nobody has a monopoly on the solutions to this so I very much look forward to seeing the proposals. To respond directly to the Deputy's question, through the winter plan and this year so far, an additional 834 acute beds have been delivered, with another 229 expected this year. In addition, 73 sub-acute beds have been added with 40 more planned for this year. There has also been substantial funding to increase home support hours, as the Deputy will be aware. The strategic plan for critical care is now in place. It aims to increase ICU capacity to 321 by the end of this year and to 446 in the longer term. The €52 million provided for implementation of this plan will allow for an additional 66 beds to be put in place. The HSE has advised that 42 of those 66 beds are now open, bringing our baseline capacity to 297 beds as of right now.

If the Minister could send on all of that information it would be very helpful. However, an awful lot of what was promised has not been delivered. I accept what he outlined is additional capacity and that it is going to make a difference. Any additional beds and any additional staff member in the health services is something I will welcome but as I have said to the Minister on a number of previous occasions, the problems are not just ones of capacity, although that is one part of it. Structural changes must also be made, though capacity is critical. I want to see, for example, the introduction of unique patient identifiers so that we have a system that can actually speak to itself and which is integrated. I want to see an integrated waiting list system. I also want to see hospital consultants having access to diagnostic equipment. We know much of that equipment is antiquated and must be replaced. We also know they struggle and fight to get access to theatre space and we must expand capacity in that area. Last year's budget was light on capital investment. We must also follow through on all the commitments that were made, which were substantial but not all of which were delivered upon, especially in the form of beds and staff, which is the critical part. It is one thing to promise; we must deliver.

I must say I agree with much of what the Deputy has just said. On building up the acute capacity, it is the biggest expansion in a single year ever to have been attempted, as far as I am aware, and the reports back from the HSE are very positive. On the Deputy's point, there are areas where the planned expansion is not on target, largely because of Covid and the cyberattack, and obviously it has been a very difficult year. However, specifically on what we are talking about, there is really good progress and they are doing really well. The Deputy quite rightly referenced access to diagnostics. One area we have invested a lot in this year is access to diagnostics for GPs, which obviously takes some of the pressure off the acute system. The feedback I am getting from GPs, where that has been invested in, is very positive. It is keeping patients in their community for treatment. It is really a matter of doing all this so that the patient pathway the whole way through is increased so people can stay in the community and if they do need to go into hospital, they can get back out to the community as quickly as possible.

Covid-19 Tests

Verona Murphy


34. Deputy Verona Murphy asked the Minister for Health the current capacity of the Covid-19 test, trace and isolate system; the number of contact tracers currently in place; and if he will make a statement on the matter. [37673/21]

Will the Minister detail the current capacity of our Covid-19 test, trace and isolate system, state what number of contact tracers are place and give us details on these matters?

I thank the Deputy for her question. In line with the evolving public health policy advice, the HSE has put in place a comprehensive, reliable and responsive testing and tracing operation. Testing and contact tracing continues to be an important element of our response. Our current swabbing capacity is 175,000 tests per week. Demand for testing and tracing is high, as the Deputy will be aware, but every test centre around the country currently accepts walk-ins, which is being very well-received in communities around the country. Alternatively, a test can be booked on the new online booking portal for any nearby test centre, so it is very accessible right now. Contact tracing centres operate 12 hours a day, 7 days a week and are fully-rostered every day. The dedicated workforce, now totalling 930 contact tracers, has been really important to ensuring adequate capacity for contact tracing up to 1,600 detected cases per day. This involves full data gathering and phone calls to all cases and their contacts. The service can now deploy digital mechanisms to significantly increase capacity and continue to contact trace through surge periods if the daily rate goes above 1,600 cases a day.

The testing and tracing programme undergoes continual evaluation and development in response to changing demands and evolving evidence. The HSE has been provided with resources to maintain a robust testing and tracing system to meet ongoing demand. It ensures that its potential to detect and mitigate the impact of the virus across the population is maximised.

I thank the Minister. On 8 May 2020 I requested from the Tánaiste a road map for testing and tracing. He was acting Taoiseach at that time and said he would indeed ask the HSE to produce a road map and on 14 May we saw the road map. He said:

Our mission is to get people back to work, get businesses open again and get the economy humming so that we have the resources we need to build a better society... [W]e will maintain an intense focus on the virus and follow four guiding principles: isolate, test, trace and treat, so that we can quickly react if things go wrong and if [we see] an increase in cases... The crucial thing is to keep doing the right things, to stick to the strategy and maintain our focus...

At that time we had 234 contact tracers. I am glad to hear we now have 930 but I want to know whether they are full-time, that is, working continuously for the 12 hours and what number of people do they trace individually.

We have 930 staff in place. I do not know who is working or the exact hours involved but I can confirm the part in which we are interested, namely, whether contact tracing capacity is operating to its full potential 12 hours per day, seven days per week. The answer to that question is "Yes". We do quite in-depth contact tracing compared with many other countries. We do contact tracing with various protocols, with a full list of phone calls and following up on the close contacts. It is a level that many other countries do not do but we have found it very useful in identifying local outbreaks before public health teams go in. The Deputy will be aware, for example, of the serious recent outbreak in Dungarvan, which is not far from her constituency. The outbreak was identified and contact tracing was done before public health teams went in and engaged with people. I am thankful that in Ireland we have had a fantastic response from the public, members of which isolate in order to protect themselves and everybody else. As a result, outbreaks like it are being contained all the time.

The issue is capacity when the numbers start to grow. We have had an average of approximately 600 cases per day over the past week. When we had 234 contact tracers, we were seeing 1,200 cases per day. I appreciate that officials were able to handle what happened in Dungarvan with the test, trace and isolate system. I am asking about what happens in future, when we get above 1,200 cases per day, as that was the level at which it collapsed last year. What will be our capacity to deal with this when we come under pressure if we have current levels of tracing? What happens if each person has five close contacts, which, I imagine, is a minimum number? It would mean that we would have to contact 3,000 people on a daily basis. This is why I am interested. I want to know that this is a robust system, that it will not collapse and that we will not have to go back into lockdown because we did not resource our testing, tracing and isolation capability.

The daily capacity has been significantly increased to 1,600 detected cases per day. The Deputy has raised a very important question, which is, what will happen after 1,600 cases per day are detected? Based on what we are seeing in Scotland and the modelling we have from Professor Philip Nolan's team, we will very likely be looking at more than 1,600 cases per day. There are various protocols to be put in place around using electronic means and shortening phone calls in order to further increase capacity. Probably the most important part of the answer comes from the Chief Medical Officer. He made the point when this happened last winter - he made it again in the discussions we are having with the HSE about what we do when the level is reached - that there comes a level of virus in the community after which contact tracing becomes far less relevant. Contact tracing is really important in dealing with isolated outbreaks in order to find and protect people by isolating them. As the Chief Medical Officer stated, we can get to a point where contact tracing is not the focus as there is a switch to more population-based tools.

Departmental Reports

Pauline Tully


35. Deputy Pauline Tully asked the Minister for Health when the disability capacity review report will be published; and if he will make a statement on the matter. [28331/21]

When will the Department of Health's capacity review of disability services be published?

I thank the Deputy for tabling this question. To be honest and get straight to the answer, I will provide a clear timeline: it will be published within a week.

I am delighted to hear that. This report was completed last November. Many parliamentary questions on the matter have been tabled to the Minister of State by members of the Joint Committee on Disability Matters and other Deputies. The committee itself, various organisations, including the Irish Wheelchair Association, and the Oireachtas disability group and the organisations it represents have all queried the matter with her..

The Minister of State knows better than I that there is a deficit in the area of disability so this news is very welcome and important. I presume the report will help inform preparations for budget 2022. I know the Indecon report comes under the Department of Social Protection rather than the Department of Health but it is another important part of the jigsaw that will indicate the cost of disability in future. I know the indication is that it will be published in the coming months. Will this be considered in the context of the budget?

Prior to having the disability capacity review published, the Government delivered on disability matters over the past 12 months and when we went through the process of budgetary preparedness last year. It is important to provide a recap on what we have delivered. There have been 126 individuals moved from congregated settings and funding was put in place to ensure a total of 102 new residential places, as well as 144 replacements in the community. More than 80% of the backlog of assessment of needs since June 2020 has been delivered. The first programme to tackle the issue of persons with disabilities under 65 in nursing homes is in progress and a full compliment of children's disability network teams are to be in place from the end of this summer. Significant progress has been made in the recruitment of 100 therapists with an additional 85 therapists on top of that. The Government progressed these matters despite the fact that the report has not yet been published. We will continue to progress issues and put disability at the centre of our agenda at all times.

I welcome and acknowledge the work that has been done. There have been significant moves towards a social model of care and away from the health model of care, which is the right way to go. The Minister of State is doing tremendous work in that field. There are, however, some very stark statistics regarding disability. We have the lowest employment rate for people with disabilities in the EU and one of the highest poverty rates. It is certainly higher than average and we are one of the worst five countries in that regard.

The Minister of State mentioned people in nursing homes who are under 65 years of age. There are still approximately 1,300 such individuals. Significant progress is needed to move them from what are totally unsuitable settings and into community-based locations. Another statistic indicates that 0.3% of all people with disabilities access the services of personal assistants. This is vital in order to allow people to live in the community and have the supports they need. In order to move towards community services and supports, we must investment in information technology, housing, transport and education. In order to implement the provisions of the United Nations Convention on the Rights of Persons with Disabilities, UNCRPD, we must see disability-proofing across all Departments.

I concur completely with the Deputy about disability-proofing across all Departments. As I speak, we are disability-proofing the medical model through the Department of Health. When I move to a new Department dealing with inclusion and equality matters under the Minister, Deputy Roderic O'Gorman, we will reach out to every other Department, including those dealing with education, transport and employment. Disability is not just about medical needs but it is about how a person can access education, do transition planning and ensure that employment can be accessed in order to facilitate independent living with help from housing authorities. I have every faith that this disability capacity review will touch on every Department.

Covid-19 Pandemic

Mattie McGrath


36. Deputy Mattie McGrath asked the Minister for Health if he will initiate an immediate public enquiry into the handling of Covid-19 by the Government and NPHET, including an immediate investigation into the nursing home deaths; if there will be an independent external audit of the advice from NPHET and its modelling by an external team of auditors who are not otherwise engaged by the State; the rationale for Ireland’s position as an outlier in Europe in the context of the level of restrictions on hospitality and antigen testing here; and if he will make a statement on the matter. [38064/21]

I ask the Minister for Health if he will initiate an immediate public inquiry into the handling by the Government and NPHET of Covid-19, including an immediate investigation into nursing home deaths. Will he commit to an independent external audit of NPHET's advice and modelling by auditors not otherwise engaged with the State? Will he explain and justify Ireland's position as an outlier in Europe regarding the level of restrictions on hospitality and in the use of antigen testing?

I thank the Deputy for the question. It is fair to say that Covid-19 has had a devastating effect and caused huge difficulty for everyone in Ireland. That is especially true for people in nursing homes and their families, who have suffered huge hardship, as well as staff. The Department of Health is exploring ways to ensure their voices are heard.

It must be recognised that the pandemic has not concluded and at this time the priority focus of the Government remains on the ongoing management of the Covid-19 response to ensure the gains we have seen are preserved and that those most vulnerable to the virus continue to be protected. NPHET and its modelling team have served us well, performing essential roles. I pay tribute to the chairs of both groups, Dr. Tony Holohan and Professor Philip Nolan, for their leadership and expertise.

Ireland's response has been robust, as is evident when one considers some of the outcomes here relative to those in many other countries.

Ireland currently has one of the lowest number of cases per capita within the EU and UK and thankfully, when this is over and if things continue as is, Ireland will have one of the lowest levels of excess mortality also.

Our vaccination programme is also performing extremely well. By the end of the week the vaccination programme is expected to have administered 5 million doses, with more than 2 million adults fully vaccinated and more than 70% of the adult population having received their first dose. I am delighted to be able to share that when one considers the target population, Ireland has either the highest or one of the highest participation rates right across the board.

The Deputy raises the very important point of antigen testing. In January I established the rapid testing group chaired by Professor Mark Ferguson. More recently I have established an expert advisory group on rapid testing, chaired by Professor Mary Horgan, to support the roll-out of rapid testing right across sectors in the country.

I commend and thank the front-line staff, the nursing staff and their attendants.

The independent investigation I seek should include a cost-benefit analysis of the Government-imposed lockdowns to date. For instance, the overall costs of the lockdowns must include delayed diagnoses and missed diagnoses, the effects on mental health and other health-related services, together with the economic and community impact versus the benefits derived from the longest-ever lockdown in Ireland.

Ireland has had the longest lockdown in the world and the second highest rate of nursing home deaths, which is so sad. Aon death amháin is one too many in any situation, but these were in nursing homes. Of these deaths, we know that 50% of the people who died were infected in 575 nursing home buildings and 15% of the deaths were due to people being infected in 86 hospital buildings. This is what I am coming at. I put it to the Minister that people go to those trusted institutions for care and protection and to the hospitals to get better, not to pick up an infection. We need a thorough external and independent investigation to find out where the mistakes were made and if we can be ready in the future to avoid something like this.

It sounds like the Deputy and I agree that everything that can be done to protect people in the nursing homes and right across the residential care sector must be done.

The Deputy will be aware that an expert nursing home group was brought together. They did a huge amount of work and produced a comprehensive report. Critically, an implementation group was put together because the Minister of State, Deputy Butler, and I wanted to make sure that this was not just a report that sat on a shelf. An awful lot of work has been done. HIQA and the HSE have been involved. As the Deputy is aware, the Defence Forces were at times brought in to help out as well. The Minister of State, Deputy Butler, and I will shortly bring forward quite ground-breaking legislation on the regulation of the nursing home sector and home care more generally. I share the Deputy's view that everything that can be done must be done for people in the nursing home sector and in home care.

I put it to the Minister that of the approximately 5,000 Covid deaths in Ireland, 40% of them occurred in nursing homes. Internationally, the Republic of Ireland has the second worst rate of nursing home deaths in the world after Canada. As society returns to normal, this issue must be addressed to bring release for the many families who have lost loved ones in the most tragic and traumatic of circumstances over the past 15 months. They must get answers. I am aware that a number of court case challenges are coming up in this regard. I have spoken with and met nursing home staff and I have visited one or two homes by invitation. They allege that they were literally left without personal protective equipment and in some cases were left without oxygen, which they allege was taken away by the HSE. This is shocking. We must examine this fully. I do not want an internal investigation. We must have an external, inward-looking investigation that has no commitments to any sectors in Ireland. It must be open, honest and transparent to find out if we can learn from the huge mistakes and the lack of readiness and preparedness for any kind of a pandemic. We must learn from the mistakes.

We absolutely have to learn from what happened. Some things were done well but undoubtedly there will have been mistakes made. I assure the Deputy that a constant review has been ongoing for a long time. The Minister of State, Deputy Butler, and I have had numerous meetings with the Department, with the HSE and with HIQA to be able to go through it, nursing home by nursing home, around the country, identifying those nursing homes that are most at risk.

HIQA in the first instance. As for how it works, HIQA does a very thorough examination right across the sector and then identifies specific challenges that individual nursing homes may have. They engage with the HSE and the Department to make sure that the supports are put in place. While I hear clearly what the Deputy is asking, I wish to assure him, as well as those people in the nursing home sector and their families, that this is not something new. We have constantly been reviewing, revising and learning and putting in place more and more safeguards right the way through this pandemic.

Vaccination Programme

Catherine Connolly


37. Deputy Catherine Connolly asked the Minister for Health the details of the financial cost of the Covid-19 vaccination roll-out in Ireland; the details of the indemnity given to pharmaceutical companies with regard to the Covid-19 vaccines including the estimated cost of same; his plans to introduce a Covid-19 vaccine compensation scheme; and if he will make a statement on the matter. [38065/21]

I welcome the opportunity to ask a priority question. It is very specific. It is about the cost of the vaccination roll-out, the nature of the indemnity given and to how many pharmaceutical companies, the cost of that and the nature of it.

Equally important is an issue I had asked about in December in a question to the Taoiseach, and which I have raised many times since, namely, the matter of a compensation scheme. The Taoiseach had said he was working on it.

Perhaps in my second chance to speak I will come back to the Meenan report.

The overall initial funding allocation for the Covid-19 vaccination programme and related expenditure approval is for a total of €200 million for 2021. Core responsibility for the operational delivery lies with the HSE, which provides detailed estimates of the gross cost of implementation to the Department of Health. While the cyberattack has had some impact on data reporting systems, the latest figures available from May indicate expenditure of approximately €121 million. It is envisaged that the overall costs associated with implementation of the vaccination programme will be significantly in excess of the €200 million already allocated. My Department will continue to work closely with the HSE and the Department of Public Expenditure and Reform to ensure cost-effectiveness in the context of the Covid-19 vaccination roll-out.

Regarding indemnity, the content of the advance purchase agreements, including provisions relating to liability and indemnity, are negotiated with vaccine suppliers by the European Commission and its negotiating team acting on behalf of the member states. Member states may decide to opt in or opt out of any of the advance purchase agreements, APAs, for vaccines but member states do not have scope to recast the provisions of the agreement. The clauses in the APAs relating to indemnification and liability are open-ended. They require member states to provide legal supports, costs and payment of claims arising from any damages associated with the administration of the vaccine. I am aware that the UK and several European countries have introduced vaccine injury compensation schemes, although there are no plans at present for the introduction in Ireland of a Covid-19 vaccine compensation scheme.

I thank the Minister and I look forward to getting that written reply and going through the figures. I believe that the Minister has said that to date it is €121 million - I did not quite catch it - or was it €200 million spent to date?

On the indemnity, it is of vital importance that we know the nature of the indemnity. I am truly tired of getting an official response that the EU negotiated this for us and that is it. I would really like to know what is the business case on that and the risk assessment, or whatever words one uses at the level the Minister is at, to tell us what we have signed up to.

On the scheme for compensation, the Meenan report was published in 2020. The Government has had it since January 2020. Paragraph No. 14 says: "Regarding vaccination programmes the Expert Group accepts that there is a strong moral argument that the State, which actively encourages vaccination, should accept responsibility for those who suffer harm as a result." The expert group stated there are "pragmatic reasons" to support the establishment of a compensation scheme and that "The Expert Group recommends the establishment of a vaccine compensation scheme as a matter of urgency." Perhaps the Minister will comment on that.

On the Deputy's first question, the budget for this year was prepared on a no-vaccine basis. No provision was made for expenditure relating to the implementation of the vaccine programme. I subsequently approved an initial reallocation of €200 million. That was previously intended for the purchase of personal protective equipment. The HSE is reporting that as of May, €121 million of that €200 million has been incurred. Our estimates are that the final bill will be well in excess of €200 million.

I will endeavour to get as much detail as I can for the Deputy with regard to the indemnity provided.

I am sorry if the responses the Deputies received have caused frustration. The probable reason for the responses is that the details of the indemnity were not up to each member state. It was essentially a case of whether we wanted the vaccines and if we wanted them, we had to opt in to the indemnity scheme. I will respond in the next reply to the Deputy's broader question on the Meenan report.

I am not going away and I will keep persisting because this is the most basic information that we should have. Vaccines are an essential part of the treatment of the virus. We also need full information on the vaccination programme at every level. I do not know the cost. The Minister told me he approved up to €200 million, but that was prior to vaccination. Could we have the information on how much the vaccination programme is costing per month and per year?

The Minister said he will come back to me on the Meenan report, but I will not have a chance to respond. The report is dated January 2020. Mr. Justice Meenan said the expert group recommended the establishment of a vaccine compensation scheme as a matter of urgency. The urgency has been highlighted by recent publicity and public commentary concerning certain vaccines. That is going back, and that has multiplied a hundredfold now with Covid. It seems that no progress whatsoever has been made. Perhaps the Minister could clarify the issue.

In June 2018, the Government agreed to the establishment of the expert group to review the management of clinical negligence claims. It was chaired by the High Court judge, Mr. Justice Charles Meenan. The expert group examined the system from the perspective of the person who has made the claim to explore if there is a better way to deal effectively, yet more sensitively, with certain cases. Personally, I believe there is. Mr. Justice Meenan submitted the final report on the current system for managing clinical negligence claims to the then Minister for Health and Minister for Justice in January 2020, prior to the onset of the Covid pandemic. The Government subsequently published the Meenan report in December 2020. One of the report's recommendations is that a compensation scheme be established.

On foot of a request from my Department, the Health Research Board, HRB, carried out an evidence review on the vaccine injury redress programme in other jurisdictions, which was completed in March 2019. The expert group's report, in addition to the HRB's evidence review, and consultation with other Departments and relevant State agencies will inform the development of proposals regarding the establishment of a compensation scheme, including the need for primary legislation, and work to advance policy development in this regard is under way in the Department.