Long Covid Health Services: Motion [Private Members]

Deputy Seán Canney

I move:

That Dáil Éireann:

acknowledges that:

— the most recent waiting list figures available from the National Treatment Purchase Fund show over 79,000 patients are waiting for an inpatient or day case procedure, and a further 625,000 are awaiting an outpatient appointment;

— the Irish College of General Practitioners has indicated that only one-in-five general practitioner (GP) practices can take on new patients from the General Medical Services Scheme as they are at full capacity, and only one-in-four can take on new private patients as they are unable to employ another GP or replace a retiring GP;

— according to the Irish Nurses and Midwives Organisation, 10,679 patients who were admitted to hospitals in October spent time on a trolley before securing a bed, which was more than a 25 per cent increase on last October; and

— more than 27,000 people left Ireland's emergency departments before being seen by a doctor during the three-month period from July to September this year;

recognises that:

— the World Health Organization has defined the post Covid-19 condition, also known as long Covid, as a condition which occurs in individuals with a history of probable or confirmed SARS-CoV-2 infection, usually three months from the onset of Covid-19, with symptoms lasting for at least two months that cannot be explained by an alternative diagnosis;

— while there are some 200 conditions associated with long Covid, common symptoms include profound fatigue, shortness of breath, post exertional malaise, dysautonomia, neurological and cognitive dysfunction, as well as others that have an impact on everyday functioning, with symptoms appearing following initial recovery from an acute Covid-19 episode, or persisting from the initial SARS-CoV-2 infection;

— research highlights the real burden long Covid represents to the Irish population and an already overwhelmed health service, highlighting the importance of finding scientific solutions which can tackle the underlying mechanisms that are causing such diverse and debilitating symptoms;

— while there is a lack of knowledge associated with the management and treatment of long Covid conditions, this is not the first infection-associated chronic illness triggered by a viral infection, with many long Covid patients meeting the diagnostic criteria for myalgic encephalomyelitis and chronic fatigue syndrome;

— the duration of illness can be variable, with some patients who developed long Covid after contracting Covid-19 in the first wave in March-April 2020 having made little or no recovery to date;

— due to the heterogenous nature of long Covid there is currently no one universal diagnosis or treatment, however, medical evidence indicates that symptom management can improve quality of life;

— research published by the Health Protection Surveillance Centre on Irish blood donors indicates that 69 per cent of adults in Ireland have been infected by the virus;

— there are likely to be 336,451 adults nationally who are suffering from or have suffered from medical conditions associated with long Covid, based on an extrapolation of Netherlands-based research published in The Lancet in August 2022 which attributed long Covid symptoms to 12.7 per cent of patients infected with the SARS-CoV-2 virus;

— patients with long Covid, many of whom are young with no underlying conditions, have presented with prolonged multisystem symptoms which can impact quality of life, affect ability to work and cause significant disability for some;

— long Covid is having a significant impact on our labour force, and an Australian study on long Covid indicates that even low rates of Covid-related permanent illness or disability could still lead to a significant future societal burden from the disease;

— some 0.81 per cent of Enhanced Illness Benefit claimants were certified unfit to return to work at least 12 weeks after their initial infection, meeting the emerging scientific criteria for long Covid;

— on a population basis over 21,000 people may be unfit to work due to long Covid, which excludes those who have relapsed after initial recovery from SARS-CoV-2 infection or the tens of thousands more experiencing less severe forms of long Covid who have reduced participation while in employment;

— just 22.5 whole-time equivalents of the 70 health service staff to be appointed by the Health Service Executive (HSE) to work with long and post Covid patients were recruited up to last month, with patients waiting up to 10 months for initial assessment before joining record waiting lists to see other specialists;

— long Covid services do not exist for children;

— the clinic in the Mater Misericordiae University Hospital Dublin treating neurological conditions, such as brain fog associated with long Covid, has been forced to reduce its service due to a lack of funding;

— many Irish patients have been forced to seek costly treatment overseas due to a lack of clear referral and treatment pathways being developed in Ireland; and

— the primary mechanism to prevent long Covid is to minimise the incidence of Covid-19 infection, by ensuring that all practical measures to reduce the transmission of the virus are introduced and maintained in a time appropriate manner, including the provision of Evusheld to those who are immunocompromised or where vaccination is not recommended; and

calls on the Government to:

— address chronic workforce issues within our GP practices, primary care, and acute hospital services;

— fully staff long and post Covid clinics as committed to on foot of the HSE plan of September 2021, which must be updated to reflect the changing skill set required to support the emerging evidence on the treatment of conditions associated with long Covid, such as direct access to neurological clinicians;

— establish a multidisciplinary public health team incorporating patient advocates to review and manage long Covid care within the population;

— establish a dedicated and specialist-led long Covid clinic for children who are without a dedicated centre at present;

— deliver in tandem with, instead of consequential on, the establishment of long and post Covid clinics, fully resourced long Covid services across GP practices and community services to ensure a national service is in place for all who need it;

— ensure that services and supports adapt and expand based on learnings from implementation, emerging evidence in relation to long Covid and current and projected demand for all specialists and services;

— develop a public awareness campaign on what long Covid is, highlighting the risks posed to the entire population, including the young and healthy, and how to minimise the risk by reducing the transmission of the SARS-CoV-2 virus;

— urgently complete an analysis of existing waiting lists to establish the incidence of long Covid and the scale of the challenge facing the heath service;

— establish a long Covid electronic patient register to provide a secure database to store and analyse detailed information in relation to the number of patients presenting to long Covid clinics, the symptoms they are presenting with and their treatment outcomes;

— ensure that all healthcare and frontline workers who are unfit to work due to long Covid are entitled to special leave with the removal of the arbitrary eligibility date of 7th February, 2022, for healthcare workers and further ensure that the current scheme does not abruptly cease in June 2023;

— recognise long Covid as an occupational illness for all healthcare and frontline workers;

— commence an information campaign providing the best available current advice in the management of conditions associated with long Covid and other post viral chronic conditions to GPs, the medical profession and those experiencing long Covid conditions; and

— develop an innovative rehabilitative and recovery programme that is designed to meet the needs of those experiencing long Covid and other post viral chronic conditions, ensuring a return to as full and active a life as possible.

I am delighted to move the motion on behalf of the Regional Group. This is the first major parliamentary debate on the impact of long Covid. I am delighted the Regional Group has seen fit to table the motion. It simply seeks the roll-out of specialist services to support those who have failed to make a full recovery after being affected with the SARS-COV2 virus.

While most people will make a full and quick recovery from Covid some adults and children continue to experience ongoing symptoms or can have a relapse after the initial recovery. These symptoms can persist for several months or even years. Long Covid is an umbrella name given to a broad range of some 200 post-Covid symptoms which can include conditions such as chronic fatigue and brain fog which are experienced at least three months after the initial infection and for significant periods of time and in some cases for over two years. According to analysis based on research conducted in Ireland and the Netherlands, some 336,451 adults nationally are likely to be or have suffered some form of long Covid and an estimated 21,000 people are so unwell that they are unfit for work. Even with a small portion of these long Covid patients presenting to our health service with complex health conditions in an already overcrowded emergency department and GP surgeries, they will overwhelm our health service as we face into a serious winter of overcrowding.

The Regional Group believes that unless we address this challenge of long Covid in a comprehensive way and in tandem with measures to reduce the spread of Covid-19 we will just sleepwalk our health service into a crisis of chronic illness. This would put people waiting on treatments since before the pandemic further down the already horrendous waiting lists. We also want to see long Covid recognised as an occupational illness and comprehensive special leave with a pay scheme for front-line healthcare workers as well as the expansion of services for other similar illnesses such as ME and chronic fatigue syndrome.

I thank my colleagues in the Regional Group for putting forward this very important motion. In particular I acknowledge the work of Deputy Denis Naughten for his great work in drafting this motion together with our administrator, Cáit Nic Amhlaoibh. It is important that we take this very seriously. The motion calls on the Government to address the chronic workforce issue in our GP, primary care and acute hospital services and to fully staff post-Covid and long Covid clinics, which I think is the most important thing. This has been committed to on foot of the HSE plan of September 2021. It must be updated to reflect the changing skillset required to support the emerging evidence on the treatment of conditions associated with long Covid such as direct access to neurological clinicians. We also need to establish a multidisciplinary public health team incorporating patient advice to review and manage long Covid within the population. We need to establish a dedicated and specialist-led long Covid clinic for children who are currently without a dedicated centre. That is a vital cog in ensuring that children are treated for this illness and that it is recognised that children have this illness.

It is important that we deliver in tandem with, instead of consequential on, the establishment of post-Covid and long Covid clinics fully resourced, long Covid services across GP and community services to ensure a national service is in place for all those who need it. I understand the Government is not opposing this motion, which I welcome, but it is important not just that it does not oppose it. We need to take action now to ensure that long Covid is treated in the way that it has been promised to be treated, as a very serious issue for the people who are not able to work and are suffering.

Deputy Verona Murphy

Before I get into long Covid, I call on the Government to launch a full independent review into the handling of Covid. We need answers to things like what happened in our nursing homes in 2020; how our ICUs across the country were under-resourced and what improvements we have seen as a result; why the HSE lacked capacity despite all of the billions pumped into it; how the Government, the State broadcaster and many other national media outfits performed and what lessons have been learned; and, finally, whether the Government can introduce a restrictive covenant period in employment contracts to ensure that former high-ranking HSE officials are unable to take up employment with companies that have been subject to or awarded contracts during their tenure in the HSE. I hope that the Government will consider this as part of restoring confidence and ensuring transparency for the people of Ireland in its health service.

The Covid response has raised a lot of questions and there is no denying that Covid-19 has had a more significant and ongoing impact on some people more than others. I am sure we have all heard of cases from friends, family or constituents where Covid-19 has emerged as a major ongoing problem, sometimes for weeks and months after the initial infection. Long Covid is presenting itself in a variety of forms with a variety of symptoms. The ability of some people to return to work has been compromised or limited by a continuation of Covid symptoms, most commonly fatigue and ongoing breathing difficulties. Using the figures available to us, the inability to return to work or fully return to work may be affecting as many as 21,000 people. Obviously we hope that it will not be as high as that but we do need to have dedicated resources in our health system to help as many of those people back to their vibrant selves as possible.

The motion calls for the Government to do many things. One is to get to grips with staffing levels. Pay and terms and conditions in the health service, where recruitment is an ongoing problem, must be improved. We have heard promises of waiting lists being abolished and services being improved but this can only be done if we have the people to do it. There are no specific services for children with long Covid. As we know and recognise in other areas, children often need differentiated care for a variety of illnesses than adults. Children are obviously in a very important developmental stage physically, emotionally and socially. That is why long Covid may have more devastating and lasting effect on those who get it at an early age. The motion calls upon the Government to establish a dedicated and specialist-led long Covid clinic for children who are now without a dedicated centre. A dedicated team working solely on long Covid in children may be able to bring about better recovery and better outcomes, in particular the prevention of lasting mental health problems or stigma in later life.

For those of all ages currently suffering with long Covid this motion is also calling on the Government to develop an innovative and rehabilitative recovery programme designed to meet the needs of those experiencing long Covid conditions and other post-viral chronic conditions to ensure that they can make a full return to as full an active life as possible.

I remind the Government that in December 2020, it published a report reviewing the law of torts and current systems for the management of clinical negligence claims, led by Mr. Justice Charles Meenan.

In its report, the expert group states that it "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 report recommended that a vaccination compensation scheme be established as a matter of urgency. I hope the Government will acknowledge the findings of this report and introduce the scheme without further delay.

If those experiencing long Covid can get the help and support they need as soon as possible, outcomes will be better. This is the same for any illness. The earlier it is treated, the better the patient's chances are. Better personal, social and economic outlooks will be the result. I conclude that the Government is not opposing the motion and is evidently accepting it. Our hope is that the entire House will do likewise. I thank my colleagues, particularly Deputy Naughten and Cáit Nic Amhlaoibh, for putting the motion together.

Deputy Michael Lowry

Since this motion was first mooted in the media by Deputy Naughten and taken up by the Regional Group, I have been inundated with emails and calls. Each person who contacted me told his or her own harrowing story. Many have been suffering since the first wave of the virus back in 2020 and none of them know how long their suffering will last. In Tipperary alone, 670 people are certified as unable to work due to long Covid. It is estimated that 330,000 adults have been impacted by long Covid nationally. Many of these people are gravely ill with debilitating symptoms, yet only 22.5 whole-time equivalent staff have been appointed by the HSE to work with long Covid patients. Long Covid will be the straw that breaks the health service if urgent action is not taken.

It is not just adults who have been affected. Thousands of our young people are afflicted. Emily will be 16 on 16 November. Her parents, who live in County Tipperary, have given permission for me to share her story. For those who may not know what long Covid is all about, this young girl's story sums it up. Emily is a typical teenager. Prior to July of this year, she was full of the joys of life. She had a large circle of friends, was a member of her local GAA club and was pleading to go to parties with her older sister. Her phone was constantly beeping with messages from her friends. In July, both Emily and her sister contracted Covid. They had similar symptoms. They isolated and followed all of the instructions and eventually the virus passed. However, months later, Emily is still not back to her bubbly self. It hurts her to breathe, with sharp pains shooting from her chest through to her back. She has also developed serious digestive issues, something she had never known previously. Her digestive system ceased to function normally. Her symptoms are debilitating and confine her to home. Chronic fatigue means she does not have the energy to leave home, even if she could. By means of elimination and having tried treatments for each problem as it emerged, her local GP eventually diagnosed her with long Covid.

This young girl has become a shell of her former self. She is unable to get out of bed in the morning until she has taken two strong painkillers. As a popular teenager who loved school, who was bright and who showed great promise as a student, Emily now misses at least three days per week. She struggles through pain with pain relief on the days she can attend. Her schoolwork is suffering badly. Emily is a junior certificate pupil and is distraught at the thought of failing her exams. This young girl and her family are battling alone. They have met with nothing but obstacles. Her doctor has said that she must wait until she turns 16 to join the ever-growing waiting list for an adult long Covid clinic. Incredibly, and to our shame, there is no such service in Ireland for young people. In the meantime, Emily will continue to miss at least three days a week. Her parents feel that the school will be obligated to report her poor attendance to Tusla and worry that Tusla will not accept long Covid as a valid reason for school absence. Emily's life has changed. Her phone no longer beeps constantly with messages from her friends. She is out of the loop in school and cannot participate in sport anymore. She does not have the energy to meet up with friends. She is worried about her exams. As a girl who is not yet 16, she feels depressed, isolated and helpless. This is the reality of long Covid for young people.

Emily is not alone. There are hundreds, if not thousands, of young people in similar situations across the country. They need help. There is only so much their families can do to get them through this. Love alone does not help with long Covid. They need to be seen at a dedicated long Covid clinic for young people to help them manage and cope with their physical symptoms. They also urgently need mental health support. Emily has received zero support from the Department of Education. It has failed to give a directive to school on a protocol for dealing with students with long Covid. Our motion calls for a targeted campaign of advice and information on the management of conditions and situations associated with long Covid.

Deputy Peter Fitzpatrick

I am going to read from an email I received from a constituent of mine whose sister has long Covid:

I am writing in relation to a motion being debated by the Dáil on Wednesday of this week. The motion calls on the Government to take immediate steps to provide the supports needed by those suffering from Long Covid, to establish professional Long Covid hubs and to acknowledge the fact that Long Covid is an occupational injury/disease affecting frontline workers, including those who contracted Covid in a work environment outside the healthcare environment.

Because of Long Covid, the cost to her of medical appointments, scans and medicines since December last is in excess of €3,000 and climbing, at a time when her financial future is increasingly unclear. More importantly, and more distressing for those of us who care about Liz, is the life-limiting effects of this horrible disease. An active, life-loving person in her mid-50s is reduced to a life of exhaustion, brain fog, breathlessness, memory issues, pain and distress, with no end in sight. This is compounded by months of being referred from one organisation or service to another as each absolves themselves from responsibility by referring her on. The response from others is to send endless paperwork and forms to a person with a seriously-reduced ability to absorb detail and to action any of these processes.

Liz was a brilliant schoolteacher. She attended at school when required to do so at a time when Covid was rife. She did so at a time when the Minister for Education, Norma Foley, declared - without any qualification - that schools were safe. They were not. Liz caught Covid in her Special Ed classroom in the primary school in Dromiskin, Co Louth. She was required to attend at work in what transpired to be a dangerous environment. She does not blame her school or Board of Management, as they operated as required by the Department of Education. But she does, quite correctly, want to be supported when she suffers in such an horrific way from simply doing her job. She deserves to be treated with respect and for restrictive and ill-informed processes and supports to be adjusted with the clarity of hindsight.

Health care workers who contracted Covid at their workplace have received an exemption from the ending of the Long Covid sick pay scheme, at least until mid-2023. This exemption applies to all those who worked in a healthcare setting, whether nurses, porters, catering staff, receptionists. Liz and her family have no problem with that. Everyone who contracted Covid in a public sector work setting when they were required by their employer to attend at their workplace should be minded financially and emotionally until they are fit to return to work. If Liz had suffered bone injuries at work or other occupational injuries, she would be minded. Because she has Long Covid, she is approaching a situation where she will no longer receive full sick pay and her pension entitlements could also be adversely affected. This is not fair or moral under any code.

In terms of the motion before the Dail on Wednesday, Liz and her family and friends support every aspect of it but, in particular, we support the proposal that Long Covid caught in the workplace be designated as an occupational injury and that all and any financial supports, including pensions, are not detrimentally affected by virtue of time lost through illness arising from Long Covid.

Please support the motion in the Dail on Wednesday and please urge your party colleagues to do likewise. For those affected by Long Covid, it is the health equivalent of the Mica scandal. Long Covid sufferers are cursed with the appalling effects of an illness that they have contracted through no fault of their own but that goes to the core of their ability to function and to live as people should.

This is a plea to the better instincts of all right-thinking people. Distinctions should not be made between those who have contracted this awful illness and comprehensive supports should be provided to all. And the drawing of distinctions between categories of public servants, in terms of their rights and financial supports, is insidious and arbitrary and unworthy. My sister contracted this awful disease in a schoolroom in Co Louth. She should not be treated differently to a healthcare worker who contracted the same disease in the hospital 15 miles away in Drogheda. They were both frontline workers doing their job during the worst of times. She deserves more than that. Her family and friends will continue to fight on her behalf.

Long Covid is an occupational injury. I have only referenced one example, but I am sure the Members in each group can provide others. I know the Minister of State is going to support us, but action must be taken.

Minister of State at the Department of Health (Deputy Frankie Feighan)

I welcome the opportunity to discuss long Covid health services and I thank the Deputies for tabling this Private Members’ motion. I am responding to the motion on behalf of the Minister for Health, Deputy Stephen Donnelly, and the Government. I am aware that long Covid is having a devastating effect on people. The Minister for Health, the Government and myself are committed to ensuring that care is in place for those who need it. Some €2.2 million was allocated for 2022 to put in place a service to support those with long Covid. Budget 2023 will facilitate an overall investment of an additional €6.6 million next year for the further development of long Covid services to ensure a full national service is in place.

As Deputies will be aware, Covid-19 is still a new disease and, therefore, information on it, its features and its course are still emerging. The natural history, clinical course and consequences of Covid-19 are still not completely understood, although a lot of work is under way nationally and international to improve our understanding. Fortunately, most people with Covid-19 recover well, but a proportion of people report ongoing health issues. Long Covid includes a wide range of persistent or new symptoms that develop after infection with Covid-19. To aid recognition and management of those affected, the WHO, through a global consensus process, proposed a working clinical case definition. The WHO defines long Covid as occurring within three months of the onset of Covid-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis. The common symptoms identified include fatigue, shortness of breath, cognitive dysfunction and others that generally have an impact on everyday functioning. Symptoms may be new-onset, following initial recovery from an acute Covid-19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time. The WHO notes that this definition may change as new evidence emerges and our understanding of the consequences of Covid-19 continues to evolve.

The Deputies can see that addressing long Covid is complex. The symptoms and duration and severity of symptoms are varied as are the needs for care. Two people’s experiences of long Covid can be quite different. There is also a lot of uncertainty in the international literature about how many people experience these prolonged symptoms. According to the WHO, it is estimated that 10% to 20% of those with Covid-19 develop a variety of medium- and long-term effects such as fatigue, breathlessness, and cognitive dysfunction. A recent publication in The Lancet medical journal indicates that at present at least 17 million people are estimated to have long Covid in Europe. People who have had Covid-19 are being given follow-up care by their GP or in hospital settings as clinically appropriate. Treatment is currently focused on management of specific symptoms. Those in the community who are concerned about persistent Covid-19 symptoms should contact their GP in the first instance.

As the Deputies will be aware, building on the services in place to support patients with post-acute and long Covid symptoms, an interim model of care for long Covid has been developed and is currently being implemented by the HSE to support those in need of care. The model of care involves the expansion of some existing services and the establishment of new services across a number of settings, including GPs, community services and acute hospitals. The first priority is to ensure there are long Covid and post-acute Covid clinics operating within each hospital group to ensure a national service. To date, five new post-acute Covid clinics have been established, including clinics in University Hospital Galway, the Mater University Hospital and Connolly Hospital Blanchardstown. These post-acute clinics are managing patients between four and 12 weeks after the initial onset of infection. Long Covid clinics are managing patients 12 weeks post onset of infection, and five new long Covid clinics have also been established. These include clinics in St Vincent’s University Hospital, Beaumont Hospital and University Hospital Galway. Both Tallaght University Hospital and St. James’s Hospital are operating combined post-acute and long Covid clinics. A dedicated long Covid clinic and a post-acute Covid clinic are due to be opened shortly in Cork University Hospital. The HSE is continuing to work with Letterkenny University Hospital and Limerick University Hospital to progress the opening of clinics at both sites. Some other hospitals are operating clinics on an ad hoc basis outside the model of care, in addition to the clinics mentioned above. These include the long Covid clinic in the Mater University Hospital and the post-acute clinic in St. Michael’s Hospital Dún Laoghaire. However, the HSE is continuing to work towards aligning all HSE clinics towards a national service. To support these services, there is a tertiary neurocognitive clinic in St. James's Hospital, led by a consultant neurologist with background in neurocognitive disorders that is accepting referrals from long Covid and post-acute clinics around the country.

Concerns have been raised by some colleagues around the fact that all clinics may not fully staffed. However, I reassure them that this does not mean these clinics are not operational and actually seeing patients. It is true that recruitment is ongoing at some clinics, but I assure the Deputies that they are operational, albeit not fully staffed as per the interim model of care recommendations. Where no staff have yet been recruited, patients are being seen by existing staffing and resources. The assignment of additional staffing and resources will support and enhance the work of existing clinics operational under the model of care. As Deputies may know, to care for those experiencing long Covid, clinical input is provided as needed, depending on symptoms, by a range of healthcare professionals and, therefore, clinical leads representing respiratory medicine, infectious diseases, neurology mental health, allied health professionals, community services and general practice have been appointed. The recruitment of additional posts, including consultants in the areas of infectious disease, respiratory medicine, psychiatry and neurology, allied health professionals, and clinical psychologists and administration will continue in 2023 to staff the full service.

These interdisciplinary teams guide and support patients through all aspects of recovery, supporting care for a range of primary symptoms. The development of effective therapeutic options for patients suffering from long Covid poses significant challenges. There is no proven drug therapy or evidence-based treatment option for long Covid per se. Current treatment consists of diagnosis, advice and support and onward referral to additional services as required. This includes ruling out and managing, if identified, other underlying medical conditions such as anaemia, asthma, sleep disorders, heart failure, and supportive care and rehabilitation if indicated through our allied health professions such as physiotherapy, occupational health and psychological medicine.

I assure the Deputies that the Minister and I will continue to develop an understanding of the implications of long Covid and to prioritise supports for those affected by it to optimise health outcomes for those impacted.

Deputy Canney raised the fact that children are being impacted by this and that there is a need for more dedicated specialist-led teams. I agree with him. Deputy Verona Murphy called for an independent review, as well as a restrictive covenant on those working for the HSE. I will bring that back to the Department. She also raised the fact that fatigue is affecting 21,000 people and the need to consider staffing levels. When one considers that so many people in Europe are affected, those figures are correct. Deputy Lowry referred to Emily, a teenager, and the challenges she is facing. Deputy Fitzpatrick talked about Liz and long Covid. I hear similar stories and testimony in my clinics and around the country. I thank Deputies Canney and Naughten, along with the other Deputies in the Regional Group, for raising this issue. The Government will not be opposing the motion.

Deputy Matt Shanahan

I thank my colleague, Deputy Naughten, and Cáit Nic Amhlaoibh, who have done a significant amount of work on this issue. Without doubt, long Covid is here to stay. It is a medical syndrome; there is no doubt about that. As the Minister of State observed, it is very difficult to see where the treatment regimes are going but we have to build a comprehensive service and put it in place to look after people who have been affected. Just as important is the need to prevent people contracting Covid and mitigate the effects of long Covid.

There has been a lot of anecdotal information in the healthcare space and the education sector, both of which have been heavily impacted. We know well that people were working in compromised environments at the start of Covid. In spite of the fact that all the evidence was there from the start, it took many months to recognise that Covid is an airborne disease. Deputy Verona Murphy has asked for a review. We need to go back and look at some of the actions that were taken in the context of Covid at the very early stage. An awful lot of tricks were missed. We were very late to bring in mitigating therapies. Antigen testing, which could have significantly helped to reduce the levels of Covid infection, was not brought in until nearly 18 months into the disease. These points were never handled.

There is now a cohort who are affected by long Covid. We do not know the exact number but it could be anywhere between 3% and 5% of those who contract Covid. That appears to be a figure that will keep recurring. A person can get Covid and recover, but then get it again subsequently and develop long Covid as a result. We need to look at this syndrome. I applaud the work of Dr. Lambert. He gave a briefing in the audiovisual room a number of weeks ago. What stood out prominently was the lack of support he is getting from the Department in trying to push the initiatives he has highlighted. The Government's position in that regard is very disappointing.

It is fair to say that long Covid is now largely centred around neurological syndromes and immune responses. That being the case, it falls into the same area as myalgic encephalomyelitis, ME, fibromyalgia and other illnesses from which many people suffer. Not enough has been done for those patient cohorts either. I can think of a couple of patients with long Covid. A 52-year-old health worker in Waterford who was a marathon runner prior to getting Covid contracted the disease as a result of her work in the hospital. She was subsequently off work for nearly five months. She tried to go back to work but could barely climb the stairs. She has now taken early retirement. It is unfortunate that this has happened to her by dint of doing her job. On that point, as part of the motion we are asking the Government to recognise long Covid as an occupational illness requiring a comprehensive special leave with pay scheme for front-line healthcare workers as well as the expansion of services for other similar illnesses such as ME and chronic fatigue syndrome. This has already been recognised by the EU but it is up to each member state to ratify it. I ask the Minister of State to speak to his colleagues on this matter. This is a small cohort of patients and they need to be given supports by the State and to know that if they have long-term illness, they can claim long-term disability for Covid syndrome.

As the Minister of State outlined, long Covid is difficult to diagnose. It is based on symptoms. One cannot do a blood test for long Covid but one can certainly see the symptoms that result from it. The Government needs to develop a far greater strategic action plan. There are a number of Covid clinics in development across the country. The Minister of State highlighted that they are not fully staffed although we are trying to get there. We need to understand that every hospital in the country will need to have expertise in this area because there will be varying degrees of symptoms. Some people will require significant interaction with consultants while others will need less such interaction. There is a significant amount of work going on.

I highlight to the Minister of State a matter relating to vitamin D. Anecdotal research was carried out in Connolly hospital for the past two years - it was actually brought in to the health committee more than a year ago - showing the potential mitigating benefits of supplementing with vitamin D. A lot of work has been done and significant statistical research has shown that having a high level of vitamin D gives a person greater protection from the worst symptoms of Covid-19. That research was brought to the health committee. A report was generated. A public health piece in respect of supplementation with vitamin D could have been done and people could have been given access to vitamin D through financial supports but neither of those measures was taken and that is a great shame.

I join my colleagues in supporting the motion. We need to recognise the occupational injury that is being caused. More needs to be done to support patients and especially the caregivers who are trying to develop the multidisciplinary teams to deliver this.

Deputy Peadar Tóibín

I thank my colleagues in the Regional Group, especially Deputy Naughten and Cáit Nic Amhlaoibh, for the work they have done on preparing this important motion. Many individuals are contacting Deputies to express deep concern at an incredibly debilitating illness they have, one that is affecting all elements of their lives. Many people have indicated to me that it is similar to having a brain injury in terms of loss of cognition, chronic fatigue, heart palpitations and other cardiac issues. People are unable to work and go about their daily lives. Memory is severely affected. It also leads to depression as people try to deal with the illness. As the Minister of State is aware, it is estimated that up to 21,000 people in the State are currently unable to work as a result of this condition. It is having a serious effect on people's ability to survive, especially in a cost-of-living crisis.

It is important that we do two things. First, we need to investigate the level of impact this is having and how many people are experiencing this illness. We also need to immediately start to treat the people who have these conditions. That is not happening yet. Although the Government announced previously that investment would be made in certain clinics to deal with long Covid, that simply has not happened to the level required and people are not getting the treatment they need.

I draw the attention of the Minister of State to the significant mortality rates this year. August had the highest mortality rate of any month since the start of 2020. The mortality rate this year is higher than it was pre-Covid. There has been very little investigation into why that is happening.

There is a broader issue in respect of the Government's understanding of how it dealt with Covid and the outcomes of Covid on society at the moment. We in Aontú have brought forward a Bill that seeks an investigation into how the Government handled Covid. Unfortunately, the Taoiseach has refused to agree to that investigation. We know that more than half the people who died of Covid in this State did so in a nursing home or hospital setting. The Government is in charge of how those two sectors operate. That is an incredible situation. We saw people being moved from hospitals into the nursing home sector without being tested for Covid.

This affected people who were most exposed and vulnerable to this illness. We also know there are many costs to the way the Government handled Covid over this period. Indeed, this country had the longest and most severe restrictions of any country in Europe. We were the only country to close down the building industry for a full quarter, even though the State has the worst housing crisis of any country in Europe at present. Many of the contributions to the inflation rates we are experiencing now are due to some of the restrictions the Government imposed in the recent past.

As we look at all the different impacts of Covid, the Government needs to do this in a structured fashion rather than the haphazard fashion it is doing now. For example, I brought to the attention of the House just last week the fact that we have seen increases of 56% in the number of people who are being referred to rapid access cancer clinics in this State. The Taoiseach announced at a parliamentary party meeting that he was very concerned about the level of new and advanced cancer cases that are now hitting the health service. Yet, during the Covid crisis, when I raised the need for cancer services to be reopened, the Taoiseach laughed at me and told me to get real. It is an incredible situation.

We need proper investigation into the level of long Covid, investment in delivering services for those suffering from it and an investigation into how the Government has handled the past two and a half years.

Deputy David Cullinane

I am sharing time with colleagues. Sinn Féin will support this motion on long Covid. I thank its authors, the Regional Group, and its proposer, Deputy Naughten, for the work he has done in this area over the past number of months.

This is an area that the Oireachtas Joint Committee on Health has dealt with on a number of occasions. A number of very important witnesses have appeared before that committee, including Dr. John Lambert, who was mentioned. Many of the people who have come before the committee have been quite critical, as Deputy Tóibín indicated, of the haphazard approach we are seeing in this area. There is no joined-up approach from primary care to acute services, no full roll-out of all the Covid clinics, and patients who are immunocompromised still do not have access to medications that people in other countries do. Many of these patients say to me that their nightmare continues. They are still where many of us were in March and April 2020, that is, a situation of permanent lockdown, and fearful of leaving their homes because of the danger of contracting Covid due to the profound health difficulties they have. That is very difficult for them.

Long Covid is something we are still learning about all the time and a lot of research is still being done. We need to continue to learn but also to act very quickly as new data and new research emerges. Long Covid is a complex set of conditions, with symptoms ranging from fatigue and breathing difficulties to involuntary movement and cognitive dysfunction with ranging severity. It affects people of all ages. It is troubling that we still do not have a paediatric model of care for long Covid. I have been calling for that for some time. We need to make sure we have a particular focus on children and the impact long Covid has on them. The Minister for Health, Deputy Stephen Donnelly, needs to expedite that as quickly as possible. It is estimated that between 100,000 and 300,000 people are affected by long Covid. The fact that we cannot determine that number is in part due to the lack of supports for general practice and GPs. The fact that many of these long Covid clinics are not operational means we are not getting the real data on how many people are suffering from or have contracted long Covid and are managing and dealing with it in very difficult circumstances. The more we do, and the more health supports and wraparound supports we give, the more evidence will emerge on precisely how many people are suffering from long Covid. If we do not understand the scale of the problem, we will not be able to commit the level of resources that need to be invested.

There is also a concern that there is excessive focus and concentration on hospital supports. That is important because there is obviously a need for such supports but many of the services people with long Covid need are rehabilitative and must be provided in the community. I mentioned primary care. Much greater understanding and more education for GPs are needed. We have overcrowding in our hospitals at present, which is almost unheard of. The number of people visiting emergency departments and waiting for long periods is phenomenal. It is a disaster in many of our acute hospitals. We are then asking people with long Covid to go into these healthcare settings, where they are part of that experience of having to wait too long. They say to me that they are fearful of going into hospitals, in some instances, because of the symptoms they have. Community settings are and would be better in such cases.

There was a call from the Mater hospital for a specialised Covid clinic to be put in place and for proper resourcing of research. I raised this with HSE officials at the health committee. Even though Dr. Lambert had made recommendations and submitted business cases, senior people in the HSE were unaware of it a number of weeks ago. I found that phenomenal. He got very frustrated and took to social media to ask what in God's name is happening that the decision makers cannot make decisions quickly enough. That is symptomatic of what happens generally in the healthcare system.

We need to get serious about this illness. Covid is still affecting many people. Long Covid is a very serious illness. Everything that we can do needs to be done. We are talking about health supports but there are also other supports, for example, if people are out sick, they need to be supported through welfare supports. A holistic package of supports is necessary.

Deputy John Brady

Long Covid is a very serious and debilitating illness that is impacting on tens of thousands of people throughout the State. It is being widely ignored by the Government and across the board. I welcome the report published on Monday by APC Microbiome Ireland - a research centre based at University College Cork - in conjunction with UCC and the long Covid advocacy group. The report shows that almost 90% of those living with long Covid in Ireland have not returned to pre-Covid levels of health and many people's lives are, essentially, being put on hold as they wait for the State and the HSE to put proper procedures in place to help them.

I am one of those people who has a diagnosis of long Covid. I contracted Covid for the first time in October 2020. Following that, I still have a very severe cough. I went to GPs who gave me a diagnosis of asthma, put me on inhalers and sent me for chest X-rays, but there was no clearing of the cough whatsoever. After 18 months, they essentially put their hands in the air and said that I had long Covid but there was absolutely nothing they could do about it. I have been referred to the long Covid clinic in St. Vincent's hospital. That was in June, some five and a half months ago. I am still waiting to hear back from the clinic. It is very concerning that the clinic's website it states:

Please be aware that due to a large number of affected patients and limited available resources, we may not be able to see everyone referred to the St. Vincent's Long-COVID Clinic. However, your GP can also refer you to the appropriate local specialist...

The clinic is essentially saying that its hands are tied and it does not have the resources to see everyone. That means there is no hope for the many thousands of people who are living their lives on hold, living with a diagnosis of long Covid, and waiting to see whether they may be seen or might not be seen. That is certainly no way to live their lives.

The Government needs to get real. The resources need to be put in to help people like me, and the many thousands of people out there living with long Covid, to get on with their lives.

Deputy Mairéad Farrell

Gabhaim buíochas leis an Teachta Naughten as an rún seo a chur chun tosaigh inniu. Tá sé fíorthábhachtach. The first time that long Covid was highlighted to me was approximately two years ago. When I heard about it, it really knocked me for six when the woman in question detailed how much it had impacted on her life. Ever since then, I have raised the issue in this Chamber and through parliamentary questions because the people who have been suffering from long Covid have raised it with me. I commend all those people and the campaign groups who have continued to keep this on the agenda.

We know, of course, that Covid-19 caused a global pandemic. People everywhere recognise the severity of the virus. Now we see that some of those people who, when we were told we could stay at home, had to go out to work, whether it was in healthcare settings, stocking shelves in our supermarkets or in our factories, providing vital services on which we relied in order that we could stay at home and stay safe, are suffering from long Covid as a result of that work. They feel totally forgotten about now.

We all know people who have been affected and impacted by long Covid. I wish to read out something one woman told me about her experiences with long Covid. She said:

The worst thing about having Long covid is that nobody can tell you when you will recover.

If you have a broken limb you know it can take 6 weeks to heal, a chest infection can take a week with antibiotics but with long covid there is no magic pill and no time frame for recovery.

You cut back on expenses as much as you can but still can barely manage.

And it gets you down as you can't plan anything as you don't know when you'll be well again and able to return to work and have your normal income back.

And worrying about bills etc causes more stress which exacerbates your already debilitating symptoms.

We know how difficult people with long Covid are having it and we need to listen to what they are asking for. It is really good we are having this discussion but, really, we needed to have it two years ago. It is far too late to be having it. We need to act on this now because so many people are not able to get the help and supports they need and they are really struggling.

Deputy Pa Daly

I thank the Regional Group for bringing forward this motion. We in Sinn Féin will support it.

The various issues which accompany long Covid have yet to be properly researched and identified. There is no doubt but that many have caught the disease, many of whom I know, and continue to suffer. Some 90%, I think, who have it continue to suffer. Their lives are on hold and many of the up to 200,000 people suffering from it are suffering in silence.

The Regional Group is right to highlight the waiting list figures from the National Treatment Purchase Fund, the 79,000 people on those lists and the further 625,000 or more awaiting an outpatient appointment, and the difficulties the Irish College of General Practitioners and the Irish Nurses and Midwives Organisation have outlined. I also draw attention to the acute hospital in Kerry, University Hospital Kerry, which is at breaking point. If we do not have confidence in the Government to deal with issues of health, housing and even direct provision, how can we have any confidence that it will deal with this issue properly? As for the hospital in Kerry, more damning information emerged recently. In July, August and September of this year, admission through University Hospital Kerry's accident and emergency department was far above the State average 12-hour waiting time. The most alarming statistic was probably that for over-75s. In July, there was a 22-hour waiting time. Although things improved somewhat in August and September, for all patients there was a waiting time of 15 hours in those months. In that same period, 28% of all patients in the hospital in Kerry had to wait over 24 hours to be admitted. Performance, once patients are admitted, is poor also, with wait times exceeding three days both for those aged over 75 and under 75 years for all three months of that quarter. The winter plan is no more than a smokescreen as the real work, the planning, should have been done over a multi-year period. This motion goes some way towards addressing those issues, and I hope the Deputies in the House, in particular Deputies from Kerry, will support it.

There is also a difficulty and a crisis in home care, which has been brewing for many's the year. In my region there are 651 people waiting for home care, a gap that is often filled by relatives and friends. We need a proactive, strategic approach to workforce planning across all healthcare.

Deputy Patricia Ryan

I too thank an Teachta Naughten and the Regional Group. I also thank the advocacy groups which have stood up for people with long Covid and made the world listen when many people were being told to cheer up and get over it. Those groups have organised an email campaign. I am sure many of the Teachtaí here have heard the harrowing stories of their local constituents.

I wish to share the story of Louise O'Reilly, a nursing manager from Kilcullen, County Kildare, who was diagnosed with long Covid in July 2021. She has had pneumonia twice in the past year. Her breathing was badly affected. She had tachycardia and chest palpitations. Each week brought something new. The most debilitating part was the decrease in energy levels. When climbing stairs her legs felt like two lead blocks. Louise has two children and, as we Irish mammies know, there is nobody so full of false hope as the mother who puts items on the bottom of the stairs in the hope her kids will carry them upstairs. Last year, Louise had 16 GP visits. She now lives with poor concentration and brain fog, symptoms which were slower to develop but now seem to be the most lingering. She also experiences episodes of breathlessness and dizziness. In June 2021, Louise tried to go back to work. She struggled on and lasted a week. She went from being very active to struggling to get out of bed. Thankfully, she has a background in mental health and was very mindful of looking after hers. In recent weeks, she has returned to work part-time but the worst thing is the uncertainty about the future.

Covid needs to be recognised as an occupational injury. Not everyone is lucky enough to be facilitated with a phased return to work and not everybody can afford it. We in Sinn Féin support an accessible, community-based model of care for long Covid. Anyone suffering with long Covid or post-acute Covid syndrome should be able to get help and advice from a local GP, a public health nurse or other local health and social care professionals. An informed, multidisciplinary approach is essential. Sinn Féin also supports measures to determine the true effect of long Covid and its impact on society and the health service. Sinn Féin proposed a Bill which would have ensured that Covid-19 was treated as an occupational illness. Unfortunately, the Government refused to support that legislation, and people with long Covid are now suffering the consequences. The Government needs to support those living with long Covid. It is time to make up for lost time.

Deputy Donnchadh Ó Laoghaire

The word "debilitating" has been used in a few speeches. From the few people I have known, both through my office and in the community generally, who have suffered from long Covid, that is precisely the word. It has laid them completely low. It is quite a serious illness. Previously very energetic, active people who were very involved in the community struggle to get out of bed or maybe spend an hour or two out of bed and then return. That is the experience of complete exhaustion, flatness, mental fog, inability to concentrate and incredibly low energy and high fatigue. Obviously, that has huge implications for people's lives. Some employers are understanding but others are not. It has implications for parents trying to look after their children. It has implications for carers trying to look after the vulnerable and people who previously had responsibility not only in their work lives but also in their private lives. Long Covid has made that challenging. It lasts for a long time. Since we know so little about it, it is very difficult for people to be given answers and timelines from doctors that are so unclear. Where is the light at the end of the tunnel for these people? Some make a gradual recovery but some still suffer from long Covid quite some time later.

I also wish to flag the issues faced by those who almost certainly and realistically had Covid in the very early months of the pandemic but who could not get a PCR test because the system was completely overloaded. Some of those who are suffering from long Covid have found it very difficult to navigate the system because they did not have a positive PCR test, even though everything else pointed to their having long Covid. They have had difficulties.

I commend the work done by Deputy Naughten on this issue and on the motion, which Sinn Féin supports. A lot more is needed in respect of post-Covid and long Covid clinics. There are not enough of them.

I wish to raise another issue, one which Dr. John Lambert flagged to the health committee, namely, that long Covid is being viewed primarily as a respiratory issue. Obviously, there is a respiratory issue but there seems to be a clear neurological issue as well. The health system and the Government are not taking that sufficiently seriously.

Whether in respect of supports in work or in healthcare, an awful lot more needs to be done for those who are still suffering with long Covid.

Deputy Ruairí Ó Murchú

I thank the Regional Group for bringing forward this welcome motion. We need supports for those who are suffering from long Covid. Some of them got Covid doing work society deemed necessary.

I received a letter from Mary on behalf of her sister, Liz. It was also sent to me by other people, including friends of Liz.

I will read out some of it:

My sister, Liz, is a 56-year-old primary school Special Education teacher who contracted Covid-19 in a school in December 2021. She is now suffering from severe Long Covid symptoms and has been off work since. Her life is seriously impacted with ongoing long term chronic health issues and serious financial concerns. Because she is unable to work, she is seriously stressed about her future, her pension and the fact that her illness is not recognised as an occupational injury, which impacts her entitlement to financial cover for periods off-work. Because of Long Covid, the cost to her of medical appointments, scans and medicines since December last is in excess of €3,000 and climbing, at a time when her financial future is increasingly unclear. More importantly, and more distressing for those of us who care about Liz, is the life-limiting effects of this horrible disease. An active, life-loving person in her mid-50s is reduced to a life of exhaustion, brain fog, breathlessness, memory issues, pain and distress, with no end in sight. This is compounded by months of being referred from one organisation or service to another as each absolves themselves from responsibility by referring her on. The response from others is to send endless paperwork and forms to a person with a seriously-reduced ability to absorb detail and to action any of these processes.

This is not good enough. I could continue. We can all imagine. We are failing Liz and we need to do something about it.

Deputy Duncan Smith

I thank the Regional Group and Deputy Naughten for bringing this motion to the House. No more than the Labour Party and others, the Regional Group does not have Private Members' business very often so an awful lot of thought and care go into choosing the issues deemed to be of importance. A thorough debate in the Dáil on this issue is long overdue.

People suffering from long Covid are fast becoming one of a number of forgotten elements of the Covid pandemic. The pandemic is still with us in many ways. We hope we will not see the days of 2020 and 2021 again but the sufferers of long Covid are living with the condition and its ramifications every day. I asked a few people over the past couple of days whether they knew anyone with long Covid or had any experience of it. Those who did not thought long Covid was people suffering from fatigue. Anyone who has met someone with long Covid or has been contacted by constituents, as I and others have, will know that it is far more complex and life-altering than that. One person who contacted me contracted Covid in September 2020. This person was unable to work for almost a year. This person works as a photographer but literally could not hold the camera steady for ten months due to muscle fatigue. Even though the person is back at work, they need an assistant with them if they are on an all-day job so they can complete a full day. The assistant is needed to carry bags, such is the level of fatigue. The person in question considers themselves one of the lucky ones who has largely recovered from long Covid but states that the health supports that are needed are not widely available.

Another primary school teacher who contracted Covid in January 2022 returned to work at the end of August in advance of this school year. They have crashed many times being unable to complete their school day and have not received the support within the workplace they need and deserve. This person has reluctantly handed in their resignation. This is a teacher leaving our education service because of the impact of long Covid at a time when we need teachers. This is not a person at the end of their career. This person said they have a mortgage, kids and all the bills and cost-of-living pressures but they just cannot continue to work.

Someone else with long Covid symptoms since March 2020 said they know only too well that the health supports needed to deal with this are not widely available and the person has had to travel abroad to get the services they need. Another woman wrote on behalf of her daughter, who was a young healthy 37-year-old at the time of contracting Covid and was working on the front line. She was infected in March 2020, has not been able to work since then and has again been forced to travel. This is person who has spent two and a half years suffering, first with Covid and now with long Covid, and has had to travel abroad for treatment. This is a healthcare worker who has worked on the front line.

The final example I will share today involves someone who again contracted Covid in March 2020 and has since developed long Covid. This person has not worked since then. This person was being treated in the Blanchardstown clinic before it was closed. They were supposed to be transferred to the clinic at Beaumont Hospital. The person's GP keeps referring them for tests and most of the time, the tests come back not showing anything. There are no further tests and the suffering goes on. This person is being moved from Billy to Jack in the health service and is getting nowhere. This is a very serious case.

The number of people suffering from long Covid is growing because people are still contracting the disease. Yet, as this motion speaks to, what underpins this lack of service is the failure to recruit and retain healthcare professionals throughout our health service. As we move towards the end of 2022 and into 2023, the people who are suffering long Covid are increasingly feeling forgotten by our health service and political class. That is why it is important we are discussing this issue.

A related issue, which I have raised with the Minister previously, is counselling for people who have lost someone to Covid. There is a unique experience if someone was lost a loved one to Covid and did not have the ability to say goodbye in person, to grieve or to have a funeral with family members present. Those wounds are still open in families all over the country. Again, we need to pay attention so that those people are not forgotten.

Yesterday, Deputy Nash and I spoke to workers - contract cleaners, caterers and security staff - along with their trade union, SIPTU. These workers have not received their pandemic recognition payment. This is another forgotten element of the Covid pandemic.

This motion is very clear in what it is asking for. Regarding its acknowledgement at the start of the delays in the NTPF, difficulties in recruiting in GP and primary care services and acute hospitals and patient waiting lists in emergency departments, we see this repeated and continued near collapse and permacrisis that exists in our health service just to keep acute services and emergency services running, which means that further down the line, people with long Covid and post-viral respiratory or non-respiratory conditions are not being given the services they need.

I commend the motion. I know it is not being opposed by Government, which is its trick, but it has our full support. What we would like to see after this is a real long-term plan - not a winter plan or an emergency plan - to ensure the people who are suffering with long Covid get the symptomatic treatment they need in the hope that they can recover or at least manage their symptoms to such an extent that they will be able to lead a fuller life than the life they are leading now. Thousands of people are suffering and not enough is being done.

Deputy Róisín Shortall

I thank the Regional Group for tabling this important motion and acknowledge Deputy Naughten's work in this area over some time. He certainly stuck with it for a long time, as indeed have other Members. Unfortunately, the Minister for Health has not responded to this. It seems as though the Government is hell-bent on sidelining long Covid. As such, any opportunity to highlight issues related to long Covid care and support is very welcome. There are so many people suffering from the condition, yet the Government seems to just turn a blind eye.

We can all appreciate that many people do not want to hear about Covid and want to move on but that is a luxury long Covid patients simply do not have. Symptoms such as chronic fatigue, depression, breathlessness, blurred vision, migraine and brain fog act as a constant reminder of their condition. It is estimated that over 300,000 adults in Ireland have suffered or are suffering from these symptoms of long Covid but you would not think it from the Government's response.

The Government's healthcare plan ignores the science. It has completely left children with long Covid behind and the social welfare response has made us an outlier in Europe, in the worst possible way.

I am particularly concerned about the model of care for long Covid, which has failed to keep pace with the science. In fact, it was out of date before it was even published. The plan is primarily focused on the lungs and heart and not on the brain. The neurological and psychological impacts of long Covid have been known for quite some time, having first been identified in the medical literature in December 2020, nine months before this Government's plan was finalised. Yet only one neurologist is funded under the Government's plan, and this is for the entire country. You really could not make this up.

Alongside ignoring the science, this Government has ignored patients. Last July, I asked the Minister for Health if long Covid patients were consulted during the drafting of the model of care. I was told "No", because it was a new disease. This is no reason to exclude patients. If anything, it is all the more reason to include them. Equally, what about children? The new long Covid clinics do not accept patients under the age of 16. Instead, children are directed to their GPs. It beggars belief that in the third year of the pandemic the Minister still has not managed to put together a plan for children.

Another glaring omission from the plan is the Mater hospital's long Covid clinic. I have repeatedly questioned this Government's decision not to fund this clinic. It is the longest-running clinic in the country. Instead, the Minister has dithered, thereby forcing the Mater hospital's clinicians to cut back services in the north inner city. How much longer will the business case for a multidisciplinary long Covid clinic in the Mater hospital sit on the Minister's desk? He has done nothing about it and this is the centre that has treated most people in the country for long Covid. The particular expertise exists in the long Covid clinic in the Mater hospital under Dr. Jack Lambert, and yet the Government and the HSE will not engage with him. I honestly cannot understand what the reluctance has been to fund this service. Clearly, what the Minister was trying to do was to run down the clock in this regard.

I was disappointed to hear this morning about what has happened with this clinic. Dr. Jack Lambert has been in touch to say there has been an instruction to phase out the long Covid clinic in the Mater hospital due to the fact that the HSE has refused to engage with the clinic in respect of its business plan, which was submitted to the HSE in July 2022. There has been no response from the HSE. An instruction has now been given by management in the Mater hospital that due to the fact that the HSE has refused to fund the long Covid clinic in the hospital, the clinic will have to close by the end of this year. This is the clinic where there is the most expertise and the one which has treated hundreds of patients, and it is going to close at the end of the year because of the failure of the HSE to engage with it and to provide adequate funding. The management and the Mater hospital have made it clear that if funding were provided, the hospital would be more than happy to continue operating the clinic.

I am, therefore, putting it to the Minister of State that he and the senior Minister owe it to the many hundreds of people who have been helped by this clinic, and to those who would dearly love to be taken on by the clinic to receive the necessary treatment, to ensure that the HSE engages, however late in the day, with the Mater hospital concerning the maintenance of this clinic. I ask the Minister of State to raise this issue with the Minister, Deputy Stephen Donnelly, as a matter of urgency today.

There have also been serious staffing concerns right across long Covid and post-acute clinics. It seems that only 22.5 out of 70 posts funded under the plan have been recruited for. I repeat that is only 22.5 out of 70 posts. It has been more than a year since this plan was published. Was no workforce planning done in this area? We know precious little workforce planning has been done right across the health service and this is the biggest challenge now to the provision of health services. It seems, however, that no workforce planning at all has been done in respect of Covid clinics. During last month's hearings in the Joint Committee on Health, we learned that the waiting list for some long Covid clinics can be up to five months, and even longer. Reports are coming in from many patients that they have been told the wait is closer to ten months at this point. This must feel like a lifetime when people are dealing with symptoms such as overwhelming anxiety, depression, breathlessness, brain fog and fatigue. These patients need much quicker access to clinical psychology, neurology, physiotherapy and occupational therapy services. For some, while they languish on waiting lists their problems are compounded by financial pressures.

Let us take Emma from Kildare. She is a nurse who just returned to work after contracting Covid-19 on the wards in April. Her life has been turned upside down by long Covid. She has been unable to care for her children and everyday activities have become exhausting for her. She was refused sick pay in August and September and has had to go back to work. She can, however, only work greatly reduced hours, which leaves her at least €400 short monthly. This is the reality of long Covid and the Government has failed to acknowledge how life-changing a diagnosis it can really be. All healthcare and front-line workers who are unfit to work due to long Covid should be entitled to special leave as an absolute minimum. Arbitrary deadlines should be scrapped.

There are, of course, other issues regarding the Government's failure to adequately address the Covid-19 issue. One of these is the whole question of the Department of Social Protection's failure to revise the position regarding occupational illnesses. Why is Evusheld still not available to immunocompromised people in Ireland, despite its approval by the European Medical Agency, EMA, last March? I could go on and on, but I have run out of time. The Minister of State knows long Covid patients are suffering. They can no longer be given the cold shoulder. I want the Minister of State to take this issue up with the Minister, Deputy Stephen Donnelly, in a serious way. It is time to change course and the Minister for Health has to act.

Deputy Gino Kenny

I commend the Regional Group and Deputy Naughten for his continued work on long Covid. We are three years into this pandemic. The world did not know the term "Covid-19" until three years ago. Since then, this virus has claimed millions of lives, affected hundreds of millions of people and caused economic chaos across the world. Many of us who got Covid-19 have recovered fully, thankfully. A vaccine has been developed which has been hugely helpful in the fight against the pandemic. A whole cohort of people who got Covid-19 in the last three years, however, have not recovered fully.

As a member of the Joint Committee on Health, Professor Jack Lambert's critique of long Covid was a revelation to me and many others on the committee. In my naivety, I thought the symptoms of Covid-19 were mostly respiratory. As Professor Lambert said, cognitive and neurological symptoms can also be devastating to those who have long Covid and continue to suffer these symptoms.

The most important aspect of this debate is that people in this situation must be listened to and supported. This is the main thing in this debate. For too long those with illnesses such as fibromyalgia, myalgic encephalomyelitis, ME, or Lyme disease have been largely dismissed as having something that is largely in their own heads and been told they should just get on with things. Obviously, this is not the case by any means. In his critique, Professor Lambert laid out in bare terms that people are suffering physically and mentally in this regard. I got Covid-19 about four months ago.

Physically it takes its toll, but I cannot imagine dealing with those symptoms continuously for months on end. It must be most distressing on those who are in that situation.

For those who have long Covid, the main issue is support. There is hope. People who have long Covid do get better. However, there is a cohort of people for whom it lingers. That can be detrimental, not only to their physical health but also financially. They cannot go back to work and that is a significant impediment on their financial circumstances.

Not classifying Covid-19 as an occupational injury was a huge mistake by the Government. This should be an occupational injury. If one works in a medical setting - for example, if one is a nurse or doctor - one can get time off, etc., but if one is in a different setting, such as an educational setting, it can be much more problematic.

If there is something to come out of this debate - the Government has put these specialist clinics forward - it must be that there is quite a lengthy waiting period to see a specialist. The average waiting time is ten months. Given the situation, it is not good enough. If we listen to and support these people, the situation will be much better for those who are experiencing long Covid.

Deputy Paul Murphy

It is important that we are discussing this and I thank the Regional Group for bringing the motion forward. This is a huge issue. It is not discussed enough and it will become an even bigger issue. As the motion notes, there are likely to be well over 300,000 adults in the State who are suffering or have suffered from medical conditions associated with long Covid, based on an extrapolation of research done in the Netherlands.

I have seen at first hand people I know who have been affected by long Covid and continue to be, and the debilitating effects of it are immense. There is obviously a spectrum here in terms of how people are affected but at the high end of the spectrum, it is completely debilitating for people.

A report compiled by APC Microbiome Ireland, which is based in UCC, surveyed 1,000 people with long Covid. It found that nearly 70% of them were severely limited in their ability to work while 60% had missed work days due to their long Covid symptoms. Sixteen per cent of participants said they were unable to work at the time of the survey. Some were sick for up to 20 months while the median period of illness was over a year.

Within this general topic of long Covid, the question of long Covid for children is not discussed enough. I am sure many Deputies have received a message from Ms Hayley O'Connell, who is 11, turning 12 this January, and has long Covid and ME. Ms O'Connell states that she has had long Covid for about a year and a half and it is not easy. Hayley adds that you miss out on a lot of activities like going out with friends or going to the playground because you purely do not have the energy, and that it is not just about being tired - it is so much more. She adds that it also involves leg cramps, muscle pain, being weak and headaches, and that there is so much more. This was avoidable. We must ensure that all children and everybody are protected from this in the future.

In a way, there are two aspects to this. The first is to do the research on long Covid and provide the funding and the resources in terms of treatment of long Covid now. The HSE needs to establish a multidisciplinary public health team to review and manage long Covid. It is vital that this team includes patient advocates so that the voice of patients experiencing it is incorporated. It is a real problem that we still do not have long Covid services for children. The rundown that is happening in terms of the Mater is scandalous, to be blunt. It is probably a year or more since I was involved in a campaign, which was thankfully successful, to defend the long Covid clinic in Tallaght. We still do not have enough of them and the Government is not taking it seriously and is not providing the resources.

The other side of this question is that the best cure is prevention. We are still not doing enough to stop people getting Covid. Every time someone gets Covid, there is a risk - it is a small risk but it is present and one aggregates it over everybody - that 10% of people end up with long Covid. Therefore, we need to do now what we should have done two years ago, which is to focus on the central question of ventilation and filtration. It is almost a year since we introduced and had passed on Second Stage the Workplace Ventilation (Covid-19) Bill 2021 to give workers the right to clean air at work, which would include, obviously, schools and all indoor public spaces. We now, finally, from Thursday last, have the HSE opening up a consultation process on its code of practice for indoor air quality. I welcome this but it comes too late for the hundreds of thousands of people who are already suffering or have suffered from long Covid and the tens of thousands who will contract Covid and long Covid in the coming winter months. We need action in terms of ventilation and in terms of filtration such as high-efficiency particulate absorbing, HEPA, filters, now.

Acting Chairman (Deputy Denise Mitchell)

Moving on to the Rural Independent Group, there are four speakers who have two minutes each. The first speaker is Deputy Michael Collins.

Deputy Michael Collins

One of my constituents contracted Covid in January 2021. This is one of many stories. He was diagnosed with long Covid three weeks ago. His symptoms have been present all this time and have made it impossible for him to carry out the simplest of tasks, such as driving, going to the local shops and even walking short distances. He has had to give up sports such as hurling, football, soccer and golf. His life is no longer the same because of this. He was due to fly to Australia in August 2021 but had to cancel all his plans because his symptoms have not improved. He would consider himself a young, healthy and fit individual who was involved in everything but can no longer live his life appropriately the way he used to before Covid. He has also been unable to work for months now and fears he will never be capable to return with his current condition. Due to this, he had applied for illness benefit and was turned down, which is ridiculous. Through sheer determination, he was eventually able to receive a community welfare payment. He has spent quite a substantial amount of money over the past six months on hospital bills and medication without any support from the Government. It is a disgrace that he was turned down illness benefit payment in the beginning and that he had to go about obtaining his own long Covid clinic appointment in Dublin. There are very few support networks out there. I would suggest that this be urgently rectified for all of those throughout the country who have been tragically affected so that individuals such as this man can begin the journey of hopefully getting their lives back on track in the near future. Surely the Government, which paid so much attention to locking down the country for months on end during the pandemic, should not now turn its back on people who are suffering from the lingering impacts of Covid. This is the situation of one of my constituents. It is the unfortunate situation of quite a lot of people.

We are calling it long Covid, but others might say it is the effects of the vaccination. We do not know. What I am saying is that this is a very serious situation and it should be looked at.

Deputy Danny Healy-Rae

I thank the Regional Group. Obviously, I support their motion.

I want to raise something else with the Minister of State, Deputy Butler. It is urgent and needs to be addressed. I want to talk about a girl who has serious intellectual and physical disabilities. She has been in and out of St. Mary of the Angels for many years as a respite patient but since her father died over a year ago, she has been full-time in St. Mary of the Angels because her mother cannot care for her. This big, strong girl is nearly 40 years of age but it takes an awful lot of work to handle and mind her. Now the HSE and St. John of God Hospital are saying that this girl must leave this residential care and the only other place she has to go-----

Acting Chairman (Deputy Denise Mitchell)

I ask the Deputy to stick to the motion.

Deputy Danny Healy-Rae

I have got permission. The only place this girl has to go now or where she is told she has to go is up to County Meath. There is no residential bed in Kerry for this girl. The HSE is saying that if her mother does not agree to this, it will take the mother to the High Court and make the girl a ward of court. This is very serious. Is this what the HSE is about? They say they are doing it for this decongregation model. They want to move her to County Meath. That is not acceptable. I am appealing to the Minister of State, Deputy Butler, in the strongest terms not to let the HSE take this mother to court to make her daughter a ward of court.

Deputy Michael Healy-Rae

I thank the Regional Group for tabling this very important motion. Research highlights the real burden that long Covid represents to the Irish population. We have an already overburdened health service, highlighting the importance of finding scientific solutions that can tackle the underlying mechanisms that are causing such diverse and debilitating symptoms. More than 27,000 people left Ireland's emergency departments before being seen by a doctor during the three-month period from July to September. I am not trying to say this is all down to long Covid problems but long Covid is adding to the problems we are having. According to the Irish Nurses and Midwives Organisation. some 10,679 patients who were admitted to hospital in October spent time on a trolley before securing a bed. This is an increase of more than 25% on the figures for October last year.

The situation with our GPs throughout the country is that they are overwhelmed. There are not enough of them. If we are to provide a proper healthcare service, we have to start from the ground up. We have to have the doctors on the ground in our parishes and communities. We have to have centres of excellence, of course, but we have to have more healthcare centres that can deal with people, whether those suffering from long Covid or other issues, and direct them away from accident and emergency departments because, quite simply, they cannot manage. As I did yesterday, I again want to pay tribute to those working in Kerry University Hospital. They are many criticisms of the management and various issues in the hospital but I thank those in that hospital and in all our community hospitals, whether in Kenmare or Cahersiveen, and in the nursing homes in County Kerry.

Deputy Mattie McGrath

I compliment the Regional Group for tabling the motion. Many people are suffering from long Covid and they have a diagnosis after great cost to themselves and great energy spent, even though they have very little energy to try to get a diagnosis. It seems a blanket has been put over Covid and we cannot discuss it or debate it. One narrative has had to apply all of the time. People are very ill. More them are like young Roy Butler in Waterford who lost his life after the vaccine. Will the Minister of State meet his family? They were in touch with me quite recently. They are desperately trying to get information from the vaccine companies. I remember one day the Taoiseach came in here with all guns blazing and gave carte blanche indemnity to the vaccine companies. Now we cannot find the wherewithal to support people who have long Covid. Many of them are nurses, doctors and front-line workers in many areas. They battled and we stood up here and clapped for them. Some of them are still waiting for the €1,000. It is shocking that they are still waiting for the €1,000 payment they were supposed to get. This has all been a very sly game. We saw that one of the heads of Pfizer recently admitted the vaccine was not tested on how effective it would be against the spread of Covid. There are a lot of answers needed. We need to look after people who have long Covid and who are vaccine injured. This will go on for a long time. Meanwhile big pharma is riding off into the sunset with billions of profits and the Irish taxpayers are patsies once more thanks to the new globalists and the Taoiseach. He came in here and everybody supported him. Why should we indemnify those companies if they are so safe? They had no trials done. They fobbed us off all the way. Now people are ill and injured and suffering long Covid. They must be looked after. Why are 100,000 people on trolleys on a weekly basis? Why are twice as many children in Crumlin today as this time last year? Ask the questions. The answers are quite obvious if we open the eyes and see.

Deputy Thomas Pringle

The issue of long Covid is very serious and I fully support the call in the motion to fully staff post-Covid clinics, to establish a multidisciplinary public health team to review and manage long Covid care in the population, and to develop the rehabilitative and recovery programme designed to meet the needs of those experiencing long Covid. The effects of long Covid are extremely concerning. Many people in my constituency of Donegal are experiencing long Covid and the effects are devastating. The health supports needed are not widely available and many of my constituents are suffering chronic ill-health without access to essential medical care. It is a very serious issue but it appears the Government and the HSE would prefer to turn a blind eye to it. One constituent who reached out to me is a young 11-year-old girl who has ME. After getting long Covid she is struggling to attend even three days of school. She says that some of her closest friends still do not understand that she does not like missing school and not doing homework. She says she hates it. She says that missing school and falling behind makes people want to do anything to be normal again. This is heartbreaking.

The symptoms are not the only issue that sufferers must endure. Long Covid is now seen as an ordinary illness and sufferers are getting only reduced rates of pay. I have also been contacted by a constituent who is a member of An Garda Síochána with a young family of six children aged between five and 17. That person is receiving only half pay due to being absent with long Covid and is considering resigning. This is completely unacceptable, especially given the current cost-of-living crisis. The rate of sick pay in general needs addressing. We cannot punish people for being sick. Dealing with illness is extremely stressful and can have a detrimental effect on mental health and family finances. We should not be adding to people's stress during a difficult time. People cannot afford to take a pay cut when sick. If anything, they need further financial support to help with medical costs. I support the motion. We need to start taking long Covid seriously. I would go further and say the rate of sick pay should be greatly increased for all those who require it.

Deputy Marian Harkin

I thank the Regional Group for tabling the motion on long Covid. I am pleased to be able to contribute to the debate because I have been contacted by many people who are unwell. Their lives have been turned upside down. They have gone from being fit and healthy to being sick and exhausted. People are searching for answers. They want their lives and their health back. Those people deserve to be represented. They deserve to be heard. The motion from the Regional Group provides an opportunity for this and I thank them.

The motion calls for action on many fronts, including fully staffing long Covid and post-Covid clinics, as already committed to by the HSE in September 2021. I think only one third of promised whole-time equivalents were in place by last month. This is not acceptable. The motion also calls for the establishment of a multidisciplinary public health team incorporating patient advocates who will review and manage long Covid care in the entire population. It is crucial that the patient voice is heard. There are too many silos and too much compartmentalised thinking when it comes to treating and supporting people with long Covid. We need to prise open some closed minds when it comes to dealing with the totality of what long Covid includes. The motion also calls for the establishment of a dedicated long Covid clinic for children and, crucially, for the recognition of long Covid as an occupational illness for all healthcare and front-line workers.

I want to read a few lines from one of the many people who have contacted me on this issue.

I'm a 41 year old nurse wife and mother of five from north county Leitrim. I contracted Covid at work in January 2021 pre vaccines with inadequate PPE. Fast forward over 18 months later I've still not returned to work and remain unwell. Covid has massively impacted my health. I've now got ongoing shortness of breath, muscular pain, nerve pain, joint pain, fatigue and brain fog. Pre covid I worked full-time, now I need to lie down after a trip to Lidl.... Covid has stolen my health, career and my life as I knew it from me. It is so disheartening that Government have still not acknowledged Covid as Occupational Illness. I got this illness because of work and I feel like HSE and Government are leaving me to rot. Its soul destroying and a awful way to treat the very ones who had no choice but to go to work with no vaccine and inadequate PPE.

That is the strongest case that can be made for recognising long Covid as an occupational injury for healthcare and front-line workers.

I have contacted the Minister, Deputy Stephen Donnelly, about the need for a long Covid clinic for the north west, to be located in Sligo, but so far there has been no progress. Nationally there are an estimated 336,000 adults affected by long Covid. This number keeps increasing. We need a long Covid clinic in Sligo. I want to use this opportunity to support Professor Jack Lambert and his long Covid clinic in the Mater.

An issue raised by many of the speakers is that of contract workers, security and cleaning staff who have not yet been paid the pandemic payment.

Deputy Nash organised a meeting yesterday at which four of them spoke. I was ashamed that they had to come to Leinster House concerning what should have been paid to them long ago. Before the introduction of personal protective equipment, masks and vaccinations, etc., they protected people in healthcare settings. They should be paid and thanked.

Deputy Joan Collins

A campaign on my.uplift.ie seeks to fund long Covid multidisciplinary clinics. It was initiated by Miriam Cullen, who is in the Public Gallery with other long Covid patients. I thank Deputy Naughten and the Regional Group for using Private Members' time to discuss this serious issue.

The current HSE plan for long Covid medical support is inadequate. It proposes only eight post-acute Covid clinics nationwide for newly diagnosed people for the first 12 weeks. Should a person need continued care, there will only be six long Covid clinics nationwide for sufferers to attend. One of the problems with the proposed care plan is that if a person is newly diagnosed in County Donegal, he or she may attend a post Covid clinic for 12 weeks in Letterkenny, but should further care be needed, he or she would go on a waiting list, with thousands of other people, for the nearest long Covid clinics, which will be in Galway and Dublin. This problem is mirrored throughout Ireland and I ask people to sign the petition.

This is a serious situation that can no longer be tolerated. We have to get our heads around what is happening in communities, involving thousands of people. It is likely that in excess of 336,000 adults are suffering with long Covid every day. This figure is based on the extrapolation of research based in the Netherlands published in The Lancet in August 2022, which attributed long Covid to 12.7% of patients infected with the virus..

The fact that long Covid services do not exist for children is scandalous. It is a disgrace that the clinic in the Mater hospital, which treats neurological conditions such as brain fog associated with long Covid, has been forced to reduce its services due to a lack of funding. It is important that there is an electronic patient register. We have to know how many people have long Covid in order to provide the care that is needed. There are other points I wanted to make but I only had two minutes.

Minister of State at the Department of Health (Deputy Mary Butler)

I welcome the opportunity to discuss long Covid health services and I thank the Deputies for tabling the motion, especially Deputy Naughten, who has raised this issue continuously in the House for the past 12 months. A Private Members' Bill was tabled last night on home care, which I was delighted to attend and speak on, and I am here again to discuss long Covid. These debates are important and we have to have them. I welcome the tabling of this motion.

Long Covid is a challenging condition for those who experience it and for service planning and delivery. There has been progress in establishing a national service and the Government will allocate additional resources in 2023 to ensure the full implementation of the service. The budget will facilitate an overall investment of an additional €6.6 million next year for the further development of long Covid services to ensure a full national service is in place, which is an important point. We are moving away from the postcode lottery to a national service and no matter where a person is living, he or she will get support.

There is probably not one family or extended family in Ireland that does not contain a person who feels they have symptoms of long Covid. They are experiencing symptoms they did not have prior to getting Covid. I know a person in my extended family who has been dealing with multiple issues for the past 12 months. There may be some Deputies who previously leaned towards being Covid deniers and are now talking about long Covid in the Dáil today. It is important that we accept and realise it is a real thing. I know it is a real thing judging by the interaction I have had with people who have long Covid.

We have to talk about this as knowledge develops internationally. Two and a half or three years ago we did not know anything about Covid and now we are experiencing the effects of long Covid. As knowledge develops internationally, it is important that the HSE’s interim model of care is adapted to ensure it will be in line with the most up-to-date evidence. We have to adapt, be flexible and nimble to make sure we can support the best national approach to supporting those with long Covid.

The HSE will continue to monitor demand for services and to model the numbers of people affected by long Covid based on national and international data. In this regard, an epidemiological survey is planned that will provide insight into the prevalence of long Covid in the Irish population and risk factors for developing long Covid. This study will inform further service development. I am informed by the HSE that this study is in phase 1, which involves testing the design of the study and recruiting the personnel required.

The HSE has also commissioned HIQA to conduct an international review to further inform the development of the service to ensure it is in line with international best practice. The review is expected to be completed later this month. HIQA has carried out several very useful evidence-based reviews over the duration of the Covid pandemic, many at the request of the National Public Health Emergency Team, that have helped to provide an evidence base for various public health measures implemented over the past two and a half years.

As with all aspects of our national public health response to Covid-19, it is essential that the most updated evidence continues to be used. The HSE and the Department of Health continue to monitor international data and research to ensure all available evidence is used to improve service planning and delivery. The Department, through its lead funding agency, the Health Research Board, HRB, currently supports a number of studies into long Covid. The HRB will continue to promote long Covid as a critical area where evidence is required to inform clinical practice and policy development. With the support of the Department of Health and HRB, Ireland continues to participate in international research studies on Covid-19, including the WHO Solidarity PLUS trial and the EU SolidAct. As Members have heard, providing care for those experience long Covid requires a multidisciplinary response, particularly as symptoms and their impact can be so variable. I have been struck by how varied the symptoms are for different people.

General practice plays a key role in the delivery of a national long Covid service with the initial role of GPs being to exclude acute or life-threatening complications and other unrelated diagnoses. As part of the implementation of the model of care, the HSE has engaged with the Irish College of General Practitioners, ICGP, and other professional bodies. Through this engagement, it has identified the opportunity to provide further education and training in the management of long Covid, including when and how to refer patients to specialist services. The HSE is liaising with the ICGP on how future training and education can be optimally designed and delivered. I understand the HSE is also engaging with patient groups, such as Long Covid Ireland, on service development, which is important.

Fortunately, evidence to date continues to indicate that most children recover quickly from long Covid and the incidence of long Covid in children and young adults is low. The best available evidence supports the provision of care to children by their GPs and, if necessary, by general paediatricians, who work in multidisciplinary teams and have specialist terms to refer to, including paediatric respiratory and neurology teams as needed. The national clinical programme for paediatrics and the national clinical advisors and group lead for children and young people continue to work closely with the HSE long Covid team to review evidence and support access to care.

The motion speaks to the need to ensure services are in place for those with care needs as a result of long Covid. I assure colleagues that addressing Covid-19 is something all Government partners have prioritised in the programme for Government. The Strategic Approach for the Management of Covid-19: Preparedness for Autumn/Winter 2022/2023, which was published last month, acknowledges the need to ensure provision of a national service for those suffering from post-acute Covid and long Covid. It also emphasises how the clinical understanding of this condition will continue to evolve through the review of expert guidance to reflect best practice and ensure an effective service, with a health workforce suitable upskilled in the recognition and management of both post-acute Covid and long Covid.

Five new post-acute Covid clinics have been established, which manage patients between four and 12 weeks after the initial onset of infection. Long Covid clinics manage patients 12 weeks post onset. Five new long Covid clinics have also been established. Patients are referred by their GP to these clinics as needed and more clinics are due to open in the near future in Cork, Letterkenny and Limerick. To care for those experiencing long Covid, clinical input is provided as needed, depending on symptoms, by a range of health care professionals, including those working in respiratory medicine, infectious diseases, neurology, mental health, allied health professions, general practice and other community services.

These interdisciplinary teams guide and support patients through all aspects of recovery, support and care for a range of primary symptoms. This, coupled with the HSE's planned service developments, will ensure that all necessary supports will be put in place.

I reiterate that those affected by long Covid will continue to be cared for through our health services. The Government and the Minister have committed to continued investment in ensuring a national service is in place. The service is evolving as international and national evidence becomes available to help us better understand the illness and its consequences. It will continue to evolve as needed to ensure those in need of care due to long Covid can access it. I again thank Deputies for raising this important issue. I was happy to come to the House and speak to it. As different statistics emerge, I believe we will deal with long Covid for some time to come.

Deputy Cathal Berry

I welcome the Ministers of State. I am grateful for the opportunity to contribute to this important debate on long Covid. I would like to commend my good colleague, Deputy Naughten, and Cáit Nic Amhlaoibh, our group administrator who, in fairness, did all the heavy work in preparing the motion. I acknowledge and welcome the presence of patient advocates and long Covid patients in the Gallery, who are very welcome. I also acknowledge the constructive contributions from all Members. Long Covid is too important to leave the Government with the monopoly on responsibility. It requires every side of the House to pitch in with constructive ideas to see whether we can address this national problem, just like we have done in the past.

Long Covid is real and it is recognised by the WHO. The Minister of State, Deputy Butler, was reassuring in her reply and I am heartened to hear what she said. It is a massive issue that affects significant numbers of people, judging by the correspondence we have received in the past week. While the numbers are large, they would be much larger were it not for the vaccination programme and co-operation of the public with the control measures introduced over the past couple of years. The situation is much more manageable than it would have been otherwise.

I am conscious of what Deputy Fitzpatrick said, namely that we should not establish a hierarchy of patients. However, a disproportionate number of healthcare workers are in the long Covid cohort and we need to examine why that is the case. They did not do anything wrong; in fact, they did exactly what we asked them to do. As a Parliament, we asked them to man the barricades, so to speak, during a time of crisis. They did that very effectively. As a result they have been affected disproportionately. The State has a duty of care to that group in particular. It is in the State's interest to address this. We need to get people back to work and support them on their journey.

What I like most about the motion is that it does not just list problems but includes a comprehensive list of potential solutions. I wish to focus first on the need for greater supports from a research point of view. The Minister of State, Deputy Butler, outlined that this is a novel condition and we do not know a whole lot about it. We need to fund research not just in Ireland but internationally. It is an international illness and there needs to be multi-centre trials. Perhaps if the Ministers of State are in Europe, they could use their good offices to get as much information as possible and get international research going on how best to assess, investigate and treat long Covid.

We need to get the doctors involved. Professor Jack Lambert has been a lone voice in the wilderness for the past while. I am reassured by what the Minister said about the HSE engaging with the ICGP, which is as it should be. The Royal College of Physicians of Ireland should also be involved. Perhaps it is an issue for the CMO. He might extend an olive branch. It is on board already, but if they are running study or CPD days it might be an idea for them to cover the topic of long Covid to get the message out and share experiences from the point of view.

The third area I wish to focus on is resourcing. Everyone in the House recognises that this is not just about money; it is also about structure and getting clinics up and running. As the Minister of State, Deputy Butler, outlined, the clinics are not yet fully manned, but need to be. I have the pleasure of travelling past the children's hospital this morning, as I normally do. Aside from the financial issue, which is a debate for another day, it is reassuring to see the building going up. It is to be hoped that by 2024 it will be up and running. We cannot wait until 2024 for a dedicated paediatric clinic. The Minister of State said this should be paediatric-led, which is correct, but one of the children's hospitals in Dublin needs to be designated as a long Covid paediatric centre of excellence.

I am heartened by the debate. Many commitments have been given, and we need to translate them into action. We can say all we want in this Chamber, but is all about the implementation. As a wise person once said, "It is by our actions they will know us", and that is how we should be judged.

Deputy Denis Naughten

I acknowledge the support of my colleagues in the Regional Group. The reality is that many patients with long Covid are not being believed. The motion provides some official acknowledgement that they are being listened to. In fairness to most Deputies, they have not recognised this issue to date because patients have not come to them directly. I want to thank Cáit Nic Amhlaoibh and, in particular the library and research service for its support and for performing significant background research over the past year that has assisted me in helping to highlight the need to support long Covid patients across the country. I thank the Ministers of State and colleagues across the House for their support in allowing this important motion to be adopted unopposed. I want the Ministers of State to keep two figures in mind when the debate is over. One is six months and the other is €500 million.

At present, long Covid patients have to suffer for, on average, six months before getting a first appointment in the specialist clinics being established by the HSE throughout the country because these clinics are not being staffed. The Ministers of State made reference to long Covid clinics, in particular St. Vincent's University Hospital, Beaumont Hospital and University Hospital Galway. There are just two staff appointed to St. Vincent University Hospital's long Covid clinic. No staff have been appointed to the Beaumont clinic or University Hospital Galway's clinic. That is why people are waiting. The Mater Hospital clinic is set to close at the end of this year.

Long Covid patients with serious and debilitating medical conditions, from brain fog to chronic fatigue, are waiting an average of ten weeks from the date of referral to specialist clinics, with the longest wait being 42 weeks for patients trying to access the clinic in St. Vincent's University Hospital, Dublin.

We must not forget that to meet the criteria for long Covid, a patient must experience symptoms for at least 12 weeks and if they are lucky they will get to see a GP be referred to a clinic within four weeks. This results in people suffering with long Covid related symptoms and having to struggle with their illness for at least six months, on average, or well over a year if they are waiting to access support in St. Vincent's University Hospital Dublin, as Deputy Brady said. While those waiting the longest after a referral to St. Vincent's hospital are those in Tallaght, who are waiting for 26 weeks after referral, in Cork University Hospital the wait is 20 weeks and the wait in University Hospital Galway is 16 weeks after referral.

Long Covid is costing at least €500 million in lost work and welfare alone. Data from the Department of Social Protection show that 0.81% of those who contracted Covid-19 and claimed the enhanced illness benefit payment were medically certified as being unfit to work 12 weeks later. Extrapolating this across the total number of people infected with Covid-19 in the adult population equates to 21,459 adults who are unfit to work or hold down a job. If we use the arbitrary six-month waiting time for care, this equates to €586 million in lost wages and welfare payments alone, never mind the impact long Covid is having on our already overburdened health service.

We heard personal stories from colleagues in the House earlier. We have long Covid patients in the Gallery, each and every one of whom represents thousands of patients throughout the country, many of whom are watching this debate on Oireachtas TV.

I will leave two stories with the Minister and the Taoiseach. One is from a ten-year-old boy named Oisín and the other is from an 11-year-old girl named Órla. The ten-year-old boy, Oisín, performed when the Taoiseach visited to open his school recently. It was a very proud day for him and his family to have the Taoiseach there but, sadly, his mum, who is housebound, was not physically able to witness that performance because she has long Covid. Eleven-year-old Órla is attending school just three days per week because of the symptoms of long Covid but, as she says, "I am still struggling and some days, I even have to go home earlier". Covid has had a considerable impact on all of us but I ask that the Government to ensure that our children, such as Oisín and Órla, do not continue to suffer because long Covid patients cannot get access to the medical care that will make a real difference on their road to recovery.

Question put and agreed to.

Dáil Éireann debate - Wednesday, 9 Nov 2022

Long Covid Health Services: Motion [Private Members]

Dáil Éireann debate -
Wednesday, 9 Nov 2022