Dáil Éireann debate -
Wednesday, 18 Oct 2023

Vol. 1044 No. 2

Trends in Mortality and Estimates of Excess Mortality: Statements

Minister of State at the Department of Health (Deputy Hildegarde Naughton)

I welcome the opportunity to discuss trends in mortality and estimates of excess mortality. The Department of Health actively monitors and reviews all available data on mortality, including excess mortality, as it becomes available, to gain a better insight on underlying mortality trends in Ireland and factors influencing these. While the Department does not produce estimates of excess mortality, it works closely with the Health Protection Surveillance Centre, HPSC, the Central Statistics Office, CSO, and other stakeholders to monitor estimates of excess mortality. A number of different methodologies have been developed by organisations and academics internationally to try to estimate levels of excess mortality. It is important to note that estimation methods vary depending on a number of factors including differences in methodology and the data used. There is, therefore, no internationally agreed method on the estimation of excess mortality.

Official data on mortality in Ireland is collected by the CSO based on deaths registered with the General Register Office, GRO. The latest final data on deaths from the CSO is for the deaths occurring in 2020. Provisional data, based on date of registration of the death, is currently available for 2021 and 2022. It is important to note that in Ireland currently, a legal period of three months is allowed for the registration of a death. Analysis by the general register office has found that, on average, approximately 82% of deaths are registered within this three-month time frame and, therefore, data for the most recent period is provisional and caution is required in interpreting this data.

Ireland’s age-standardised all cause death rate declined steadily from 1,152 deaths per 100,000 in 2007 to 923 per 100,000 in 2019. In 2022, the provisional age-standardised all cause death rate was 937 per 100,000. While this was an increase from 2021, it was below the age-standardised all cause death rate of years prior to 2018. As most causes of death vary significantly with people's age and sex, the use of standardised death rates improves comparability over time and between countries.

A key factor potentially influencing mortality trends is demographic change and the changing age structure. Ireland’s total population increased by 8.1% between census 2016 and 2022. There was a fall in population in some younger age groups such as children under four years. In contrast, the number of persons in Ireland aged 65 and over increased by 22%, more than double the 10% increase that occurred in the EU 27 over the same period. Within this age category, the highest increase was experienced by those aged 75 to 84, growing by 28%, while the EU 27 only experienced a 3.4% increase in the 75 to 84 age group.

While Ireland continues to have a younger age profile than most of the EU, our population is ageing and coming more in line with the EU average. As we might expect, persons in older age groups account for the majority of deaths. In 2019, 82% of all deaths which occurred in Ireland were among persons aged 65 and over. Some 29% of all deaths were in the 75 to 84 age group. We know that the number of adults aged 65 years and older is increasing by just under 4% annually and the number of adults aged 75 and older is increasing by just over 4% a year. The substantial increase in the number of persons in these age groups annually gives rise to an expectation of an increase in the absolute number of deaths occurring in Ireland, compared with the number of deaths that occurred during the years 2016 to 2019.

All data on excess mortality are estimates and, as I noted earlier, many different methodologies have been developed by a number of organisations internationally to try to estimate levels of excess mortality. Some of these methodologies are long-established, such as EuroMOMO, a European mortality monitoring activity, while many were developed in response to the Covid-19 pandemic, such as by Eurostat and the CSO. It is important to note that the different estimation methods vary considerably in the estimation of expected deaths. For example, the number of years involved in the baseline average may vary, where 2016 to 2019, is a four-year average, while others use a single year. The actual timeline may vary, for example, the years 2016 to 2019 or 2010 to 2013. Methods may allow for seasonal variation. Methods may apply statistical significance tests before mortality is considered to be excess. Nationally and internationally, work is currently under way to further refine methods to estimate excess mortality.

EuroMOMO, Eurostat and the CSO have published estimates of excess mortality during winter 2022-23 for Ireland. The most recent estimates from EuroMOMO estimate that during winter 2022-23, Ireland experienced excess all cause mortality for all ages during five consecutive weeks in late December 2022 to early January 2023. Mortality has been close to or below baseline since the second week of January 2023. EuroMOMO estimates that other European countries, including the UK, Austria, Belgium, Denmark, France, Germany, Italy, the Netherlands, Portugal, Sweden and Switzerland, also experienced excess mortality for a period last winter when flu was circulating at high levels.

When considering the EuroMOMO data on excess mortality, it important to note that influenza activity was at very high levels in Ireland during December 2022 and early to mid-January 2023. The number of influenza case notifications to the HPSC in the last weeks of 2022 and early weeks of 2023 was the highest of any week since 2017. Previously, flu surges of this magnitude recorded similar increases in excess deaths in winter 2017-18, which was characterised as a severe flu season. While EuroMOMO data is the most robust available, the modelling of excess deaths does not take into consideration Ireland's 4% increase in adults aged over 65 from 2019 onwards. This gives rise to an underestimation of expected deaths and an overestimation of excess mortality.

Eurostat publishes monthly estimates of excess mortality that compares the number of people who died from any cause in a month with an historical baseline for that month from pre-pandemic years, 2016 to 2019. Since March 2020, Eurostat estimates that the EU27 has had a higher number of deaths than the 2016 to 2019 average in almost every month. Since early 2022, Ireland has followed a similar pattern, that is, the number of deaths in each month has been higher than the average number of deaths that occurred during the same month between 2016 and 2019. This method does not account for population growth or an ageing population, which significantly underestimates Ireland's expected deaths. As we know, the number of persons in Ireland aged 65 and over increased by 22%, more than double the 10% increase that occurred in the EU27 over the same period. Some 82% of all deaths which occurred in Ireland were among persons aged 65 and over. While both EuroMOMO and Eurostat are based on similar data on the number of deaths that occur, because of the different methodologies used to estimate expected deaths and excess deaths, these methods generate different estimates of excess mortality levels.

The CSO recently published an update of their frontier series publication, Measuring Mortality Using Public Data Sources 2019-2023, which includes an analysis of rip.ie death notices and estimates of excess mortality. The CSO adopts a similar methodology to Eurostat to estimate excess deaths but, in the latest release, it uses a number of different baseline periods to illustrate how the estimation of excess deaths depends strongly on the baseline chosen and provides a range of estimated excess mortality rather than a single figure for each month.

An issue impacting analysis of mortality trends and estimates of excess mortality for Ireland is the time lag in death registration. As I outlined, in Ireland a legal period of three months is currently provided for the registration of a death. In the short term, the response to address the issue of this time lag has been the use of rip.ie data during the pandemic. While timely and with high coverage, it lacks key inputs, such as cause of death and age of deceased. Following a public consultation in 2021, work is under way by the Department of Social Protection, the General Register Office, the Department of Health, the Health Service Executive and the CSO to improve the timeliness and process of death registration in Ireland. This involves two main actions: the Department of Social Protection is progressing the civil registration (electronic registration) Bill 2023, which will legislate for more timely registration of deaths; and the development of technical solutions to allow notification and certification of deaths by hospital staff and GPs is under way within the HSE. The technical, procedural and legislative change required will, however, take some time to be implemented.

Considerable analysis is ongoing in relation to mortality trends in Ireland. In 2022, neoplasms, diseases of the circulatory system and external causes were the main causes of death among persons aged under 65 years. Diseases of the circulatory system, neoplasms and diseases of the respiratory system were the main causes of death among persons aged 65 years and over. Data for 2022 are provisional and based on date of registration of death.

The Health Protection Surveillance Centre will continue to participate in the EuroMOMO network to monitor trends in excess mortality during the upcoming winter. The EuroMOMO network is also working closely with the European Centre for Disease Prevention and Control, ECDC, to further develop and enhance its methodology to estimate excess mortality. The CSO is also continuing to examine methods for estimating excess deaths and mortality analysis. Internationally, the Department of Health is engaging closely with the OECD in its work on incorporating demographic change in its excess mortality estimates and the use of excess mortality as an indicator of the impact of climate change.

The Department of Health will continue to actively monitor and review all available data on mortality as these become available to gain a better insight on underlying mortality trends in Ireland and factors influencing these. The Department will also continue to work with all stakeholders to determine the most accurate estimates of mortality data in Ireland.

An Cathaoirleach Gníomhach (Deputy Mattie McGrath)

Anois táimid ag bogadh ar aghaidh leis Sinn Féin agus an Teachta as Port Láirge, Teachta-----

Deputy Hildegarde Naughton

David Cullinane.

An Cathaoirleach Gníomhach (Deputy Mattie McGrath)

Gabh mo leithscéal. How could I forget?

Deputy David Cullinane

Well, that is it. The Cathaoirleach Gníomhach represents some of Waterford as well.

An Cathaoirleach Gníomhach (Deputy Mattie McGrath)

Indeed. I represent it well.

Deputy David Cullinane

You do indeed.

I welcome the fact that we have statements on trends in mortality and estimates of excess mortality. It is important that we have clear, factual and evidence-based data put on the public record. Some of the information given by the Minister of State is very helpful. I have seen some misinformation and mischaracterisation in respect of this topic, especially online, which is unhelpful. It is very important that we have a chance to have a debate on this matter and to have factual information. It is also one of the reasons we need more investment in digital transformation in healthcare because it is sometimes difficult for the HSE and the healthcare systems to capture data. We know that data are rich as regards decision-making in healthcare and that many of our IT systems across acute primary community healthcare do not speak to each other. We do not have interoperability and we lag behind other European countries in our digital transformation of healthcare. I wanted to make that point at the start.

I acknowledge the important strides that have been made over the past few decades in improving life expectancy in this State. In 2021, life expectancy at birth stood at 82 years. This is obviously a positive feature of life in Ireland and demonstrates how far we have come since independence. It is also important to recognise this progress, part of which is to do with improvements in innovations in health, new medicines and therapies, a better healthcare system, and all the improvements we have seen over decades. All of that has to be recognised.

As the Minister of State said, however, we also have an ageing population. Since 2016, the total population has increased by 8%, but the number of people aged 65 years and over has increased by 22% and the number aged over 75 has increased by 25%. We have to acknowledge that in the context of this debate and what we are discussing. The average age now stands at 38, which is up from 36 in 2011. People are having children later in life, as we know, and fewer of them are having children. While some of that is due to lifestyle choices that people have made, and we know the difference between when people have children now compared with maybe 30 or 40 years ago, we also have to recognise that social changes are being driven by the lack of housing and childcare supports, which are preventing young families from forming and settling. The Government has to address the barriers young people face to avoid, or at least mitigate, the severe impact that unplanned demographic challenges can and do have on the sustainability of social services.

It is not enough to just recognise the progress that has been made. It is essential that we also react to it. The demographic changes will obviously heap additional pressures on our hospitals, which they cannot bear. If we do not plan for those demographic changes, then we will not be able to deliver the health services that people need. I will deal with some of those issues when I talk about the existing level of service funding in healthcare, which we know is, in part, to deal with those demographic changes, in the context of what happened in budget 2024.

Our older people are already funnelled into hospital-based care because of a lack of alternatives at home and in the community. I pointed that out to the Minister for Health time and again. He does not need it pointed out as everybody knows, from the Sláintecare report and the very extensive debates we have had on healthcare, that we need to reorientate the healthcare system to ensure that we have the right care in the right place at the right time for patients. While we need to put more capacity into our hospitals, we have to do much more in relation to GP capacity, out-of-hours GP care, making better use of community pharmacies, building on the enhanced community care model that we now have in healthcare, which I welcome, making sure that people with chronic pain and chronic conditions are treated and managed in the community where we can, and delivering the statutory home care scheme to ensure that people can be cared for in their homes. All these are areas where we need more investment. All of that is also necessary as we deal with the huge changes and transformation we are seeing in healthcare.

I also acknowledge the significant innovation we are seeing in healthcare. I am always blown away when I go to training colleges and see people who are being trained to work in our healthcare system, and the first-class research and development and training capacity. It is just incredible. We are at the cutting edge of it. We see it in nursing and across many areas. I have no doubt that all of that training and capacity is leading to better health outcomes, when we get those people to come to work in the public system. The problem is we do not get all of them. As I said, because of other societal problems, such as housing, we are unfortunately losing some of them out of the country. That is regrettable.

We need to change our approach to healthcare to focus on improving quality of life and focus on care in the community to reduce hospitalisation. Our focus should also be on prevention and early intervention, not just treating disease but, where we can, preventing it. Again, this is one of the areas in healthcare we do not talk enough about. We maybe do not invest enough in this area. The Irish Heart Foundation and others are doing some very good work and research in this area in respect of cardiac disease. If we can reduce instances of disease, it is obviously more cost-effective and more beneficial in the management of our health services, but it also means that people will live longer and will not be in hospital.

Long waiting times are also storing up problems and making matters worse. They make care much more complicated and reduce the ability of people to stay at home, manage conditions locally and live independently.

I take this opportunity to raise with the Minister of State the issue of the deficit in healthcare spending and this year's budget. I know there will be statements on this in the Dáil tomorrow but we cannot have a debate on the impact of demographic pressures on healthcare and avoid having a conversation about the money that was given to the health service last year and this year to deal with those pressures. One of the reasons we have what are called existing levels of service funding given to Departments is to deal with a number of areas. These include pay demands, inflation, which is running at a high level in healthcare, and the increase in population and demographic pressures. The heads of the HSE and Department of Health, speaking at the Joint Committee on Health some months ago, conceded that the health service did not get enough money to stand still last year. Whatever the level of service funding that was given, it simply was not enough. That has, in part, created what is a big deficit this year of potentially €1.5 billion.

Matters were made worse in the budget just gone. The current head of the HSE has stated clearly on the record that we do not have enough money to run the health service next year. I understand that at a press conference today, the Minister for Public Expenditure, National Development Plan Delivery and Reform, Deputy Donohoe, stated it was likely we would have a deficit in healthcare spending next year. Not only is it likely but it needs to be pointed out to the Minister that he has guaranteed there will be a deficit next year. He has also guaranteed that we now have a recruitment embargo in place on the front line, in hospitals and elsewhere, that will have an impact on patient care. We know, from all the studies that have been done in Britain, the European Union and internationally, that if people are waiting for longer in emergency departments, their outcomes will disimprove. The quicker people can be treated in emergency departments, the better their health outcomes will be. When there is a recruitment embargo in areas such as non-training non-consultant hospital doctors, NCHDs, and junior doctors, healthcare assistants, home helps and lots of other areas, that will bite and have an impact on services. I visited St. Luke's General Hospital in Kilkenny on Monday where I met hospital management. They told me they were already finding it very difficult to hang on to non-training junior doctors who were being poached by the NHS in Britain and health services elsewhere. They are really concerned about the impact of this recruitment embargo and what it will mean. St. Luke's hospital has improved in terms of the number of patients on hospital trolleys.

Another example I will give, because it has been talked about so often by Ministers and is in my constituency, is University Hospital Waterford. There have been no patients on hospital trolleys in the hospital for more than two years. That was partly due to a lot of work that was done. Of the many ingredients that enabled that to happen, one was that the hospital opened up a sixth medical ward with 35 beds. This ward is allowed to stay open through unfunded posts and agency staff. A decision has been taken to scrap 7,000 unfunded posts and cut back on the agency spend by a third. I do not have a difficulty with cutting back on agency spend as long as it does not bite on services. I have been told by hospital managers in Waterford that they cannot keep the sixth ward open unless they take staff from elsewhere. One of the areas they will take staff from will be cardiac care, which means the second cath lab that was opened to deliver additional cardiac capacity will not deliver the full benefits it should deliver. This is one local example. I am sure that in the coming days, weeks and months as we face into a very difficult winter, this will become more apparent.

On excess deaths and what contributed or caused them in recent years, I have been very clear about putting factual information on the Dáil record and being responsible when we talk about this issue. We know, however, and it is accepted in the health services internationally, that if there are pressures in emergency departments and people are waiting for days on end on trolleys - I have spoken to many families for whom that has been a very bad experience - it will have an impact on the health outcomes of patients.

In addition to investment in primary and community care to ensure that alternative clinical pathways are available and people who should not be in hospital have other options, hospital managers talk about the need for more hospital beds. It is not the only solution but it is one of them in some hospitals. As the Minister of State will know, the Minister for Health, on three occasions last year, including very loudly at a meeting of the health committee, promised and announced 1,500 rapid-build beds. They seem to have dropped off the face of the earth. Certainly no additional funding was made available in the budget and we do not know if these beds will be funded at all. Without those beds in hospitals, we will to be able to give hospitals the additional capacity to enable them to deal with the issues in emergency departments. That will be on the Government and the Minister with responsibility for public expenditure and reform who, thinking out loud and speaking as if he was not a direct contributor to this, said we will have a deficit in healthcare next year. He made a deliberate decision to underfund the health service. That will have consequences.

Having spoken to some clinical leads in healthcare, I am also concerned about cancer, cardiovascular treatment and diabetes in maternity. All these areas need year-on-year additional funding to advance and to deliver their strategies. The health service has been starved of additional funding in these areas. If anybody believes this will not impact on the future of healthcare services, patient outcomes and patient safety, they are living in cloud cuckoo land. It will have a real impact. I have given an example of what this will mean in an acute hospital in my county but we will see it right across all of the clinical programmes and the national strategies. Every strand of healthcare has been starved of additional funding. Worse still, we have not even provided the health service with enough money to stand still. Given what we have already seen with the recruitment embargo, the scrapping of 7,000 jobs and the disappearance, it seems, of 1,500 rapid-build beds in a puff of smoke, all of that will bite, and I think we will see more.

That big black hole the Government has created in healthcare will now be bigger next year because of the deliberate strategy of the Government. Maybe it thinks it is good to leave this to the next Government. Sinn Féin has said the Government has thrown in the towel on healthcare. Maybe it is the case that it has given up because it will not be in government next time around and has decided instead to leave it to the next Government. That is irresponsible because anybody who understands how healthcare is funded will say there has to be certainty on funding. In the absence of such certainty, there is chaos and confusion. We need multi-annual funding and accountability in healthcare, not cuts.

I listened very carefully to what Government representatives said in response to all of this as they have tried to pivot and shift this onto the HSE, arguing that the HSE is wasteful and needs reform. Nobody has been shouting that more loudly than I have. We do need to reform the HSE and there is waste. I have been pointing out a lot of these areas, including management consultancy, outsourcing, agency spend and so on. It is only now that the Government is waking up and saying it will do something about it. Even if all of that was delivered, at the best estimates it still would not come within an ass's roar of dealing with the deficit. I am very concerned about all of that. While I am pleased we are having this debate on excess mortality and related issues, I could not let the issue of the budget go without putting those points on the public record.

Deputy Duncan Smith

I welcome the opportunity to debate this issue. It is a difficult one to discuss for a number of reasons. I found the Minister of State's opening statement to be helpful and very honest about the complexities in the epidemiology and the difficulty with calculating excess mortality. Those are very real difficulties and complexities. This issue was first introduced to many of us, including me, through online debates during the Covid pandemic, particularly in the misinformation wars in which excess mortality was weaponised as a phrase to target the Government, State and health service response to Covid-19. We could talk about that until the cows come home. Overall, however, the vaccination programme and the response at the time from our health service and front-line healthcare workers were a great source of pride.

Collectively, the country tried to do its very best. However, that is where I first came to realise the meaning of this term "excess mortality" on a regular basis and to dig down into it.

The data on excess deaths, as the Minister of State, Deputy Naughton, said in her statement, are difficult to calculate and to agree upon and there are huge sensitivities to them as well. When one is debating the different methodologies, it is not like debating methodologies in other parts of social science or anything like that. When one is dealing in relation to deaths, it cuts far deeper. There are huge sensitivities to it.

The accuracy of the data on excess deaths that come from EuroMOMO, as I said, are disputed, with Eurostat showing a 16% excess death rate in Ireland. However, the data have been partially collected from RIP.ie, which, as the Minister of State mentioned, do not include key information, such as the age of the person who has passed away or the cause of death. These are real pieces of information that are needed if one is to calculate excess mortality as it can be as a result of a number of things, including issues with the healthcare system. Where, I suppose, we want to get to if we are examining excess mortality is us asking whether we are experiencing high levels of excess mortality and whether that is due to a failure in the healthcare system or another failure in the State. We are not there yet in terms of being able to stand over any kind of methodology to rigorously examine that and the lack of accurate data tracking excess deaths is a concern because we need to get to a place where we are using these data to ensure that we are planning for the health service, we are planning for the HSE and we are planning resource allocation. Of course, in the past eight days we have been having a huge debate. We will have a big debate tomorrow, and rightly so, about resource allocation and funding for the health service. Ultimately, we want to fund the health service and it needs funding because sick people need to be made better and we have to avoid people who are very sick passing away. It is vitally important.

The lack of funding for the HSE in the coming year, as has been further copper-fastened, both yesterday and today, by the Minister for Public Expenditure, National Development Plan Delivery and Reform, who seems to be calling the shots here in a hard-headed and heavy-handed way, is an absolute disgrace. It will cause harm, as Mr. Bernard Gloster, the CEO of the HSE, says. I stated yesterday, in speaking with the press, that when one is causing harm with the health service that means sick people will get sicker and very sick people will die. That is the reality of it. As predicted by Mr. Gloster, if he is to try to protect accident and emergency and access to the healthcare system, the impact will be in the clinical strategies such as cancer strategies, diabetes strategies, sepsis, our biggest killer, and heart disease, another one of our biggest killers. These are the areas that will be impacted by the recruitment freeze and the lack of funding. This is the reality.

When we are measuring the impact of this in terms of the harm caused, we will need to be able to compute, rely on and have trust in any kind of excess mortality methodology. We are not there yet. Of course, the best way to decrease deaths and to not have excess mortality is to have a functional, properly-funded and resourced healthcare system. None of us in this House, including the Minister for Health, can say hand on heart, given this budget and given where we are and where we are going, that we have a functional, properly-funded and resourced healthcare system because it has been shown and demonstrated clearly over the past eight days that we will not have that in the next year.

Deputy Colm Burke

First, we need to be careful about how we use statistics. One month's figures do not make a trend. We also need to be careful of using figures from unofficial sources.

The CSO publishes quarterly reports on vital statistics, which include births and deaths. Quarter 1 figures for 2023 were published on 25 August. As regards death registration, they correctly point out that many deaths occurring in a particular quarter may not be registered until the following quarter. They indicate that of the 10,205 deaths registered in quarter 1 2023, only 59% or 6,062 deaths occurred in quarter 1. The remainder of the deaths registered in quarter 1 occurred in the fourth quarter of 2022. A similar pattern emerges for every quarterly death figure.

The CSO has now produced figures for its best estimate of deaths occurring in any one quarter. Its estimate for deaths occurring in quarter 1 of 2023 is 8,413; in quarter 1 of 2022 is 8,858; in quarter 1 of 2021 is 10,037; and in quarter 1 of 2019 is 8,618. The CSO figures indicate that there is no great difference between the first quarter of 2019, which was pre-Covid, and the figures for the first quarter of this year.

However, there are two figures which will contribute to rising death numbers in the years ahead. One is a changing age profile of the population. CSO figures show that between census 2016 and census 2022 the number of people in the group aged between 75 and 84 increased by 28% and the number aged 85 and more increased by 25%. Figures released in the past few days show that the average life expectancy in Ireland was 71 years when we joined the European Union. According to HSE figures released in August this year, life expectancy in Ireland is now 84.4 years for women and 80.8 years for men. People may be living longer but, of course, death comes for everybody sooner or later. An ageing population will result in higher annual death rates over time.

The other factor which will over time also contribute to higher deaths is the overall growth in population. The Irish population has increased by 1.5 million people since 2000. That is a 40% increase in 23 years. A rapidly-rising population will inevitably see a rise in the number of deaths from the wide variety of illnesses and conditions which can occur.

Some people are using RIP.ie as an accurate measure of deaths in any one month. I am not aware of any research by any academic institution on the accuracy of RIP.ie figures. RIP.ie figures may well serve as a useful measure of monthly deaths but, I repeat, one month does not make a trend. Of course, many people in older age groups dramatically reduced their social contacts during Covid while others may have delayed medical check-ups. When Covid restrictions were eased, an increase in deaths might be expected. For a variety of reasons, there are always higher deaths during the winter months. However, every winter the flu kills many people and causes hospital overcrowding. Getting the Covid vaccine and the flu vaccine and following public health guidelines on the prevention of infection will reduce the number of deaths and reduce hospital overcrowding in the winter months ahead.

It is important as well to acknowledge the work that has been done in the health service over the past 20 years. I note my colleague, Deputy Cullinane, acknowledged the part the health service has played in making sure that we have increased life expectancy of 11 years in the past 50 years - our life expectancy has gone from 71 years to on average 82 years. A huge contribution to that is people being more aware of how to mind their own health but also the contribution that the health service, GPs, doctors, nurses and hospitals make. In fact, when one looks at the changes that have occurred in healthcare in the past 20 years, for instance, where long ago one went in for a procedure and one could be four or five days in hospital and now many of those procedures are day procedures and people are in and out faster, the volume of patients who are being seen in the hospitals and clinics has increased dramatically.

On an average day people will give out in some way or other about the health service but they do not realise that there were over 3.5 million outpatient appointments last year, which is over 65,000 or 66,000 people a week, going into our hospitals for care in some form or another in clinics. It is important to acknowledge the work being done in that area.

We have a great challenge, however, and it is important that we note it. The latest CSO figures show there are over 805,000 people aged over 66 years. That is a huge growth in the population in that age group. It also means that by 2030, which is only six years away, there will be more than 1 million people aged over 66 years. We need to be sure we can plan for that and that we deal with the whole area of home care and step-down care from hospitals. I find it frightening that while we discuss this matter here, there are over 600 people in hospital who we could be discharged but we do not have a co-ordinated mechanism in place to get people out of hospital in a timely manner. That is one issue with which we need to deal. We need to built step-down facilities so that someone can get into a step-down facility for three to four weeks and out of hospital care because the cost of hospital care is extremely expensive. It is up to €7,000 or €8,000 per bed per week whereas a step-down facility will cost €2,000 per bed per week at most. Much work needs to be done in the area. Much work must also be done on home care. We need a more attractive package to be available to get more people into providing home care. Take the figures in the Cork and Kerry south-west region. Over 1,800 people were employed by the HSE to provide home care two years ago. We lost 400 of those. To be fair to the HSE, it has recruited more people but we have not recruited a sufficient number of people to provide the packages they require. One lady was on to me in recent days. She is 90 years old and has to use a walking frame to move around her own house. She is living on her own. The best I can get for her is one hour a week of home care. That is not sufficient. We have to look at the whole area of how we provide an attractive package to bring people into that area and give them the support that they can help people live in their own homes, to live there securely and to have the additional support they require.

We will also have many more people living on their own where families have moved away from their own location. They might be working in Dublin or in other parts of the country and it is not as easy for them, especially if they have young children themselves, to give the time to their parent as they would wish. The importance of home care needs to be further looked at and delivered on. It is about how we attract people in and how we can try to attract those who were providing home care but who left the sector back into the system. What do we need to do to make that attractive?

We need to examine the whole issue of step-down facilities. I am not satisfied that we have a sufficient capacity in the area of step-down facilities. Going into the October bank holiday weekend, will we have administrative people on call during that weekend to assist doctors? If a doctor comes in on the bank holiday weekend to discharge a patient from hospital and if that person does not have the necessary supports at home to go back home, are there administrators there to ensure the suitable step-down facility can be identified in order that such a person can get out of hospital on a Saturday or Sunday of a bank holiday weekend or during Christmas? It is fine to say that consultants have to work on Saturdays and Sundays to discharge people but we also need to ensure the administrative support is in place as well to ensure we can deliver the step-down facility that the person requires. These are the things on which we need to start focusing.

I mentioned the population rising by 43% in 23 years. We have not grown the number of hospital beds by 43% in the same time. Part of the reason is, as I said earlier, because we have many procedures now that do not require admission to hospital but are daycare procedures. But that means we still have a huge growth in population and we now need to plan to cater for that growth and to deliver the infrastructure in a timely manner.

I thank the Minister of State for bringing this debate forward. It is important that we get accuracy in the figures in this area.

Deputy Ruairí Ó Murchú

This has been a useful exercise, in that a lot of information has been put out there by the Minister of State and others. Deputy Colm Burke had no difficulty in reeling off a lot of useful figures. Particularly since we entered the Covid period we have been dealing with a lot of disinformation and misinformation. There have been some who will abuse the data and others who fall prey to that. It is something that needs to be dealt with.

There is a lack of statistics and information that needs to be collated on older people. Deputy Cullinane spoke of the need to see the digital transformation. We know the issues about systems in healthcare and the need for proper operating systems for patient information and patient care that allows for best practice and best-case outcomes. We all know the issues in the HSE and the vulnerability to outside attack which we must all be prepared for in this day and age. When we need systems to be interconnected and to communicate to each other we also need to be sure that we have the relevant protections and firewalls and to ensure we can at least mitigate the dangers that exist today.

I will return to an issue I have raised many times, namely, elder care and particularly during Covid. I thought at this stage we would have further information on the inquiry into the State’s reaction to Covid would be and what we would discuss in particular modules. There were several issues with nursing homes. I refer to Dealgan House in Dundalk where 23 families suffered the loss of a loved one during Covid. They have interacted with many Ministers by now and many other politicians across the House to try to get those answers. It will have been three years in November since a small number of the families met the Minister for Health, Deputy Donnelly, to ask him to get answers to their questions. He did say that people required some sort of mechanism or device to provide these answers. These families have been incredibly brave and resilient. Between freedom of information requests and sometimes, when politicians have been helpful, in responses to parliamentary questions, these have provided a huge amount of information but we really need to get down to some form of investigation or inquiry to provide those answers. Those answers are also needed more generally. We constantly talk about best practice and learnings.

We should set in train what is necessary to provide these families with the facts regarding any of the questions that remain concerning nursing homes, the HSE and all others involved. That needs to be done and then we need to make sure there are protocols and best practice for how we go forward regarding elder care in general and also in dealing with the possible pandemics in the future. There are enough dreadful things going on in this world and we do not want to see this beyond that.

I had about 14 different points but they will stay for another day. Regarding the Minister of State's remit, I will address the family addiction support network, which got an element of funding for a specific project through the community innovation funding stream through the Department of Justice. We need to look at what was in the Guerin report around providing the network with the capacity for sustainable funding, rather than living on volunteerism and fundraising, which is not sustainable in the long term.

Deputy Róisín Shortall

From the outset, I have to say that I wonder about the motivation behind this debate. I also want to note that some of the people who were loudest in calling for this debate are not present in the Chamber for it at this point. One only has to do a cursory search of excess deaths on social media to find any number of conspiracy theories and anti-vaccine content. I am not by any means saying we should ignore the statistics for excess mortality because they are important but we should question the framing of this data by some, along with the reliability of some of the sources. When it comes to excess mortality, the two most commonly referenced sources are Eurostat and EuroMOMO. However, as Professor Anthony Staines recently pointed out, their findings and data sources are very different. For example, Eurostat, which collects data from rip.ie, has repeatedly reported high excess death rates in Ireland. For August, it reported excess deaths of 21.1%, the highest in Europe. EuroMOMO, in which the Health Protection Surveillance Centre, HPSC, participates, found that Ireland has been in the normal range, with no substantial increases in mortality since March. One issue with Eurostat is the methodology. It compares the number of people who died in a given period with a historical baseline, in this case, 2016 to 2019. This does not take account of rapid demographic changes or a population ageing faster than anywhere else in Europe. When we interpret this data, particularly around winter, we must also be cognisant of waves of Covid, flu and other respiratory illnesses. In respect of Covid and the first three months of the year, there were 307 deaths as a result of the virus. That is about 13 people a week. Between October 2022 and March 2023, influenza infection led to 170 deaths.

Another factor which must be considered when looking at the winter figures is hospital overcrowding. Analysis of HSE data by the Irish Patients' Association, IPA, found that more than 1,200 patients died last winter as a result of delays in hospital admissions. When this figure was put to Fergal Hickey of the Irish Association of Emergency Medicine, IAEM, he said these estimates were "probably conservative". Addressing these avoidable deaths must be a key priority for the health service as we enter the winter months this year. Nonetheless, I do not believe that there is evidence of any hidden or sinister reason for excess deaths in winter, aside from our health system's predictable, yet unacceptable, inability to deal with winter surges.

Unfortunately, it is difficult to envisage any improvement this year when the Government continues to underfund the health service relative to demand. It is almost as if this Government is oblivious to the changes in demographics and the impact of inflation and has given up on reforming our health service. Much of the additional funding required this year was to maintain the momentum and keep the progress going of the implementation of the reform programme, Sláintecare. The question must be asked, where does this stand now, given that funding falls so far short of what is needed. For example, what happened to reviewing our model of elder care? In April 2020, the then Minister for Health, Deputy Harris, said that the current model was not fit for purpose and that a serious conversation about elder care would be required after the pandemic. We are still waiting for that serious conversation. I accept that the commission on care is due to begin its work next year but it is still not clear if it will examine the increasing privatisation of older persons' services. This is key to the model of care. A month after the comments of the former Minister, Deputy Harris, the Taoiseach also said we needed to consider alternatives to nursing homes such as "more and better home care". Yet, we know with the home care budget provided this year and the allocation, which was due to be almost 24 million hours, is being cut back in order to meet commitments to pay staff properly. Older people needing home care are paying the price for what we should have been doing anyway, which is putting homecare workers on a proper financial footing concerning their pay and conditions.

It is extremely disappointing that those improvements in pay come within the same envelope and that older people will pay the price for that. It is very disappointing, not least following the downward revision concerning the loss of almost 2 million hours and, in addition to that, the considerable number of people on waiting lists. Why has there still been no movement on the statutory right to home care five years after the commitment to introduce a statutory scheme? We still do not even have the heads of a Bill. If we were serious about this and committed to introducing a new model of care, we would put much more energy, time and effort into ensuring that long-standing commitment was delivered upon. Unfortunately, it looks to be some way off still.

Deputy John McGuinness

A general discussion outside of this House regarding Covid and what went on at that time will range across the spectrum of conspiracy theories, some facts and a listening ear to decide what is best to do to explain to people what happened. During Covid, there were a lot of lockdowns but elderly people in homes felt it more than most and those that died during Covid had to do so without the general support of their families. The issue around Covid, vaccinations and what people thought at the time, plus the deaths, disturbance and trauma caused to families sparked the debate around the number of people dying.

I was a member of the Special Committee on Covid-19 Response. We discussed in detail just how people were to be looked after and our response in real time in terms of the Department, the various front-line staff and so on. It would be worthwhile to look back on that and to have a discussion to learn from just what exactly did happen during Covid. Then we can address the increase in deaths since Covid. Some people consider that there are a lot more deaths now than in comparison to previous years and normal life expectancy. I am beginning to think that the number of deaths is unusual and, therefore, we should examine that and try to understand what is the cause of that. I accept that we have an increased ageing population and that would explain some of the numbers. What shocks me in my own county is the number of young people who are dying, the number of cancer cases being reported and the range of the types of cancer that people are suffering from, in some cases causing death. We should educate ourselves on what is happening and we should try to understand the types of cancer and where they come from.

I have learned also from my own constituency about a case where a factory was blamed for the high death rate, for example, in Castlecomer, north Kilkenny. It involved a farmer, Dan Brennan. We had a debate on the issue at the agriculture committee. He only found out what had happened after the fact. When the factory closed, all of his animals and farming activities improved immediately. It is clear that the adverse effects resulted from the emissions from the factory. He was located across from the chimneys of the factory. Instead of dismissing that as something that was irrelevant or something that did not happen at all, which is often the case when we discuss issues like this because they can be associated with conspiracy theories, when we get into the detail of them, for example, in Dan Brennan's case, we discover that certain things were happening at the time. All of what had shown up in the tests carried out by the then Department of Agriculture, Fisheries and Food on his animals and how the growth of trees was affected stopped some time after the factory was closed. We need to understand what was in the air at that time that caused all of that to happen. Similarly, we need to understand in relation to either vaccines or unusual cancers why all of that is happening.

I read emails that came into my office from one individual who lives in Kilkenny, and I have read reports on the numbers that have died. Because the numbers are so different by comparison to other years, that in itself should set off at least some alarm bells and it should focus the minds of those in authority on why that is happening, setting aside the ageing of our population. If we were to do that, we might dispel some of the extreme explanations that we read about and we could address the reasons it is happening and learn from them.

I would certainly support further investigation into the numbers. I certainly would not support the argument being dismissed on the grounds of it being something that is made up or coming from sharing stories on the Internet or elsewhere. There is a basis here for a discussion, which we are having in this House, and for some action to be taken. As well as that, we have an obligation to allay the fears of those who are very concerned about the number of deaths.

I spoke to my local undertaker in Kilkenny and he too is very surprised by the numbers. Some of the offerings on YouTube tell us what is going on and what users believe is going on. Taking the extreme elements out it, I believe that we should look at it. Any look-back on where all of this is coming from should really take into account what was happening in our nursing homes at that time.

We in this House decided to recognise those that were working on the front line during Covid and afterwards, but it is amazing the number of people who have been excluded from the Covid recognition payment. That should be looked at as well. We should not just say that was for another agency or group to look at. If we are serious about these health-related issues, we owe it to ourselves and the next generation to examine what is being said. We also owe it to those who work on the front line now to understand why they were not paid. They seem to have a legitimate argument. When we put it to Ministers, we are told that it is really not their decision but if we made the decision in this House, which we did, and we have paid out significant money to those that were on the front line and entitled to it, then I believe it is time to look at those who feel they have been left out. In a way, it is the same principle as looking at an argument that looks to be extreme now but on examination it may not be that extreme. Instead of pushing to one side the loud voice on the other side of the argument just because it is connected to something odd that might appear on the Internet, we should actually take on board more in our deliberations as to why the particular argument is being made.

In short, I believe the numbers are unusually high. It is important that the Department of Health, the Government, and any other Department, should examine this to determine why and to learn from what has happened in the past. If we do not do that, we could be just storing up a problem for the future. Any new vaccine that came out very quickly during that time is due to be appraised anyway. It should be looked at because of the fact that the vaccine suddenly came from nowhere. Is it the best? Can we do better? Are the complaints on the issue valid? The number of people who want answers is such that we should facilitate some form of look-back and determine what those answers should be.

Deputy Paul Murphy

There are two issues here that need to be separated.

One is the question of whether there is excess mortality and whether there are excess deaths. The second question is, if there are, what is the cause? The two are often intertwined and the subtext of much of the discussion on excess deaths, unfortunately, involves the implication, which is without foundation, that these deaths or a significant proportion of them are being caused by vaccines.

We need more data but, based on the data we have available so far, particularly Eurostat data, there are reasons to say that there is excess mortality in multiple European Union countries. While they are not Eurostat data, there are data showing excess mortality in multiple countries around the world. The point has been made that August 2023 saw Ireland having the highest rate of excess deaths at in excess of 20%. We also know that life expectancy has fallen around the globe.

There is some evidence to suggest there is something happening here. The question then is what that something is. The first and most obvious cause of this rise in mortality is Covid, which did not exist before late 2019. Covid is still a significant cause of death in Ireland. It may be the case that the political establishment and much of the media commentary would wish that Covid had gone away and was something we talk about in the past tense but, unfortunately, it has not gone away. It is simply the policies that have changed. A policy of effectively closing our eyes to it and letting it rip is now the dominant policy worldwide. Some 954 people in Ireland have died from Covid since 3 January 2023. This includes 84 people in the past four weeks. In particular, a disproportionate number of people are still contracting Covid in hospitals and nursing homes, where they are particularly vulnerable and where the disease can result in people's deaths more quickly than would otherwise be the case.

Another explanation that is likely to be a factor is post-Covid morbidity. There are higher incidences of heart attacks, strokes, chronic diseases like diabetes and neurological problems in the months and years following a Covid infection, something which contributes to excess deaths. This may even get worse over time as people suffer repeated reinfection. A recent major study found a substantial rise in the risk of cardiovascular disease, including heart attack and stroke, for at least a year after Covid infection. For many people, this can manifest as higher blood pressure, a long-term silent killer that can add to excess mortality in later years.

Another explanation is delayed access to healthcare such as delayed cancer diagnoses during the pandemic leading to less effective treatments and higher mortality. That is combined with a general backlog in all areas of the health system, including many non-fatal areas, after the Covid pandemic, something which has been exacerbated by years of underfunding, which is to be repeated next year, a recruitment and retention crisis that will be worsened by the recruitment freeze that has been announced and an increased population over recent years, which further stretches resources. This has led to very long waiting lists and hospital emergency department overcrowding, both of which lead to greater mortality. In February, the Irish Patients Association estimated that accident and emergency department overcrowding caused 1,300 deaths last winter and, in April, the president of the Irish Medical Organisation, Dr. John Cannon, said: “It’s now inevitable that overcrowding and understaffing in the health services is causing avoidable fatalities.”

I will link this to the question of long Covid. During a Topical Issue debate earlier, I made the point that, in years to come, we will look back at the current policies on Covid around the world and see them as a social crime. It is a social crime in terms of the millions of people who have died from Covid and who are still dying from Covid with many of those deaths being avoidable. It is also a social crime in terms of the tens of millions of people who are being confined to an extremely marginalised life. They are not able to go to work or to school, their conditions are not recognised and they are not getting the support they need. That is really and utterly scandalous. People suffering from long Covid have been found to have higher mortality rates. One study of tens of thousands of people with and without long Covid found that people with long Covid had more than double the mortality rate within 12 months when compared to those who had not caught Covid. The rates were 2.8% versus 1.2%. The lead author of the study said: "Based on the study, individuals diagnosed with long COVID were more than twice as likely to need care for cardiovascular events and 3.64 times more likely to have a pulmonary embolism."

The likely cause of the increase in mortality and excess deaths is pretty obvious. It is staring us in the face following the pandemic we have been through and the policies we have decided to follow, policies I have certainly not gone along with, of effectively pretending Covid does not exist any more and not taking long Covid seriously. We should demand that the Government takes long Covid seriously and implements the measures that were unanimously agreed by this Dáil last November, which included proper investment in long Covid clinics, making sure that they operate every day of the week and are accessible to people across the country, taking Covid and ventilation seriously, the reintroduction of masking in healthcare settings, educating people on the fact that Covid is still with us and on the dangers of long Covid, and educating GPs to ensure people are being referred to the proper pathways for long Covid.

Deputy Barry Cowen

Any discussion or statements on excess mortality must take account of our very recent past and the difficulties and terrible deaths associated with Covid. We commend the Government, the health services and the schemes aimed at ensuring everything is done to help and assist those who remain at risk. I think of the ongoing vaccination schemes and so forth. However, in the main, we are living longer and we can be thankful that we are a lot healthier. In recent decades, we have been making progress on heart disease and cancer care. It is incumbent on us to pay tribute to all those who work with our elderly, both in care settings and in the community, and to families who care for their loved ones and ensure their lives are fulfilling and lengthy.

Mental health is an issue for all ages but, in this instance, I want to acknowledge the difficulties associated with the mental health of the elderly. Again, we should not be shy about committing to assisting, congratulating and working with all those who help in these spheres, including volunteers, men's sheds now active across many communities, women's sheds being initiated in many places, active retirement groups and family and community resource centres and cultural organisations, all of which are embracing the task of ensuring that retirement and old age become an opportunity for many to enrich their lives. The Government should continue along its path of assisting and helping those groups to ensure that is the case.

The healthiest surroundings for anybody who is aged and who needs care is in their own home and their own community. The fair deal scheme helps and assists in providing necessary funding for those who require nursing home care. Many homes built 30 years or more ago are not compatible with the needs of the aged or those who need care. Local authority schemes that assist in providing funding to adapt homes are fine but there is never enough and there are many on waiting lists in my own county and, I am sure, in others.

If it were such that the fair deal scheme could be extended to allow for house adaptation and the new low-carbon economy retrofit, and if the Sustainable Energy Authority of Ireland, SEAI, could be involved in that scheme, I might use this opportunity for nothing else only to impress upon the Government the use, assistance and value that could be associated with that initiative, as compared to the costs associated with nursing home care. Those people we speak of would then have an opportunity to remain in their homes and communities, and to have their families who are committed to them, in such a better, more graceful and altogether more appropriate surroundings. Then I am sure that the mortality rates that others are talking about - with which I do not necessarily agree or attest to - would be declining. We could increase again the huge progress we have made on that in recent times.

When I noticed this debate taking place, I sought the opportunity to impress upon the Government the prospect of extending the fair deal scheme to cater for house adaptation and for making those homes available where there is a willingness on the part of the occupants, their families and communities to ensure they play a participative role in the community throughout their lives, rather than in the first three quarters of their lives.

Deputy Peadar Tóibín

Aontú has been raising serious concerns over excess mortality for two years. There has been a prolonged period, month after month, where mortality figures have been far in excess of the normal in this State. We have been doing so through debates here, through parliamentary questions and in the media. It is deeply frustrating that the Government has not taken this issue seriously at all over the last two years.

At different points in the last two years, there has been clear evidence of excess mortality. If one talks to people in mortuaries, undertakers, priests and doctors, they will say that excess deaths have been peaking over and over again in the last two years. The Irish Examiner carried out a review of RIP.ie figures, which showed that over an eight-week period in the winter of last year, there was a 20% increase in mortality figures over the previous year. The previous year, in itself, comprised a Covid-19 death spike. That is an incredible situation. If one takes last year's spike in deaths and compare it with the pre-Covid-19 period, there was a difference of 3,000 extra deaths in a period of eight weeks over the pre-Covid years. These are incredible figures.

I have asked the Minister for Health, Deputy Stephen Donnelly, in parliamentary question after parliamentary question going back two years, first, if he accepted that there were excess deaths; second, did he know what the cause of those excess deaths were; and third, what actions was he taking to ameliorate or fix the health issues that were so significant. In all of those questions, in fairness, the Minister, Deputy Donnelly, admitted to me that there was a significant level of estimated excess deaths. He pointed to the Eurostat figures of certain months being around 13% to 19% more than the average pre-Covid figure for excess deaths. For the last 12 months before this June, every month was up with regard to excess deaths.

The frustrating and shocking thing about this is that while the Covid-19 pandemic was going on, logically, excess deaths were front-page, prime-time and 9 o'clock news issues. Yet, when Covid-19 receded, the issue of excess deaths became completely invisible in political discourse and media scrutiny. I want to know why that is the situation. Why is it that the Government has, in general terms, admitted that there is a problem, has not made the effort to investigate why there is a problem, and has not really put in any resources to actually tackle the problem? Why is the Government being backwards in dealing with that particular issue?

It is incredible that I have asked the Taoiseach about this question, and he admitted that it was the case that there were excess deaths. He said he would go to the chief medical officer, CMO, to find out what the issue was, and he never came back to the Dáil with a response from the CMO. In a bizarre twist, a Gript journalist, just in the last ten days, asked the Minister, Deputy Donnelly, what he thought of the excess deaths and what he was doing about it. The Minister said that he did not know anything about excess deaths, even though he had answered three questions in the previous year admitting that there were significant excess deaths happening. There is something really strange in the way the Government has been dealing with this.

I understand that we live in a political system where there is a significant level of group and herd mentality, where political parties, especially the political establishment, tend to think as one, unfortunately, on a range of issues. This a little bit more, however, and the reason I think it is a little bit more is that the Government made significant decisions in the two years of the Covid-19 pandemic that had major consequences for people's health. The Government closed down significant elements of cancer services. This was a major mistake and I stated so over and over again in this Chamber. Some 480 people get cancer every day and 24 people die of cancer every day in this country. No public health system that is doing its job would close down the treatment for patients with cancer. I had skin in the game at the time. I got cancer in the middle of the Covid-19 situation as well, and I delayed my treatment significantly because we were told not to go to GPs, or not to stuff GPs or accident and emergency services up because of the issues around Covid-19. The current Tánaiste and the previous Taoiseach, Deputy Micheál Martin, ridiculed me for stating that the Government should not have been closing down cancer services at the time. It was quite an extraordinary response from the Government.

There are also the heart disease, stroke and mental health services. All of those treatments were reduced significantly during the Covid-19 pandemic. It was not just Aontú that was pushing back against this. We had clinicians and senior medical professionals who said that the Government was making a mistake and that there would be a tsunami of far more advanced illnesses hitting the health system in the near future if the Government did not intervene. The Government kept sitting on its hands on this. It even closed down screening cancer services in this country.

I have done a good bit of work on Tusla figures in recent times and there has been a radical increase in the number of children who are being referred to Tusla, including 77,000 children last year and 83,000 this year. More than the number who sit the leaving certificate are referred to Tusla on an annual basis. I have spoken to people in the sector, and they have told me that a significant reason for this is that schools were closed down in the State for longer than practically any other European country. Critical services that help children in difficulty were closed down. Mental health services were closed down.

We have been calling for an investigation into what is happening with regard to excess deaths and what happened during the Covid-19 pandemic but the Government has refused to do it. The Government says that maybe there should be a review, it should not be public, that it should not be about pointing fingers or getting anybody into trouble. Yet, there are no concrete plans to carry out an investigation.

An investigation is critical for a number of reasons. First, we need to make sure that the mistakes that happened during the Covid-19 pandemic never happen again. We had a situation where nearly 10,000 older people were pushed out of hospitals and into nursing homes, many of them not even tested for Covid-19, seeding Covid-19 in these nursing homes - the areas most exposed to the illness in the country - and causing thousands of deaths. We need to make sure that never happens again.

We also need to make sure there is accountability in the system. There is no accountability. The reason why the Government is pushing back against an investigation into what happened during the Covid-19 pandemic is because the Government knows that it made major mistakes that led to large numbers of deaths in this country. If there is an investigation, it would have to take responsibility for that. As is the case with so much in this country, the State never wants to take responsibility for its actions. Any time there is an investigation or a tribunal, the Government is pulled kicking and screaming into a situation where there is an investigation.

We owe the people of this country a public investigation. We owe the people who lost their lives during the Covid-19 pandemic in the nursing homes, the ground zero of Covid-19, a public investigation. We also owe the people who are losing their lives today in the excess deaths figures a public investigation, to see why that is happening. We owe it to future generations to make sure that this will never be repeated. If this does not happen, we are going to see this crisis happen over and over again.

It is not just the Government that is pushing back against this.

There is practically silence from every other Opposition party in Leinster House. Most other Opposition parties were actually pushing the Government to do more through restrictions during the Covid pandemic. There was one political voice in the form of a political party, and that was Aontú, and it will call the Government out repeatedly over the wrongdoing related to Covid and the refusal to investigate to ensure we can save lives in the future.

Deputy Mattie McGrath

I thank the Ceann Comhairle for facilitating this debate because I have asked for it at meetings of the Business Committee for the past 18 months. I remind Deputy Tóibín that while the Rural Independent Group might not be a political party, it has been fighting on this issue for a long time. I have fought at every meeting of the Business Committee, and thanks to this we are here today.

According to data from the General Register Office and rip.ie, Ireland has experienced a significant rise in excess deaths since 2021. In 2021, there was an increase of 14.8%, translating to 4,600 excess deaths. In 2022, there was a spike of 18.4%, amounting to 5,700 excess deaths. This is so sad because one death is one too many. Up to September 2023, there was a rise of 19.4%, amounting to 4,500 excess deaths. In total, there have been 15,000 excess deaths since 2021, which is alarming. A preliminary analysis shows that the excess death increase in Ireland for August 2023 was around 21.1%. Therefore, there is something wrong.

The Minister for Health did not even bother to come in to the House, which is disappointing. This statement is not directed in any way at the Minister of State, Deputy Heydon. I have raised this issue so many times but have got no answers from the Minister. He would go to the Chief Medical Officer and come back with nothing, just ignoring it. He cannot hide his head in the sand and send in the junior Minister responsible for agriculture to deal with this. It is an insult. I am aware that the Minister of State, Deputy Naughton, was in earlier.

The mortality rate for September is 19% above normal. This is shocking. Eurostat figures indicate Ireland’s mortality rates were above the EU average in each of the 12 months between July 2022 and July 2023 bar one month, July 2022, when our rate was 16.4%. Since January 2023, Ireland has been exceeding the EU average every month, at an ever-increasing cost.

We are aware of the bedlam in the health service and see what is happening in the accident and emergency departments. We see cutbacks all over the place and new embargoes affecting the recruitment of home helps. Do our people not matter to the Government anymore? We want an international, independent inquiry into the deaths alongside an international, independent inquiry into the way Covid was handled. My group and I are saying strongly that we want an independent inquiry, not one carried out by the usual suspects, such as retired eminent justices. I am referring to somebody from outside the country who would be fair, objective and discreet.

Deputy Michael Collins

In recent times, Ireland has seen a remarkable demographic shift, with a 22% increase in the number of individuals aged 65 and over between 2016 and 2022, significantly impacting mortality rates, considering that most deaths occur among older age groups. This demographic change likely contributed to a higher absolute number of deaths. Disturbingly, Ireland has recorded excess all-cause mortality for five consecutive weeks from late 2022 to early 2023, with substantial excess mortality due to pneumonia and influenza during that period. This phenomenon is not unique to Ireland. Other European countries have observed similar trends.

Furthermore, the data collection methods used in Ireland raise concerns, with excess deaths consistently surpassing historical averages. Given this alarming situation, we firmly believe an independent inquiry into the excess deaths is imperative. The trend is shocking and merits an investigation, including a pandemic inquiry.

The lack of specific Government measures to address these excess deaths is deeply concerning. We need answers on the causes and implications of these fatalities, as well as a plan to prevent them.

There is a serious rise in the number of strokes and haemorrhages. In my constituency, Cork South-West, the number of people dying is astonishing. Thanks be to God, some people are recovering from illness. Unfortunately, young people have lost their lives. There is no answer to this. What is going on is a mystery to some people, but not to everybody.

During the Covid-19 pandemic, many illnesses went untreated, further straining our healthcare system. We must improve data collection and analysis to understand these issues better. Waiting times for medical services have grown, affecting the well-being of citizens and potentially contributing to excess mortality. As our healthcare system grapples with these complex challenges, we must take immediate action. We need an independent inquiry into the excess deaths, better data collection practices and comprehensive plans to address pressing concerns in our public healthcare system.

Deputy Danny Healy-Rae

I am glad to get this opportunity. There is still a massive number of people dying in County Kerry. The worst thing that ever happened in our country was reflected in the number of elderly people and others who died alone in hospitals and nursing homes. Despite all they did in their lives for community and family, they died on their own. That must never be allowed to happen again.

There is a lot of conversation. The minute I mention the word “vaccination”, I am accused of being anti-vax, but the conversation is being had and people are asking why all the deaths are happening. They are asking whether they are the result of Covid or the vaccinations and they need answers. We need to have an independent investigation into what is happening because life is precious and we want people to live as long as possible. We still want the babies being aborted to live. The increase in deaths all over needs to be investigated. People are dying from clots, heart attacks and strokes. Doctors and nurses will talk about this privately but they will not state in public what they believe to be the cause. It is as if they are silenced. They know the cause because they were dealing with the patients who died, including people in their 40s – young people who should be around for many years to come. There is concern over what is happening in our community. The Minister of State, Deputy Heydon, should please adhere to the request for an independent investigation into what has happened.

The Chinese have got away scot-free without being held to account regarding how the virus started and how we paid such a high price for it.

An Leas-Cheann Comhairle

Táimid ag bogadh ar aghaidh go dtí an Grúpa Neamhspleách, represented by Deputy McNamara. He is down as sharing with his colleague.

Deputy Michael McNamara

I am very happy to share with my colleague or any number of colleagues who wish to have time because I simply have not formulated my thoughts on this. It seems quite clear to me that there has been an increase in excess mortality rates but I have no idea why. Various reasons are posited, some conspiratorial and others not. Deputy Paul Murphy might not wish me to join him in anything but I join him in saying I have an open mind about the matter. We do need to find out what is behind the excess deaths.

I have just a couple of observations. There seems to be a worrying trend. Diagnoses of various cancers, in particular, were delayed as a result of Covid-19. With the benefit of hindsight, I believe it was probably inevitable. Hospitals were simply overcome treating people with Covid-19. The one thing I took from what was happening was that there was almost a hierarchy in that deaths from Covid-19 were almost regarded as more serious than those from anything else. That was a major worry of mine, but that is not in any way to take from the pain and suffering of families who lost people to Covid-19.

My mother was in a nursing home and, thankfully, died before Covid-19 arrived. In April 2019, she was quite ill with a flu that was doing the rounds.

A number of her fellow patients died at that time and a nurse said it was really sweeping through and had taken X number of them. I remember the figure. It was a relatively large proportion of the long-term patients. The nurse was sad about it and compassionate. The standard of nursing provided by this nurse and all the nurses in Raheen Community Hospital was excellent, as was the care provided by all the staff.

I was struck during the Covid-19 pandemic by how accepting we were that people die. It is inevitable that we die, especially at a certain age. However, if the same number of patients had died in Raheen Community Hospital in April 2020 as died from influenza in 2019, there would have been an RTÉ van outside and the matter would have been the subject of discussions in this House. That struck me as somewhat strange. We became incredibly focused on Covid-19 to the exclusion of everything else and that was problematic.

It also became apparent that everyone was saying we needed to follow the science. Unfortunately, science is not clear, particularly what cutting edge science indicates and does not, at any given time. It is now abundantly clear that the earth orbits the sun, but it is clear several hundred years after people nearly lost their lives for suggesting it was so. It was not clear at the time; it is now. Many things are not clear now.

It is concerning how much ideology influences scientific belief. It is wrong to suggest that scientists, any more than anyone else, can park all their views when they are arriving at a determination. No one can. We need to be aware of that in this House and society needs to be more aware of it. Everyone brings baggage with them and it informs how they view the world, how they do their jobs and all the decisions they make. People cannot park their ideologies, philosophies or what drove them to be scientists and to give their lives to science and suddenly say there is an objective right and wrong answer. I am not convinced they can.

I am, however, convinced that people are increasingly adamant about the correctness of their views and that their views are not in any way influenced by anything other than the truth. When social media first arrived, it was believed it would provide a kind of town hall forum for respectable debate, not only between neighbours and friends, but between people all over the world. Instead, it has led to people becoming incredibly trenchant in the expression of their views because they find them echoed. Sometimes it is enough for people to feel affirmed in their views if they are echoed once anywhere else in the world and they become increasingly trenchant. The discussion of excess mortality in social media is just one example. It was evident throughout the Covid-19 pandemic, on both sides of the debate. Concern has expressed by many about conspiracy theorists on one side, but there was plenty of abuse going around on all sides and from people with all viewpoints on how we as a society should respond to Covid-19.

I have taken enough time to say I have no idea what is causing this excess mortality but it needs to be investigated and that we must realise that those who investigate it probably do not have a monopoly on accuracy.

Minister of State at the Department of Agriculture, Food and the Marine (Deputy Martin Heydon)

I thank all the Deputies who contributed to this important debate.

It is important to note that peaks of mortality are not unusual in winter, most commonly as a result of factors such as cold snaps and the increased circulation of respiratory viruses, in particular viruses with epidemic and pandemic potential such as Covid-19 and the flu. The Health Protection and Surveillance Centre reported significant excess all-cause mortality in Ireland during the first wave of the Covid-19 pandemic and again in January and February 2021 during the third wave of the pandemic. Those aged 75 years and older were most affected. During these two periods, excess mortality reached the highest levels ever recorded in Ireland since data become available in 2009. The HPSC also observed a period of significant excess mortality during December 2022 and January 2023, over five consecutive weeks. Influenza activity was at very high levels in Ireland during December 2022 and January 2023, with a high number of influenza hospitalisations reported. Excess all-cause mortality has been observed in previous seasons when influenza viruses circulated at high levels in Ireland and Europe, such as during the 2017 to 2018 flu season.

The HPSC has extensive ongoing surveillance in place to monitor morbidity and mortality associated with Covid-19, influenza, respiratory syncytial virus, RSV, and other respiratory viruses and liaises closely with the European Centre for Disease Prevention and Control and the World Health Organization. Considerable ongoing public health measures are implemented, including Covid-19 and flu vaccination, antivirals for treatment and prophylaxis and various non-pharmacological interventions in order to reduce associated morbidity and mortality. These measures include a programme for the administration of Covid-19 booster vaccines and influenza vaccines for vulnerable populations and those most at risk of severe infection.

Covid-19 and influenza vaccination provides the best protection for vulnerable populations and those most at risk of severe disease and death. It is widely recognised that vaccines save lives. They are a simple and effective measure that help reduce our risk of becoming ill from viruses and they also help prevent the spread of infection.

The HPSC conducted a Covid-19 vaccine impact study from December 2021 to March 2023. An adapted formula from an internationally recognised and peer-reviewed methodology was used to estimate Covid-19 vaccine impact in Ireland during the Omicron period. National surveillance data on notified outcomes, national vaccine coverage data and vaccine effectiveness estimates sourced from the World Health Organization’s live systematic review of vaccine effectiveness were used to estimate the impact of the vaccination programme. Between December 2021 and March 2023, the study estimated that the Covid-19 vaccination programme in Ireland prevented the following outcomes: 102,000 hospitalisations with Covid-19; 3,300 intensive care unit, ICU, admissions due to Covid-19; and 16,000 deaths due to Covid-19. The study concluded that during an Omicron period from December 2021 to March 2023, the Covid-19 vaccination programme prevented Covid-19 related illness, including ICU admissions and deaths due to Covid-19. Vaccination therefore protected population health and capacity in the healthcare system. The benefits of vaccination are ongoing, emphasising the importance of vaccination.

The Covid-19 booster vaccine is currently available free of charge to certain groups, including those aged 50 and older. The flu vaccine is also available for free to certain at-risk groups, including those aged 65 and older. The alignment of Ireland’s Covid-19 and influenza vaccination programmes during the autumn and winter period of 2023 will serve as a critical enabler to maximise uptake of both vaccines to eligible cohorts, where possible and appropriate.

Again, I thank all those who contributed to today’s interesting discussion and important debate. I reiterate that a significant amount of ongoing work is being undertaken on mortality trends in Ireland. I take this opportunity to reinforce the need for timely death registration data. I outlined earlier the ongoing work that is being undertaken by the Department of Social Protection, the General Register Office, the Department of Health, the HSE and the Central Statistics Office to improve the process, including timeliness, of death registration. I welcome a speedy completion of the technical, procedural and legislative changes required to enable more timely access to death registration data.

Cuireadh an Dáil ar fionraí ar 4.50 p.m. agus cuireadh tús leis arís ar 5.14 p.m.

Sitting suspended at 4.50 p.m. and resumed at 5.14 p.m.