Living with Covid-19 Restrictions: Statements

I thank the Minister for Health for coming to the House and invite him to make his opening statement.

This is a great honour. This is my first time speaking in Seanad Éireann.

The real Seanad.

The real Seanad. I am absolutely thrilled to be here and thank the Cathaoirleach for inviting me today.

For colleagues in the Seanad, I apologise ahead of time for having to leave at some point to go over to the convention centre. Obviously there are various things going on there but I wanted to make sure that I came in here, gave the initial opening and stayed as long as I could but at some point I must go, which I am sure colleagues understand.

As Senators will be aware, last month the Government took the very difficult decision of moving the country to level 5 of the strategy for dealing with the virus - Resilience and Recovery 2020-2021. The decision to move to level 5 was driven by a concern that the spread of the virus in Ireland would, if unchecked, grow beyond the ability of the public health system to manage, which would inevitably lead to very serious and very negative consequences for hospitals and the many individuals at risk of serious illness or death from Covid-19.

It is understandable that some people are tired - I am sure everybody is tired - and frustrated by the restrictions, which we have all been living with now since March of this year to a greater or lesser extent. Obviously, as we are all aware, we are in the middle of a once-in-a-century pandemic. I think we all hope that it is a once-in-a-century pandemic. The World Health Organization reports that confirmed cases of Covid-19 have now passed 50 million cases worldwide with 1.25 million deaths. By any measure, that is a very significant and tragic global event.

Many of our European neighbours are suffering really quite brutal resurgences of the virus right now. France, Spain, Italy, Belgium and the Netherlands, to name but a few, are experiencing real difficulties, including with hospital capacity. Germany's response to the pandemic has been widely praised, and quite rightly widely praised, but even Germany now has more severe Covid-19 patients than at any point since the pandemic began. It had nearly 3,000 people being treated for the virus in intensive care facilities in the last two days, which exceeds its previous peak in April.

In Ireland, we have now detected over 65,000 cases of Covid-19. We have, tragically, seen over 1,900 of our fellow citizens die from the disease. Many others have suffered extremely debilitating bouts of the illness requiring hospitalisation and, for some, assistance with breathing via ventilation. I would like to express my deepest sympathies to the families, friends, loved ones and colleagues of all those who have died in Ireland so far this year from Covid-19. I know my colleagues in the Seanad will join me in wishing them the best and extending our sympathies to them.

It is important to remember that while there have, undoubtedly, been some positive developments regarding improved outcomes for Covid-19 patients in intensive care, and some drugs have been shown to be somewhat effective in certain circumstances, we do not have a cure for Covid-19 at this point. There is a major global effort to develop a vaccine for the virus, as we all know. Ireland is part of the process that will be procuring supplies for the EU. The EU Commission is continuing negotiations with major pharmaceutical companies that are working to develop a vaccine. There are advanced trials ongoing at present for several of these vaccines. Pending that development, we are continuing to work actively to suppress the virus to the greatest extent possible.

At this moment in time, that leaves us with what are termed "non-pharmaceutical interventions". We are talking about social distancing, cough and sneezing etiquette, wearing face coverings, avoiding crowded situations, and not attending or, indeed, not leaving the home when symptoms appear. Covid-19, as we know, spreads when individuals and groups come into close contact with one another enabling the virus to move from one person to another. So for now, the public health advice is essentially for each of us to act and behave as if we are a close contact to protect those around us from infection.

For now, we must all act like a close contact to protect those around us from infection.

The HSE has worked intensively over the past number of months to put in place a comprehensive, reliable and responsive testing and tracing operation. We have on-island capacity to test up to 126,000 people per week, which can be increased to 140,000 per week using the surge capacity that is in place with a German lab which is partnering with the HSE. I want to recognise the work the HSE has done on this. Contact tracing has not been perfect the whole time, and we all know that. We would always love for testing and swabbing times to be quicker, but our testing rate and capacity is one of the highest in the world. The HSE initially met NPHET's requirement to get to 100,000 tests per week. I then met with the HSE and asked if it would look at going higher. My sense was that if there was a big surge in the disease, we would want to go higher. It has now increased capacity from 100,000, which was already very favourable by international standards, to 140,000. It has in place sufficient contact tracing to contact trace 1,500 new cases a day, and that capacity is increasing every week. On the basis that we are now looking at lower levels, namely, several hundred cases per day, thanks to the efforts of everyone in the country around levels 3, 4 and 5, I am now engaging with the HSE on moving from volume to breadth and depth in respect of contact tracing. This will enable us to get in as quickly as possible and do what is referred to as forward contract tracing, which seeks to determine who any of us might have given the virus to; and backward contact tracing, which essentially entails going back to find the sources of the infection. That is going to be one of the big focuses going forward.

The Covid plan sets out our approach to managing and living with Covid in a range of areas. The plan sets out five levels of response, each with a number of measures designed to help us all lower the overall Covid transmission. The aim is to allow society, individuals, communities and businesses to be able to operate as normally as possible, while suppressing the virus by targeting it according to the ways the public health teams and the scientists tell us it spreads.

At level 5, which obviously we are at now, there is a range of measures designed to minimise interactions between individuals in many situations to limit the transmission of the virus. Among the most significant is the decision to close non-essential retail outlets, and workers are asked to work from home where they can. Restaurants, cafes, bars and pubs are restricted to take away or delivery service only. Most difficult of all for many is that people are asked to stay at home, save for the exceptions provided for in the regulations, and to exercise within 5 km of their homes.

While there are many things we cannot do at the moment, many essential retail outlets and other businesses are open, for example, manufacturing and construction. There is also an opportunity to use support bubbles. In trying to learn as we go with Covid, I, as Minister for Health, was very conscious that people living on their own were suffering hugely in terms of isolation. We have put in place the support bubbles, which allow people living on their own or a single parent with kids to essentially link in with one other household, and that then becomes the extended household, which is really important.

Covid only emerged in the human population late last year. In that time, we have developed the testing protocols, developed a greater - though it is fair to say not a complete - understanding of its transmission profile, gained insight into the particular populations that it poses the greatest risk to, and embarked on an enormous worldwide effort to generate vaccines and drug therapies to counter the virus.

The majority of people have acknowledged the need to adapt to these new behaviours. We all slip up from time to time, but it is very reasonable to conclude that people have been resilient, and have demonstrated really quite remarkable fortitude and solidarity in the face of what has been a very tough year, and that is what we are seeing right now. Through levels 3, 4 and 5, we are seeing the virus being pushed back in every single county in this country. That is a manifestation of a nation stepping up, working together, following the public health advice and essentially working to keep each other safe.

I think people deserve great credit for that. There is no health service in the world that has infinite capacity to meet the demand of uncontrolled spread of Covid. We witnessed the scenes earlier in the year of very advanced healthcare systems in Italy, Spain and New York in which hospital networks came under very severe pressure. Unfortunately, several European countries are again experiencing very concerning growth in the number of people being admitted to hospital and critical care in recent weeks. There are alarming reports from across Europe describing how many countries are running out of intensive care beds, as well as doctors and nurses to treat patients. Those are exactly the kinds of situations we moved to avoid when we decided to move to level 5 some weeks ago.

It is worth reminding ourselves that our efforts have been successful. It provides us with reassurance that we can reduce the number of cases - at great cost, it must be said - and limit the impact of the virus. We reduced the numbers earlier this year and flattened the curve. The people of the midlands reduced the numbers there during the local lockdown and the country as a whole is reducing the numbers and flattening the curve again. The 14-day incidence has fallen from more than 300 per 100,000 in the two weeks to October 25 to slightly more than 150 per 100,000 today. The most recent data show that case numbers are continuing to fall and that our seven-day incidence is now 63 per 100,000, which is again reassuring and good to see. In Leitrim and Wexford the seven-day incidence rate is now less than 30 per 100,000. The number of confirmed Covid-19 cases in hospital is 291 and trending downwards.

That is not to say that the job is complete. It absolutely is not. We must keep going for the next three weeks. However, the reduction in numbers demonstrates what can be achieved when a nation works together. Ultimately, our success over the next few weeks will be determined by the extent to which each of us adheres to the letter and spirit of the measures outlined in level 5. We are asking again that individuals examine their daily contacts and make a decision to limit those contacts in line with level 5 guidance. I wish to take this opportunity to commend the efforts of everyone doing their bit in an effort to tackle the virus.

I thank the House for inviting me here today to outline our rationale for introducing the level 5 measures. To finish on a note of thanks politically across the board, I spoke some time ago to Mike Ryan of the World Health Organization, WHO. He stated that Ireland stood out as a country where there was political solidarity in dealing with Covid-19. That is not to say there is not debate and challenge as there must be, and robust challenge absolutely is required, but I wish to acknowledge that there has been a wide range of support across the political spectrum. That has not just been support for Government policy. Individual Deputies, Senators and councillors are leading by example in their own communities and constituencies. They are doing a great job. I extend a personal thanks to the Members of the Seanad for everything each of them is doing in leading in their own communities and areas as we suppress this virus.

I call Senator Conway.

I think Senator Clifford-Lee should be first.

I am going by the rota agreed at the Committee on Procedure and Privileges. If Senator Conway wishes to give way, that is fine. Is Senator Clifford-Lee sharing time?

I am sharing time with Senator Malcolm Byrne. I thank the Minister for taking the time to come into the House and explain the rationale behind level 5. There has been a wide acceptance of the level 5 recommendations and good public buy-in. Many people have been upset by the measures. Business owners have been very upset because the very hard work they have put into their businesses has evaporated overnight. However, the supports the Government has put in place have been very good. I particularly commend the Government on introducing social bubbles because it addressed what was a really big issue in the first lockdown. It is a very welcome step.

I wish to raise the issue of expectant mothers and their partners during the coming months until we come out of this pandemic, whether we are in level 5, level 4, level 3 or another level.

It needs to be addressed. I am inundated on a daily basis by expectant mothers who are going through extreme anxiety facing an unknown process alone. They need the vital support and advocacy of a partner with them at appointments, in the labour process and during post-birth visits. I would appreciate if the Minister could work with the HSE and come up with a solution because it affects a whole cohort of women and will stay with them for the rest of their lives and will be a very significant issue down the line if it is not tackled now.

I also wish to raise the impact of level 5 restrictions on young people. I had a Zoom meeting last night with a number of colleagues and members of Ógra Fianna Fáil around the country. They raised some very important issues about driving tests that I will raise with the Taoiseach. Under level 5, driving tests are not happening at the moment except for essential workers. There is now a 30-week wait for a driving test. Young people in rural Ireland are finding it very difficult because they cannot leave their homes without the ability to sit and pass their driving test, so we need to look at that. Rural isolation is a significant issue in the best of times but particularly during the current restrictions.

The issue relating to the leaving certificate needs to be resolved. We have very anxious fifth and sixth-year students who are undergoing a lot of continuous assessment, more than normal, in the expectation that the plug might be pulled on the exams down the line yet still they are expected to study and prepare for a traditional leaving certificate. This is very stressful and is impacting on their mental health.

On-campus activities need to be looked at. Perhaps social bubbles for college societies and clubs could be looked once we move out of level 5. Could clubs and societies meet with the 1 m distancing rule with masks? It would be a massive help to young people if they could meet up with their chess club or football club and so on. It would help enormously with their college experience and mental health.

We also need to look at the online learning system, which is not working for a lot of people. Many students have told me that they are worried that their learning has been impacted by this and they might fail exams and have to repeat years, which is a very significant issue.

Could the Minister address providing supports for vulnerable people living in temporary accommodation and in direct provision? This is a particularly important issue because of the living situation. We are all being asked to stay at home but some people, particularly people in these situations, do not have adequate housing.

We also need to look at providing extra support and resources to the Traveller and Roma communities, who already face massive health inequalities and have poor health outcomes. I have written to the Minister about this issue. I know Pavee Point Traveller and Roma Centre has asked to meet him to discuss the impact of the Covid-19 restrictions on these communities and I would very much like the Minister to meet with it because these communities face massive health inequalities as it is. They are doing a super job to contain the virus within their communities but they need extra help. I would appreciate it if the Minister could address those points.

We are all facing the challenges of living with Covid but it is really important that we give people hope. We are going to overcome this. As the Minister of State has said, there is good news about the vaccine. We must develop a strategy that builds on the community resilience we have had to date and looks at communities coming out of this. This is about our artistic, sporting and community groups coming together. This impacts on all of us but as Senator Clifford-Lee noted, it particularly affects young people and I will focus on this aspect.

The Minister is probably aware of an excellent piece of work by the then Department of Children and Youth Affairs and SpunOut around young people's experiences during this period. Much of the language used in it is quite concerning. Young people are anxious, isolated and worried.

That is particularly the case because many of the avenues that were open to those aged from 17 to 20 years old are now closed. Gyms are closed, many sporting activities are restricted and access to arts, drama and music activities is also restricted. The last thing someone aged 18 or 19 years old wants to do on a Friday night is to sit at home with their mam and dad watching television. They want to be out.

We are all lucky here because we can remember that time. It was the time of our learning experiences, the summer of our leaving certificates and when we went to college, and the joy of all that. It was when we went to nightclubs and, yes, when we got the shift, when we got into a relationship and when we learned about ourselves. Those things all make people smile, but they were important rites of passage. A whole generation of young people are now in danger of losing all that. We must focus on that aspect, specifically, as we come out of this situation. We can never make it up to those young people, but we must ensure they have support. I am aware that additional supports have been made available on the mental health side of things at second and third level.

I will deal with some specific issues. There is still concern regarding the leaving certificate. The Minister for Education, Deputy Foley, is correct in stating that students will be sitting the traditional leaving certificate in 2021. The problem, however, is that many teachers are working on the basis of plan B, and they are assessing more and more. I noticed today that there was talk in Wales about a return to predictive grading in 2021. That is obviously causing concern. I encourage engagement with the Irish Second-Level Students Union and that students be kept informed about what is happening.

Student nurses are the other specific group in this area. Their position has come up regularly, and it falls between the remit of the Minister for Health and that of the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris. They have been at the forefront of this fight during this period without compensation. It has been promised that that would happen and the Minister, Deputy Harris, promised that he would address this issue. The other concern I have regarding this matter concerns the experience that many of these young student nurses have had and the trauma that it will cause them. Given that experience, it is absolutely essential that they are given support to ensure they remain in nursing.

I know I have spoken about this a great deal. I have great faith in our young people. They have shown great resilience and they are helping us to this situation. Young people in arts, sports, technology and science are doing wonderful things, but they are losing all their rights of passage. We must ensure that they are at the centre of our strategy for living with Covid-19.

I have been in this House for eight months and this is the first opportunity I have had to talk to the Minister regarding Covid-19. I welcome him here to listen to our submissions regarding the Government's response to Covid-19 and the level 5 restrictions.

I express my heartfelt condolences to the families of those who have died of Covid-19 and as a result of Covid-19. I appreciate that it is always hard to lose a loved one or a relative regardless of the cause or circumstances. The suffering of those bereaved during this pandemic has, however, been amplified by the Government's policy, which has prevented them from attending funeral and removal services completely, or drastically curtailed the number of people allowed to attend those ceremonies. It is incredibly cruel to limit drastically, or to deny altogether, the right of people to celebrate and mourn the lives of their loved ones. I refer to preventing people comforting one another in their time of grief, loss and sadness by law and the threat of criminal sanction.

Did we have a pandemic preparedness plan prior to 2020? Were level 5 lockdowns, which shut down society, healthcare and the economy and imprisoned people in their homes, part of any pre-existing pandemic preparedness plan? Can the Minister cite public health policy, prior to this year, stating that during a pandemic every other aspect of public health should be ignored and subjugated to the sole aim of dealing with the pandemic?

Will the Minister confirm the total number of deaths where Covid-19 was the sole or primary cause of death? Can the Minister confirm the number of cases reported as Covid-19-related deaths? I refer to some 1, 948 now. How many of these deaths were suffered because of a life-threatening co-morbidity?

Can the Minister provide the House with data pertaining to the average age at death of those who have died of Covid-19, as opposed to the average age at death of those who have died with Covid-19? How do these figures compare with the average life expectancy in Ireland? Can the Minister provide a quantitative analysis of how many lives have been saved as a result of lockdown restrictions being imposed in an indiscriminate fashion on the general population? Can the Minister provide data justifying this level 5 lockdown-style approach and proving that a strategy of focused protection for those who are susceptible to the virus would not have been more effective and caused less collateral damage? Can the Minister provide a quantitative and qualitative analysis of the impact of lockdown restrictions on society, the economy and the health of the nation?

Has NPHET analysed the effect of the restrictions versus the effect of Covid-19? The number of deaths is important but so are the life years lost. Where is that analysis? The public deserves to see it. The restrictions will have implications. When will NPHET open up and be transparent about the expected effects of the restrictions and show the public what it expects them to be? This includes the direct health effects, the missed appointments, including mental health appointments, and the economic and related effects. I mention the quality of messaging and the leaks that are emanating from NPHET, the Government and the media. We must do better on that. No one seems to be thinking about what effect this is having on the mental health of the population. Why not? Messaging must be reviewed and leaks must be eliminated to protect the mental health of our people and ensure the survival of our economy. Why do we need daily number announcements and press conferences? The daily drip feed only builds anxiety and an unhealthy behaviour pattern among a large number of the population.

What is the living with Covid-19 plan? The current one is not working. It has caused anxiety, uncertainty and a significant economic impact. The Government needs to pick a series of measures and just stick with them for the long run, rather than the cycle of opening up and locking down. It is too much. People and the economy need certainty and the constant changing of levels only increases anxiety. Will the restrictions being applied get rid of the virus faster or end the pandemic faster? It strikes me that the only realistic endgame to this is the vaccine solution.

Speaking of the lauded press conference and coverage of the imminent vaccine by our friends in Pfizer, can we pin our hat on that? Let us examine the data on this panacea. Out of the 43,000 trial participants, I understand that only 94 people were used in the independent evaluation of it. Can the Minister obtain data from Pfizer demonstrating that this vaccine will significantly reduce hospitalisations, ICU admissions and deaths caused by Covid-19? Additionally, can the Minister obtain data from Pfizer confirming the efficacy of the vaccine in the immunocompromised, the elderly and the other at-risk groups? Can the Minister clarify the number of cases of Covid-19 that are announced each evening and if these include asymptomatic cases? Furthermore, can the Minister provide a breakdown of how many of these cases are infectious at the time of testing?

The Central Statistics Office, CSO, figures show that in the first nine months of the pandemic, there were 876 more deaths than in 2019. The data also show us the neglect of the HSE in dealing with our people in residential care settings. This problem within care homes has not gone away. What lessons have we learned from the first lockdown? To make the same mistake going forward is unforgivable. The restrictions of these lockdowns will not have any impact on the delivery of a vaccine, yet there is a message to the public that the better we behave, the quicker it will all be over. The Government, NPHET and the HSE need to tell the Irish people the truth on what they really mean by living with Covid-19.

I thank the Minister for his words, which are much appreciated. It is a busy day and we welcome his first trip to the real Seanad. I also welcome our former colleague and good friend, the Minister of State, Deputy Feighan, who will ably represent him.

It is important to start, as I like to do, on a positive note. I am a great proponent of positive politics. The Seanad espouses positive politics more than our colleagues in the other House. Yesterday's news that Pfizer has made progress on the vaccine is very, very welcome. I have spoken to some pharmaceutical companies recently and they were excited at the prospect of a vaccine. It is not only Pfizer. The work being done in Cambridge is also very welcome. The signs are good. The best scientists and medical experts and researchers in the world are working on this. It will be ground breaking, will save lives and it cannot come soon enough. We are dealing with a pandemic, the like of which has not been seen in 100 years, which requires an unprecedented Government and community response. International comparisons, especially in Europe, show that we are at the top of how we have dealt with the pandemic. We have contained the numbers of positive cases and limited the numbers of people who have lost lives. It is always appropriate that we acknowledge those people and offer our sympathies and condolences to their families. Sadly, the figures speak for themselves when we compare the delivery of our pandemic response with the six counties in the North. As a Government and as a community we can be very happy with the response. It is not something one can be proud of because even one person who contracts the virus or one person dying with it is one too many. We have not got everything right, that is for sure, but we have got more things right than many other countries. We took it seriously compared to other countries. I spoke recently spoke to a friend who lives in Brussels and it seemed the lackadaisical approach to face masks, to the practising of social distancing and to the virus generally there was in stark contrast to the seriousness with which it has been taken here.

I wish to speak about the community response. Yes, there frustration and fatigue and, yes, it is a challenge and keeping focus is not easy but the figures in the past week show that when we reassert ourselves we can deliver spectacular results. The drop in new cases to under 300 yesterday compared to 1,200 daily two weeks ago speaks for itself. I agree with others that when we move into 2021 and we wait for the roll out of a vaccine, we will have to keep the living with Covid plan under review. Where it needs to be tweaked, we should not be afraid to do so, but when it is right and the plan is correct we should not be afraid to defend it.

However, when it is right, and what is proposed and being done within the plan is correct, we should not be afraid to defend it either. Regardless of whether we like it, in this country, as in every other country, there are Covid deniers, and those people must be confronted.

The strategy we are using now has proven to be effective and to work. While one can argue about certain elements that might appear to be unfair, and possibly are unfair, one cannot turn the ship around mid-stream. We are three weeks into a six-week campaign at level 5 and I believe we must stay focused and not make any alterations. At the end of the six weeks, we should conduct a calm, reflective and mature review of the elements of level 5 that we can tweak in the future. Perhaps the Minister would give us his analysis of the vaccine and how well the country is prepared to take advantage of it when it is available. People would be interested in that. Again, we are talking about being positive and giving people hope. That would very much give people hope.

There are people who are suffering more than others as a result of the country being at level 5. Our hearts go out to the people who are unemployed and living on the pandemic unemployment payment. That is why we all must do what is required of us to ensure those people get back to work as soon as possible. Sadly, where getting back to work is not possible when we move out of level 5 because businesses have gone out of business, we must ensure that opportunities are provided through education, redeployment and re-employment. As regards the elderly, the narrative on cocooning that took place last April and May has changed, which is welcome. However, the winter months create their own dynamic, and it is important that supports can be put in place to give practical assistance to them. In the case of people with disabilities, who are mobility impaired at the best of times, whatever supports can be provided to make life a little easier should be provided. I remind citizens that some people have difficulty with social distancing, particularly blind and visually impaired people, and people should bear with them and show understanding. Due to their judgment of space they can sometimes get it wrong. It is not intentional so I call for a little patience and understanding.

I would like to have a discussion some day in the House with the Minister of State, Deputy Feighan, about his role in dealing with addiction, particularly addiction to drugs. He has hit the ground running and people in the non-governmental organisation, NGO, sector are extremely impressed by the manner in which he has taken on the portfolio. Perhaps we will have him in the House in the not too distant future for a debate on that issue.

I take this opportunity to welcome the Minister of State, Deputy Feighan, to the House.

I have a timer with me so, hopefully, I will not take too long. I welcome the Minister of State. We all appreciate the reality of the situation. We have been doing this for what feels like forever. People almost do not know another way. We are just living with Covid and in and out of things. I commend the efforts of everybody doing their bit to tackle this virus. I particularly wish to thank my sisters, one of whom is working long shifts to ensure we have sanitation items while the other is a healthcare worker caring for vulnerable people. I am sure she will be doing that after this virus is long gone. I am taking a moment to thank my sisters because I love and care for them, but there are other people who are keeping our society, well-being and economy going. I thank them and appreciate all the work. There are also people in the Seanad who are keeping everything ticking over.

I recognise that no Minister for Health or Government in living memory has ever had to deal with an issue of public health on this scale, and no Opposition has ever had to question or raise issues on something of this level. We are all learning and trying our best.

That said, we need to make sure we are taking the learning of the past on board, because the stakes are simply too high. It is not hyperbole to say that lives are indeed on the line.

We want to see, as does the public, that the learnings of the past eight months have been taken on board for the planning of the exit from level 5. There needs to be a slow, step-down approach and a moving through the levels. There needs to be proper messaging around public health guidelines, social distancing, mask wearing, hand washing, and clear and concise communication from Government on the restrictions at each point of the scale.

We are also coming into a particular time of year in Ireland. Whether one is a Christian or not, it is a special time of celebration here. We need to be very aware of the added complications that will come from that.

Will the Minister of State, Deputy Feighan, outline why the current position of the Government is to go to level 3 and not level 4 if there are plans to slowly work our way down through the levels, as were the initial the levels for working up and down?

Another issue, which I have raised with the Minister for Health a number of times, is that of student nurses. On the Order of Business this morning, I was a little bit surprised today to hear Members from the Government side, from Fianna Fáil and Fine Gael, calling for recognition and pay for student nurses. I have asked the Minister for Health at the health committee, I have asked him in writing and I have asked him in this Chamber to recognise the contribution of student nurses, who are working up and down this country to keep our hospitals open. Now, as a result of Covid, they are in a position whereby they cannot do paid work elsewhere in a healthcare setting, due to the fear of cross contamination. The Minister has refused a number of times to commit to changing this. Perhaps by having Members from the Government side and other Senators speaking up for nurses in the Seanad, I hope that this is a contribution towards a change in Government policy and perhaps we will see student nurses being paid. I have raised previously the gendered issue of student nurses. We have trainees in other areas such as apprenticeships who get paid. The vast majority of student nurses are women, so I see it also as being a gender issue. The idea that student nurses are in an educational setting and, therefore, are not workers is not going to wash with me, it is not going to wash with the INMO, and it is certainly not going to wash with the student nurses. It is shot back at us whenever we raise the issue of student nurses' pay. There are whisperings that we do not pay any other student worker during their studies so why should we pay student nurses. To that I say that all workers, regardless of student status, should be paid for the work they do. I will not go off on an educational tangent as I am wont to do, but we must be aware that if a person knows that he or she must take on an unpaid placement throughout their studies, and if he or she does not have the financial support to do so, who are we locking out of this field of study and who will not be able to undertake that field of study? What is being done about student nurses? What is the Minister of State going to do about student nurses' pay? What will the Minister of State say to those student nurses who right now are on Covid wards and putting their lives at risk to help us battle through this health crisis?

I echo the comments made about maternity care and support. I spoke in the Seanad about this recently. Not too long ago in Ireland we had a very prolific campaign around care and compassion in maternity care. There is no time when we need care and compassion in maternity care more than during this pandemic. I spoke previously about a friend who very recently had a baby. Due to the fact that her partner was not able to visit her she could not get out of the bed to go to the bathroom. Between her partner not being there and the nurses simply being rushed off their feet she had to lie in the bed, soiled. That is not how we should treat people and it has very serious long-term trauma implications. My friend is a shell of a person. This was a deeply traumatic experience for her and her partner was not there to help her. This trauma is not just happening to new parents, it is also happening to people who might have just found out that they may not be new parents, which is very tragic and upsetting. We have talked about this a number of times in both Houses. I plead once again in this House that we need to deal with this issue and I ask the Minister what will happen in this regard.

I now turn to other diagnostic areas that have suffered due to Covid-19. I met with representatives from the Irish Cancer Society recently and got a comprehensive oversight of where they are at the moment. In my conversation with them, they estimated there are currently 600 people with an undiagnosed cancer due to issues around diagnostics and the slowing down of services. That is 600 people right now who are potentially living with cancer. We are all aware that early intervention in such matters is crucial to try to ensure a positive outcome.

I am only reflecting on one diagnostic area but many areas have been affected by the Covid-19 crisis. I would welcome some comment from the Minister of State on this backlog and how it will be dealt with.

I also want to take a moment to talk about CervicalCheck and smear tests. In the past few days the requirement for a doctor's note or a doctor's referral to get a smear test has been waived. If people feel they are due one, whether it is for the first time or not, they can make that appointment. There was a very low uptake of CervicalCheck smear tests over the past few months. These are life-saving tests and while we are making enormous efforts in other life-saving areas, I encourage anyone who is eligible to go for a smear test, to make that appointment and to get that done.

We are coming into the Christmas period. We need to be slow and steady and we need clear leadership and guidance from the Government to get us through the lessons from this most recent lockdown. The first time we go through something, it is a learning experience. If we repeat the exact same things the second time without learning from them, perhaps they will become mistakes. We need to learn from exiting this lockdown to ensure we do not find ourselves in another one after Christmas. I wish the Minister of State and all in the Department of Health the very best. All of us here are with them and are working with them in our communities to try to ensure as safe an experience as possible in getting people through Christmas during Covid and out the other side.

It is nice to see the Minister of State back. How is he doing? I will start by contextualising the conversation we are having today because it is important to do so. Sinn Féin has supported the move to level 5 lockdown. We have done so because we believe it is always best to follow scientific advice wherever possible. As the Minister said earlier, we very much welcome that the numbers are coming down. It shows that level 5 is working and like him, I hope for further sustained progress for the rest of this month. We believe level 5 has the support of the vast majority of the people in this State. It is important that everybody in this Chamber, regardless of political affiliation, unites against the anti-science, anti-mask conspiratorial nonsense that is doing the rounds across social media and occasionally outside the front gates of Leinster House. It is important to combat that. It is always surprising to me that there are still people who are gullible enough to believe some of the nonsense that is out there and it is incumbent on all of us to always challenge it. We have to stick with science and progress as opposed to superstition, and worse, poisonous right-wing nonsense.

The news of a possible vaccine is a potential game changer. The Minister was rightly cautious about it in his speech but I am hoping that when he gets a chance to respond, which will probably be when we continue this debate at the beginning of next week, he might be able to outline his plans for that. I have no doubt the Department has been planning for a vaccine and I hope to hear what those plans entail for ensuring the people who need it most are the ones to get it first. We would like to hear details of those plans, though we accept that the vaccine is not quite there yet. We are all hoping that there will be some further good news in that regard.

I wanted to give that context before I went on to make some genuinely critical points about some of the issues we faced with Covid-19. I am genuinely puzzled by this first matter and my party has brought it up several times. If I go beyond 5 km I am subject to a fine. I get that and for what it is worth I support that particular policy. However, if there is a case of Covid-19 in the workplace, there is absolutely no requirement on the employer to report that case to the Health and Safety Authority, HSA. Given what we have been through in nursing homes and meat factories, not once but on a few occasions, it makes absolutely no sense to me or to anyone in this Chamber that there is no requirement on employers to report cases of Covid-19 to the HSA. It makes no sense but worse than that, it is a huge derogation of responsibility to essential workers in those areas. I would like the Government to act on this.

I cannot understand it. If we are putting the health of people first - I believe in terms of the broad policy that we are - surely to God that needs to extend to protecting workers in essential industries. There is no excuse for that. The fact that it used to be the law up to 2016 makes it all the more inexcusable. I ask the Minister of State, Deputy Feighan, to ask the Minister if he comes back next week, to respond to that point please as I think it is a very important one. I know it is one the Irish Congress of Trade Unions and a number of trade unions have raised on a regular basis and they are just not getting answers on it.

The second point I wish to raise concerns testing and tracing. There were some very impressive numbers in the Minister's speech. I hope they are the case but, to be honest, I am not entirely convinced. We have not had an adequate explanation of the appalling means by which people were hired to test and trace positions. Why were the positions outsourced to an agency? Why are we giving millions in additional profits to a private agency to hire these people? Why were they hired on zero-hour contracts? Why is it that when I speak to my trade union colleagues in University Hospital Limerick, I discover that the most recent batch of support staff that was hired was hired through an agency? Why are we outsourcing work? Surely to God we have an extensive HR department in the HSE that should be dealing with this? It just makes no sense to me. I worry about the ideology that is at work within the Department that thinks, first and foremost, about how it can outsource this project. That is a fundamental change of mindset that we need to see within the Department. We need to get away from outsourcing and move to insourcing in terms of how we build longer-term capacity.

Another example of that is the fact that we have 200 fewer permanent nursing staff in the system now than we did a year ago. How on earth can that be the case? In the middle of a Covid crisis, how can it be that we have fewer permanent staff? It goes back to the ideology of hiring people on temporary contracts, if we have to hire them, even though we know there is a significant need for long-term staffing for the healthcare services.

That in turn speaks to issues that have been rightly raised, such as that of pay for student nurses. We were told it was going to be dealt with and here we are months later and it is not dealt with. It is not sufficient to just push this off and say we will deal with it. The Government has been in place for long enough to have dealt with it. We want a satisfactory answer to that because I suspect there is no one in this room who would try to defend not paying student nurses. It is just a question of ensuring that it is done.

I agree with colleagues who have raised the issue of pregnant women not being able to have their partners with them at a crucial time. I would have thought that common sense and a degree of flexibility should have been able to sort that issue by now but, unfortunately, to date it has not.

ICU beds is another issue of real concern. In 2019 the HSE reported that there were 255 critical care beds in the system. The average stay in ICU for most patients is two to three days, but the average stay for somebody with Covid-19 is ten to 14 days, which is much longer. We have to have somewhere to put extra ICU beds and very often they end up in operating theatres, which are in turn closed down to accommodate temporary ICU so procedures are cancelled. As the Minister of State is aware, it takes six ICU staff to look after one bed, so one has to get them from somewhere else, such as coronary care or theatre nurses.

It is on the record that Sinn Féin has called every year for more ICU beds and more acute beds but this advice was, unfortunately, ignored by Fine Gael for the past decade, when it instead cut ICU beds. It is startling to recognise that we now have fewer ICU beds than we did in 2009. How did that happen? When is someone in government going to hold their hands up and say they got this badly wrong?

The final point I wish to make as, unfortunately, I am out of time, is that there needs to be a national conversation about the failing for-profit model of nursing home care, one carefully constructed on the back of millions in euro of subsidies to private sector entrepreneurs. This model has been badly exposed. It has been based on appalling rates of pay, poverty terms and conditions and an aggressive anti-union stance by employers. Incidentally, that is why we never hear from workers in these homes. We only hear from managers and owners. We never see a spokesperson from a union in a nursing home because they are not allowed. There is something fundamentally wrong with that for-profit model and we need to have a proper conversation about it.

I call Senator Higgins, who has eight minutes. I remind Senators that I will be adjourning the debate at 4.15 p.m.

I welcome the Minister of State, Deputy Feighan, to the House. Like most of those who have spoken today, I supported the move to level 5. I believe it was necessary and that it is a pity that we did not do it a couple of weeks earlier. We have seen what a reluctance to act can lead to. The model of Belgium, which the Tánaiste, Deputy Varadkar, had been promoting, is now a strong cautionary example to everybody across Europe. It shows what happens when we fail to take scientific warnings sufficiently seriously. It is also an example of what happens when we do not invest in having adequate medical support in place.

I support the level 5 lockdown and, like others, agree that we need to be very strong in challenging anti-science and anti-mask messages. As I have said before, the State has powers to deal with those engaging in harassment, making threats or causing others to have reasonable apprehension for their safety. We need to be able to use these powers where we see people attempting to do their, often essential, work endangered by anti-mask protests that seek to create a climate of danger for those essential workers.

I am, however, concerned about how this new lockdown is to be used. The previous lockdown, during which the public did extraordinary work to flatten the curve almost to a point at which zero-Covid was in sight, was wasted when we moved rapidly away from restrictions when sufficient work had clearly not been done in scaling up ICU capacity and health service recruitment. It is vital that the Minister of State indicates what comes next. I do not support the overall idea of living with Covid by way of an ongoing cycle of lockdowns. We need to show a clear strategy for moving past lessening the curve and on to flattening the curve. We need to know what it will look like when we get back down to double figures again. Will there be, for example, a massive improvement in testing, tracing and investigating the causes of cases? In Ireland, we have really only been checking with whom those who have contracted the virus have been in contact rather than investigating where it was contracted. We have not been working to track down the causes of asymptomatic spread.

Part of the cause of this is the very inadequate system of recruitment. The use of agency staff has been mentioned, as has the fact that these are insecure contracts. The HSE has a HR department. We need to recruit and train the staff who are going to work in tracing. They need to know that their contracts are secure. We also need to make sure that those doing other essential work, such as diagnostic workers, speech therapists and others, who have ended up in the testing and tracing system have contracts that allow them to carry out their own essential work. Medical and health issues, both Covid-related and otherwise, have to be prioritised.

Another priority about which people will tell one is that of relationships. One issue at the intersection of health and relationships is the situation of those undergoing scans through maternity services who may, for example, be facing the prospect of a miscarriage. That is right at the intersection of the two areas I consider most important, that is, health and relationships. Those issues may need to take priority over other issues I have previously raised and challenged people on. An example of such an issue is the fact that certain betting sports are continuing even through a level 5 lockdown while partners are still not allowed to accompany pregnant women for scans.

I will return to another employment issue. This is the crucial question because it will be the test. What is being done not only to scale up recruitment, but to ensure retention? We know there is a crisis of morale in the health service. We know that many who answered the call and came back to Ireland faced such difficulties in having their applications for recruitment processed and in getting to a point at which they felt securely employed within the Irish health system that they are now considering returning to the health services of other countries.

That will be a major loss. The student nurses have been mentioned but how are we signalling to them that we value them and we want them, when they graduate, to continue to be part of our health service? We do that by valuing them now.

Will the Minister of State inform us of what is happening with training and specialisation required for ICU staff? It takes six months to give somebody the skills to work in ICUs, so how many people have been trained in the past six months? How can we ensure we do not end up in a position like Belgium, which is experiencing a crisis with health workers who are themselves Covid positive having to work?

Retention, recruitment and the valuing of staff are crucial but I also point to a wider issue around social support to combat isolation. This is something in which Ireland has fallen short and it is a hallmark of places, including parts of Australia and New Zealand, where they have managed successfully to get to or close to zero Covid. One of the key facilities is that they support isolation by people and they make it a positive. We do not want a punitive model of isolation but rather a positive support model of isolation both for those who are diagnosed and for those who are at risk, for example, vulnerable people in direct provision or in housing hubs. I am talking about those who are basically in situations where they do not have adequate and secure housing. Senator Clifford-Lee mentioned those people in inadequate housing on halting sites as well. There is a range of people who need carefully thought through, culturally appropriate and sensitive isolation facilities, and we should not have a situation, such as I have heard, where someone has been given a diagnosis on a Friday and been told to check in on the Monday if there is a place where they can isolate. That is not good enough. We need very clear support so people can isolate properly, and that is support for those who are at risk and vulnerable as well as those who receive a diagnosis.

The question of quarantine is something that other countries have managed much better than Ireland. Frankly, in Ireland the "mind yourself as you go through the airport" model has been very inadequate. We know in other countries, for example, people have been checked on multiple times after coming into a country to ensure they have quarantined. In other countries there are quarantine hotels, for example, that are specifically set up to allow for a period of quarantine subject to testing. As the testing science is improving, that does allow for that.

My last question is very important and it concerns international solidarity on vaccines. We know Europe is purchasing a vaccine but will we support the COVAX project? Will we support other projects to ensure that, globally, health workers and those who are most vulnerable can access a vaccine when it becomes available?

I propose to share time with Senator O'Loughlin. I welcome the Minister of State to the House. As one of the people who has been most vociferous in calling for a debate on living with Covid-19, I am pleased the Minister of State is with us today. Many of the points have already been addressed.

We must keep the people with us for a protracted period. Even with the emergence of a vaccine, it is clear that Covid-19 will be around for a considerable time. I appeal to the Minister of State to look at a couple of areas. For example, on foreign travel and the aviation sector, we need to get a plan in place to allow essential workers to travel between different countries. We have to begin a process of getting people back travelling again. That requires testing and tracing and all the other activities that go on at the airport. There is a need to accept that foreign travel is an important component of living with Covid-19.

We also need to look at some of the rural activities. We have to be clear that a cattle mart is an integral part of farming and the production of food.

While I accept the necessity for social distancing and people staying the required distance apart, cattle buyers must be allowed back into cattle marts. The marts can facilitate this in a safe and effective way. Some of the rural pursuits also need to be considered, including hunting with a dog and hare coursing. Regardless of whether the latter is a sport with which one agrees, it is legal in this State but is forbidden in the current climate. These are activities that take place outside. Hunting for pheasants is another activity on which people have their own views. I am not a huntsman but I know many who are and for them, it is their only outlet and their only pursuit at this time of year. They have dogs trained for this particular pursuit and sadly, they are not able to do it even though there is no real threat or risk of catching Covid-19 in that environment.

I appeal to the Minister to consider the necessity of keeping the Irish people with us as we progress through the next phase and get to Christmas and beyond. It is really important that whatever the status of Covid-19 at that time, we allow people to come home for Christmas. There are many elderly people who may not get another chance to see their loved ones, including their sons, daughters and grandchildren. This is really important. I appeal to the Minister to take those points on board. Sadly, we do not have enough time to address all of my concerns.

I welcome the Minister of State to the Chamber. While the news on the incidence of Covid-19 among the Irish population is good, now is certainly not the time to let down our guard. We must be as consistent and vigilant as possible. Today also brings good news regarding the Covid-19 vaccine being developed by Pfizer.

While we are in this difficult situation and our hard-working public health officials are grappling with the many issues facing us, there is an onus on Members in this House to consider how to enable people to live healthy and positive lives while living with Covid-19 and its related restrictions. I was not one of those who advocated moving to level 5 because I was very conscious of the effect on businesses. I also felt that some of the extra restrictions put in place, including the closing of cattle marts and the prohibition of many outdoor pursuits, were a step too far. Golf, for example, is a non-contact sport that is very safe. It is played by many older people and also by many of those in the hospitality sector who have no business at this point in time. We must reconsider that particular ruling.

Young people have found the Covid-19 pandemic very difficult, particularly those who have started college or who are living at home. Many would like to see gyms reopening because they do not have the opportunity to engage in team sports. Given that there is no significant evidence of clusters emanating from gyms, it is time to re-evaluate their status. We must also consider alternative health services like reflexology which are used by people with difficult health conditions.

None of knows what Christmas will look like this year. We know that Santa will come but we must let our loved ones come home to see their elderly parents. Many have not been home for more than a year. It is important that a decision on travel is made soon.

I welcome the Minister of State. I wish to speak about nursing homes, particularly those that were directly affected by Covid-19 during the first wave. Normally, the director of nursing in a home can do an assessment test for viral infections and does not have to go through a GP. However, that is not the case when it comes to Covid-19. I might ring my GP and get a test very quickly but nursing homes have to wait until a GP visits.

They do not necessarily come every day. I ask the Minister of State if that process can be changed so that directors of nursing, who have years of experience under their belt, can decide if someone needs a test and can act immediately.

In accordance with the order of today I must adjourn the debate. The Senator may resume her statement next week.

Sitting suspended at 4.15 p.m. and resumed at 5.30 p.m.