Covid-19 (Health): Statements

I call on the Minister for Health, Deputy Simon Harris, to make his opening statement. He has ten minutes.

I very much welcome this opportunity once again to update this House on the Covid-19 disease and our national response to it. First and foremost, I wish to express my sympathy to the families and friends of those who have been lost to this disease since I was last in this House. Our thoughts are with each and every one of them at this very difficult time.

Last Friday, we decided as a Government that we could proceed with phase 2 of our roadmap and we could also bring in some additional measures. As always, our decision was informed by the data on the status of the Covid-19 disease in our country and by the public health advice that we received from the National Public Health Emergency Team, NPHET. As part of this phase we can now meet in our homes in groups of up to six people and we can strengthen again the private bonds that hold our society together. A maximum of 15 people can now meet outdoors for organised sporting, cultural and social events and through this we can begin, with caution and care, to rebuild the public life of our country.

The number of people who can attend funerals and cremation ceremonies has been increased to 25. This is an important issue which many colleagues in this House raised with me. The inability of friends and sometimes of family to be able to stand with those most directly bereaved at a funeral or cremation service has been one of the most difficult and painful aspects of this pandemic. Our communities found thoughtful ways to show their support and solidarity to those who were mourning despite the limits and it is our hope that the extra number of people who can now attend these services will provide further comfort at such a sad time.

Clearly, we have now moved as a country from a message of stay home to stay local, which means that we are asking people to remain within 20 km of their home or within their county boundary. We are able to make this change because our collective actions as a country have managed to suppress this virus. However, we absolutely must remain cautious and continue to restrict our movements as much as possible so we do not lose the hard-won progress we have made.

I would like to update the House today, as I do every week, about the R-nought. I have been advised by the chair of the modelling group, Professor Philip Nolan, that the R-nought is estimated to be between 0.4 and 0.8. I am told by Professor Nolan that we can be confident it remains below 1 this week. I am also very encouragingly told that there is no evidence that it is increasing or decreasing, but it is staying remarkably stable. Again, this is a testament to the huge efforts of people in this country.

We have also continued to see a reduction in the number of patients with Covid-19 in hospitals, with a welcome fall to just 75 people in Irish hospitals today with Covid-19 confirmed in the latest published numbers and 29 people in our intensive care units. Of course, I am conscious that when we quote numbers that behind each of them is a patient, a person, a loved one, and we send each and every one of them our best wishes, particularly those in the ICUs fighting for their lives. We look forward to more people being successfully and safely discharged from our intensive care units. This is a trend we have to maintain. I suggest that there are six key ways in which we can all help to do that during this new phase.

The first of these concerns close contacts. We are obviously able to meet more people again and this is great. It is something we have worked very hard for. We have missed people, missed family, and missed friends, but there is a responsibility on every single one of us to minimise the number of close contacts we meet. Now is not the time for people to be increasing their social circles. It is not the time for people to be meeting their second cousin once removed. Now is the time to consider who are core contacts one has really missed in one's life, the couple of key family members or close friends. They are the people I am going to see. I am not going to see people beyond that socially in phase 2. I am also asking people to keep a list of those they have met for contact tracing purposes. If, God forbid, a person gets Covid he or she should have a list, jotted down as a note or put in his or her phone of the people he or she met that day so that we can very quickly contact trace anybody who he or she has come in contact with.

The second point I want to make is that outdoors is better than indoors. While the guidelines now provide for indoor visits and with Irish weather that is perfectly understandably and possibly necessary, I want to encourage people to remember that meeting outdoors entails less risk and is a better choice. Even if people are meeting indoors, meeting in a well-ventilated area does lessen one's risk as well.

My third point is about self-isolation, and it is a really important point. Irish people, as we heard Dr. Cillian De Gascun say in the Special Committee on the Covid-19 Response earlier in the week, are really good for going to work when they are sick. People get up in the morning, they have a temperature and a bit of a headache, they take two paracetamol and off they go for the day. We need that habit to stop. If a person feels sick we need him or her to immediately self-isolate if he or she has any of the symptoms of Covid-19. People should not put it off, they should not wait and should not hesitate to contact their GP. We have seen - and this is one of the concerning trends in the last week - a growing number of household clusters and that is concerning. They are small numbers so far. I think it was six one week and 16 in the past week, but that makes the advice on self-isolation even more important. We do not want a man or woman in a house to feel sick, to delay self-isolating within the house, and then by the time he or she contacts the GP, all of a sudden two or three people in the home have Covid-19, so the self-isolation advice is very important.

The fourth piece of advice relates to the 2 m distance. As we begin to move around a little bit more the importance of social distancing remains high - in fact, it is more important than ever. The Special Committee on the Covid-19 Response heard today from the World Health Organization and the message is clear that social distancing and staying apart saves lives. People can have the debate about 1 m versus 2 m until the cows come home, the reality is that 2 m is safer than 1 m, and the public health advice is 2 m. I ask people to keep that 2 m distance in their social engagements to help save lives. Continuing to control this aspect of our personal behaviour will be essential to controlling the behaviour of the virus.

My fifth message is to stay local. Thankfully, we are now seeing a number of counties in Ireland which have not had a confirmed case of Covid-19 in quite a few days. Deputy Feighan may speak later to remind us about County Sligo. I think it is a county that has not had a case of Covid in three weeks. There are others beginning to get there. I think County Kerry may not have had one in three weeks as well. I am going from memory, but there are a couple of counties that have not seen a case in three weeks. There are some which have not seen a case in two weeks, and there is a number that have not seen one in a week. This is good and this is real progress, but it is so important that we use phase 2 to continue to weaken the grip of the virus, and we are asking people to stay local, stay within their own county, to limit the potential for the virus to spread or reseed across our country.

The sixth point I want to make is on face coverings and I want to be crystal clear on this.

From a public health point of view, the clear public health advice is that they should be worn on public transport and in enclosed indoor spaces, such as shops. We will be launching a further public awareness campaign on this very shortly.

People asked me whether we are going to change the law in this regard. We do not have plans to change it. We did not change it, however, to say people needed to cough into their elbow; we just got used to it. We did not change the law to say we should wash our hands for 20 seconds but we got really good at it. We have not even changed the laws in regard to the 2 m restriction on occasion. Therefore, this is about behavioural change. I accept that the evidence, and maybe even the messaging on this, has changed over time. Perhaps it has been confusing for people and has not got through in the clear way it needs to. Let us be very clear, therefore, that starting from today, face coverings are recommended. People should wear one on public transport and in shops and other enclosed areas unless they have a medical reason not to do so or are under the age of 13. That is an important message. We all need to come together and the Government has a big role to play in a public awareness campaign on this.

My final point is on hand-washing and cough etiquette. People are more than familiar with these. We have got really good at these but it cannot be said often enough that, in phase 2, they will be among the most important behaviours we can embrace to protect ourselves. The virus can live on our hands but if we wash them regularly and frequently, it makes it much harder for it to survive. These are the simple, basic, important things we can all do to stay safe while we try so hard to find a balance, the sweet spot, or a way of living safely alongside the virus. While we are working to get the numbers down and have a reproduction rate as close to zero as possible, and while the virus is still here, we have to try to get back to some degree of normality. That requires us all to work out a way to live safely alongside it.

We have all been particularly mindful of the impact of this pandemic on both children and older people during the earlier phases of the response. It is very welcome that NPHET was, I hope, able to recommend measures to make life a little better and easier for those two groups.

The protection and well-being of those in our nursing homes continues to be my priority. For that reason, I am particularly pleased our success in pushing back this disease has allowed us to bring forward, to 15 June, the phased resumption of indoor visiting at residential care facilities. This has to be done safely. Normal nursing home visiting is not resuming next week, and I know nursing home owners would want me to say that. What we are trying to do is determine whether we can, on compassionate grounds and understanding that people are lonely, allow a degree of visiting. It has to be done safely and in alignment with the guidance. As I said to a nursing home owner, I would much rather be standing here defending the individual for not allowing a visit next week than explaining why a cluster was allowed to develop in his or her nursing home again. Therefore, we need to proceed with caution. I fully get that people are dying to see their loved ones, but we have got to get this right.

Planning for the delivery of non-Covid care is well-advanced. The HSE CEO has confirmed to me that a framework document will be published next week. The reintroduction of services will be across acute hospital and community settings and planned for the reality where we have to treat both Covid and non-Covid patients simultaneously in a context of heightened safety measures and reduced capacity.

I know colleagues in this House have been particularly concerned about the restart of screening services, as have I, and I am pleased the HSE has confirmed that there will be restart dates for each of the four programmes by the end of June. We are making great progress and we should all be proud of the collective contribution every citizen has made but we must continue to be cautious.

On 5 June, the director general of the World Health Organization said that for countries that have seen reductions in the level of disease, the biggest threat is now complacency. As much as we would wish it, we cannot now decide we have done our bit and the threat is gone. As a country, we have suppressed the virus because of the willingness of the majority of our population to change their everyday behaviour and maintain the change. That remains our massive ongoing challenge.

The usual rules now apply. Both Fianna Fáil and Sinn Féin have 15 minutes each and all other parties and groups have ten. If a Member is sharing time, he or she should indicate it at the start of his or her contribution. Members, especially those in the larger parties, should share their time appropriately so they can all contribute. I am not going to police it for them. I call Deputy Donnelly. Is he sharing his time?

I am. I am going to take the first five minutes for an exchange with the Minister.

Last week, we discussed the ongoing closure of the screening programmes. The Minister just referred to them again. He said at the time that screening would recommence as soon as possible. I believe those are the words the National Screening Service gave to him. Given that general practitioners can now take smear tests, "as soon as possible" would mean that CervicalCheck screening should restart now, but that is not what is happening. Two days ago, the National Screening Service provided a detailed update as to what is happening. As the Minister said, the service will not announce the restart dates until the end of this month even though general practitioners say they can start now.

Screening is expected to have begun a phased reintroduction by the end of summer but that means hundreds of thousands of people are not going to be screened at the same time as doctors are saying they are ready to do that screening. This morning on the radio the clinical director of BreastCheck said she was not in a position to give any kind of indication as to when it hopes to resume full service.

The approach also seems to suggest screening will not start until symptomatic cases are dealt with. The national bowel cancer screening service has indicated there is a backlog of several months just to provide care to people already identified as being at high risk. The implication seems to be that screening will not be reopened until this backlog is dealt with. The logic, therefore, for CervicalCheck and bowel cancer screening seems to be that because we cannot provide the post-screening care, we will simply not screen people, which worries me greatly. It seems to take away from the patient the option of sourcing other care somewhere else. It seems to defy logic to say that because we cannot provide the care, we will not even tell people if they are at a high risk.

Is the Minister satisfied with the timeline of starting these processes at the end of the summer? If GPs are saying they can do cervical cancer screening now, why are we waiting several months? What level of capacity from the private hospitals is being brought in to provide the downstream care, such as colonoscopy, histopathology and colposcopy?

I thank the Deputy. As he knows, the four national screening programmes - BreastCheck, CervicalCheck, BowelScreen and Diabetic RetinaScreen - were paused in March in line with public health advice. Such programmes were paused in many countries around the world, including Northern Ireland on this island, as well. This was done to protect patients and staff. It is important to say people who were in the system at the time of the pause have continued to be treated. With BreastCheck, for example, women who have been screened continue to have their assessments completed and treatment plans mapped and surgeries continue to be scheduled. For CervicalCheck, colposcopy assessments and follow-up treatments continue for women who were screened before the pause.

I am glad to be able to inform the House that the four screening programmes are finalising plans to restart their work. I am satisfied that this week we have more information than we had last week and we are really getting to a point where the screening programmes can say that by the end of this month, restart dates for each of the four programmes will be announced, and also that screening is expected to have begun with a phased reintroduction by the end of the summer.

I can also share with the House that the National Screening Service has said to me, probably for the reasons outlined by the Deputy, that CervicalCheck and the Diabetic RetinaScreen are expected to restart first and they will be followed by BreastCheck and BowelScreen respectively. There is much work going on to modify screening units and this must be completed before the restart, along with the final analysis on the effects of the Covid-19 measures and the pace and throughput of the screening cohort. Screening invitations will be issued on a phased basis according to clinical priority.

Like the Deputy, I will not be satisfied until these programmes are back up and running but I am satisfied that there is an incredible amount of work being done by very dedicated clinicians. We are now seeing engagement with patient advocacy groups that we may not have seen a couple of weeks back and it is important to keep that information flow going.

I will raise the matters of mental health and respite care. Mental health specialists are confirming an increase in the number of people presenting with depression, anxiety, self-harm and other mental illnesses. I have been warning for some time now in this Chamber the impact of the lockdown on people's daily routines, not being able to see loved ones and not being able to grieve in a humane way, as well as the loss of jobs and businesses and the effects on front-line workers of witnessing first-hand the many distressing events of the past couple of months. These are all taking their toll on people, from the very young to the very old.

Family resource centres are reporting a significant increase in demand for parent and family supports for counselling and mental health services. The latest Central Statistics Office data indicate young adults feel more downhearted, depressed and anxious, while risky behaviour is increasing. The number of people rating overall life satisfaction as "high" fell to just 12.2%. We do not need statistics to tell us what everyone is seeing every day. People are struggling and for some that struggle is getting more exhausting. The fourth wave of a pandemic is the mental health wave and that is rapidly turning into a tsunami that is already breaking on the shores of this country.

I welcome the intention to publish the refreshed A Vision for Change but that is a ten-year plan. We need to see a cross-departmental mental health task force up and running straight away. We have one for tourism but not mental health. Will that task force be established and, if so, when?

On the issue of respite, I would like to know the reason we have a timeframe for the opening of pubs and restaurants but not respite services. There has not been even an indication yet of when that will happen. Carers are exhausted.

I thank the Deputy. In the interests of time I will revert to him on the issue of respite in writing but I take the point that carers are exhausted. My colleague, the Minister for Education and Skills, Deputy McHugh, is working with the HSE specifically in respect of a summer programme that I hope will see some day respite, in the first instance, for children. I will come back to the Deputy with a more detailed note on that.

While I acknowledge the work Deputy Browne has been doing in the whole area of mental health, as he said, at the request of the Oireachtas last Thursday evening, I received Government approval for the new A Vision for Change, Sharing the Vision - a Revised Mental Health Policy for Everyone. It is my understanding that the document will be launched tomorrow. The Minister of State, Jim Daly, has been briefing stakeholders in advance of that launch. Once we launch that document, we need to respond to Deputy Browne's challenge, which he has been putting to us for some weeks in the House, in respect of what we can do immediately in terms of a task force. I have heard from Mental Health Reform and others. I do not want to speak for them but they wanted to make clear that any such task force would be aligned with the new A Vision for Change document. I believe we will be in a position to do that.

We will also launch next week a new crisis text line, which will be Ireland's first ever 24-7 text service. It is aimed in particular at younger people and teenagers. I will not take up any more time on that now but the launch of the new A Vision for Change tomorrow will be an important step in establishing the task force.

I want to return to the issue of nursing homes. As we are all aware, nursing, care and residential homes bore the brunt of deaths caused by the pandemic, with 62% of deaths occurring in that sector. As we prepare for a possible second surge of the pandemic, we must learn from the past three months. Test, trace and isolate is the mantra for success. I have called for and raised with the Minister recently the importance and necessity for regular testing in nursing and residential homes.

Today, Dr. David Nabarro, the World Health Organization special envoy, attended the Dáil Special Committee on Covid-19 Response by video link. When I asked him about regular testing he stated: "Taking a comprehensive approach, to include frequent testing and paying real attention to what is happening inside these facilities, will help to reduce the risk and maintain the health of the residents." He also stated that consideration should be given to "virus testing quite frequently, perhaps at weekly intervals or even more often if there is a concern." I also asked him about the high number of deaths in this sector and he specified that Ireland is certainly at the upper end of the spectrum in that regard. To be fair, he also said that not all countries release all their figures in the way we do here. To reiterate, regular testing will provide some degree of reassurance for those in nursing and residential homes and their carers and families. We must learn lessons. If the Minister would give me an update on how we intend going forward, I would appreciate it.

I thank Deputy Butler for raising the issue of nursing homes, as she does on a regular basis. I, too, listened to Dr. Nabarro today and he rightly highlighted the challenges and tragedies in respect of the passing of people in nursing homes from Covid-19. He also said that Ireland has a very honest accounting of the numbers, which I do not think many countries can say when it comes to care homes. He also said that we have the widest circle of inclusion of all of the countries he had studied. Not to take away from the tragedy, I believe it is to the credit of our public health experts that we are shining a light and not ignoring the massive challenge that exists when it comes to nursing homes.

Deputy Butler is right when it comes to testing. This is a key issue. Last week, NPHET recommended that all healthcare workers in all nursing homes - public, private and voluntary - be tested weekly for the next four weeks. That is a very important development, which has been welcomed by nursing home staff and owners. The HSE was due to publish a type of single operating procedure to ensure there is standardisation and clarity as to how this was to happen. That was due either yesterday or today. My colleague, the Minister of State, Jim Daly, will meet the HSE and Nursing Homes Ireland on this issue this evening.

I will ask the Minister a question on the Cavan midwifery led unit or MLU. I am sure he was not expecting this question today. Sixteen years ago, there was a vision for providing the women of the Border and midlands region with a new model of maternity care. On 5 July 2004, the midwifery led units in Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda opened their doors. Since then, thousands of babies have been born under the compassionate and professional watch of midwives.

The many mothers to whom I have spoken who have used the service in Cavan General Hospital have highlighted the exceptional quality of antenatal and postnatal care offered by the midwifery led unit, MLU.

As the Minister will be aware, the Taoiseach, Deputy Varadkar, launched the national maternity strategy in 2016. This recommended that MLUs be established in each of the 19 maternity hospitals in Ireland. Why then would the Royal College of Surgeons in Ireland, RCSI, group even suggest a merger or realignment, which would ultimately limit the choice for women? It flies in the face of the national maternity strategy.

I will ask the Minister to address a number of really important questions. Has he received any correspondence from the RCSI group relating to such an alignment? Will he assure the women of the Border region and the midlands who want this service that he will support it into the future and will not support any closure of the facility? Will he explain why there appears to be a lack of support for the midwifery led unit in Cavan when the unit in Drogheda is thriving? Will he assure women that bookings will reopen? It is my understanding that, as of 1 June, they have been closed. Will he commit to demanding answers from the CEO of the RCSI as to why such terrible uncertainty and doubt has been created around the future of the MLU in Cavan? Most importantly, 10,000 women have signed a petition to ensure that the MLU in Cavan is not only saved, but promoted, supported and assisted long into the future.

I will be brief on this issue, although it is really important. I agree with the Deputy. I want this unit to remain open. I am meeting tomorrow with midwives from Cavan General Hospital and the Irish Nurses and Midwives Organisation, INMO. As the Deputy rightly said, the national maternity strategy is very clear in this regard. Women need more choice with regard to birth and pregnancy. Midwife and community-led schemes are very important and fundamental parts of the national maternity strategy. My Department was not informed of any intention to merge the services. On 5 June, the national women and infants programme applied for a drawdown of the new development funding being provided for maternity services in 2020. Included in this funding is funding for an advanced midwifery practitioner in Cavan to provide additional senior midwifery expertise. I absolutely intend to meet with the RCSI group. This cannot go ahead. I will update the Deputy after tomorrow's meeting.

Yesterday, the Taoiseach said that Ireland was compliant with WHO guidelines and in line with other EU countries with regard to the use of face masks. Walking around the city, however, one would have to wonder if that is true. It is clear that the key challenge in respect of Covid-19 transmission relates to those at the presymptomatic stage. We heard this morning from Dr. Nabarro that masks can play an important role as part of a package of measures. The current messaging on this matter has been confusing. Members of the public are calling their Deputies and asking whether one is to wear a medical mask or a face covering, when one wears one and when the other, and how one stores and carries masks. The wearing of face masks was recommended by NPHET more than six weeks ago but now, in mid-June, very few people are wearing them. We urgently need a publicity campaign to promote the correct use of face masks. We do not need the enforcement measures that have been introduced in other countries. Irish people have proven that they are more than willing to follow clear guidelines. I urge the Minister to implement a campaign to communicate a clear message with regard to the use of face masks.

I fully agree with the Deputy. We need such a public awareness campaign. I take the implicit and fair criticism that the messaging in this regard has been confused. This is possibly because so many different people and experts have an opinion on the matter. It is the clear view of our public health experts, of NPHET and of Government that one should wear non-medical face coverings when one is on public transport, when in indoor public areas including retail outlets, when visiting the homes of those who are cocooning, when visiting residential care facilities, or when in an indoor work environment in which it is difficult to maintain a distance of 2 m. We will implement a public awareness campaign in this regard.

I am sharing time with Deputies Browne and Tully. We will take five minutes each. I will raise two issues with the Minister. The first is the issue of carers, which has previously been mentioned. They are obviously a vital group in our society but they have not got the appreciation they deserve over the past three months. They have taken on incredible responsibility and been under incredible pressure without the normal respite support they would expect.

That ranges from children with disabilities to looking after parents with a range of disability challenges. It is important that we take this opportunity to acknowledge the vital role they play. If there is going to be a full five-year Dáil term, we must do better for carers overall, but now they need to know when respite services will be reinstated in their communities and when they will get a break in terms of schools and community and health facilities in their areas. I ask the Minister to respond to that. Although I probably do not need to say this to him, I take this opportunity to express to them the appreciation of the Oireachtas at this time.

I join the Deputy in expressing my appreciation to all family carers. Family carers have had to do even more caring during the pandemic. Services were closed for public health reasons and to keep their loved ones safe, but a huge burden comes with that. I share the Deputy's view that we must do more for family carers. If this Dáil lasts four or five more years, God willing, one of the interesting things that whoever is involved in programme for Government talks should consider is the carer's guarantee and some of the commitments carers are seeking in that regard, which I believe should and could be delivered by this Dáil.

Regarding disability services, and respite care fits in that space, I have engaged with a number of disability organisations and service providers over the last number of weeks and my understanding is that they are working with the HSE to have reopening plans for the end of this month. I expect there will be clarity by the end of this month. Regarding children with disabilities specifically, my colleague, the Minister for Education and Skills, has been working hard to try to put in place a summer programme that is not just the traditional July provision, although that is very important, but to expand it for children who would not usually qualify, and also to examine how it could be a health and education programme. Subject to Cabinet consideration of this tomorrow, I hope the Minister will be in a position to make some announcements then.

The next issue I wish to raise is the investment that will be required in the health service as we emerge from this crisis. I will take the opportunity to give the example of my home county of Donegal, with which we are both familiar. Letterkenny University Hospital is the sixth largest hospital in the State and a major acute hospital. Let us consider the situation before this crisis occurred. There were 17,000 people from the county on waiting lists for inpatient and outpatient procedures and appointments. If one includes Sligo hospital, it is one in eight of the county's population on waiting lists, and the lists are growing all the time. The acute stroke unit was delayed. The Minister will be familiar with the campaign for the diabetes centre of excellence. We have the numbers of type 1 and type 2 diabetes patients in Donegal so there should be a centre of excellence at that hospital. Then there is the reopening of all the beds in the short stay wards. All of these, and I could go on, were delayed because of the recruitment embargo that was in place. There is also the trolley crisis. There was an average of 19 people on trolleys in the emergency department every day over a period of years.

We must do better. I have given the example of Donegal but that is the case across the State. What are the Minister's plans or what is his vision for the next Government to have the necessary investment in nurses, doctors and beds and to move forward with the transition to Sláintecare? The vision is positive and we all subscribe to it, but where will the investment come from? What assurance can the Minister give today? People are concerned when they listen to the debates on the radio that this crisis has taken away the resources required to turn our health service. One thing we must learn from this crisis is that we can never again have the health service we had going into the crisis. We must have a very different health service. Can the Minister give a reassurance on that today?

First, I cannot be so arrogant as to presume that I will be a part of the next Government, but I accept the broader point the Deputy makes on the need to do healthcare differently. The advice I would give to the Oireachtas, whoever is Minister for Health and whoever is in government is that we must do two things. We will have to put the capacity in place, and that means beds and staff. The second thing that Covid-19 will make us do is what we should have been doing anyway, which is new models of care. That involves hospital avoidance, keeping people in the community and telemedicine. I have had some interesting meetings over the past week with the INMO, SIPTU, and the Irish Medical Organisation, IMO. They are up for it, as are disability services providers. It is models of care alongside capacity.

I accept this will require significant investment in Donegal as well.

I want to raise the issue of the ongoing delay in establishing the CervicalCheck tribunal. The 221 Plus CervicalCheck patient support group is concerned about the delay in establishing the tribunal. Its establishment by the Minister for Health was delayed due to the Covid-19 lockdown. The support group knows the Department of Health is working on a plan to reschedule its establishment but is anxious to get some clarity as to when exactly that will happen. Will the Minister give an update on the establishment of the tribunal and an idea of when it will be formed?

I am going to get a bit parochial with the next couple of issues I am going to raise. There are serious concerns among locals regarding the Department's plan for St. Brigid's hospital, Carrick-on-Suir, and when it will revert to its pre-Covid-19 role as a community palliative care and respite service hospital. It was designated as a step-down care facility for Covid patients but has been empty now for several weeks and the staff have been redeployed. I already raised this issue with the Minister on 20 May but did not receive confirmation as to when St. Brigid's will reopen. This hospital not only covers south Tipperary but also south Kilkenny and north Waterford. Will the Minister clarify when St. Brigid's will be reopened as a community hospital?

I want to raise the issue of the underutilisation of the primary care centre in Carrick-on-Suir, which opened in 2018 but has several empty rooms at present.

In my home town, Cashel, there are ongoing concerns with the Government's plan for Our Lady's Hospital. Again, I raised this with the Minister on 20 May. He confirmed that patients from St. Patrick's Hospital were moving to Our Lady's on an interim basis. The closure of the hospital in 2007 was a huge loss to the region and has increased pressure on Clonmel general hospital. Will the Minister confirm the long-term plans for both Our Lady's and St. Patrick's hospitals in Cashel and make a statement to that effect?

St. Michael's mental health unit in Clonmel is another area of concern, which I have already raised with the Department. Tipperary has a lack of dedicated mental health services. Last September, there was a protest in Clonmel over the lack of mental health beds in Tipperary. I reiterate the call for the reopening of a dedicated mental health unit in Clonmel. A county the size of Tipperary having no full-time mental health services is crazy and unfair. Will the Minister confirm that, following the recent refurbishment of St. Michael's, it will be reopened as a dedicated mental health service after the Covid crisis?

University Hospital Limerick has consistently had one of highest levels of overcrowding, an issue which will return post Covid if nothing is done. A solution for this for both the people of north Tipperary and Limerick would be the restoration of full emergency department services in Nenagh hospital. This would reduce the pressure on Limerick, while providing the people in north Tipperary with emergency department services in their own area. Opening field hospitals cannot be accepted as a long-term solution to overcrowding in Limerick. What plans are in place to address the problems of overcrowding in Limerick emergency department post Covid-19? Will he commit to the restoration of emergency department services in Nenagh?

It does not entirely come under the Minister's brief but the opening of playgrounds so soon will create problems that will affect each county council. The Minister made the point earlier of only meeting people when it is important to do so. In Cashel, there is a new playground with 150 youngsters running around it. I do not believe that is important at this stage. If the virus spreads in these settings, who will be responsible? There is a major health risk with the actions of opening them up so soon. It is unfair on councils to speed it up like the Government has done and be unclear as to who will supervise the openings. Will the Minister make it clear who will be responsible if a child or a parent contracts the virus under these circumstances?

I was deeply concerned to learn at the weekend of plans to merge the midwifery-led unit in Cavan General Hospital with the consultancy-led services there. I have been reliably informed that the unit has been closed to anyone who wished to book this facility from 1 June 2020. While women who were booked prior to that date will be facilitated, anybody attempting to make a booking after that date has been told to make alternative arrangements. It is unclear as to why this decision was taken and if there was any prior discussion within the hospital, the hospital group or the HSE.

I know there was no consultation locally with women in the area, midwives, or the representative organisations - the INMO or the Midwives Association of Ireland.

I thank the Minister for his prompt response to my letter of representation on this issue and welcome the fact that he and his Department do not support any decision to downgrade or close the MLU in Cavan. If this unit is closed, it will have a critical impact on the well-being of pregnant women and Cavan and Monaghan, and indeed much further afield, as many women choose to travel to Cavan to have their babies in the MLU. The loss or downgrading of this essential service will severely limit the choices for women in pregnancy care. Those very limits were the reason for the development of the national maternity strategy in the first place. The strategy, which was launched in January 2016, clearly advocates the expansion of MLUs, not their closure. The plan to close the unit is totally contrary to the strategy and it is a retrograde step. Consultant-led care is more costly and less effective for low risk women. The situation in the North is different. Eight MLUs are in operation across the Six Counties, with plans in place for the provision of additional units. That is an average of more than one unit per county. By contrast, we have two in the South, with one in Cavan and one in Our Lady of Lourdes Hospital in Louth.

This is not the first time that the Cavan unit has been threatened with closure. In 2011, there were plans in place to close the unit as part of a so-called cost-cutting measure. Will the Minister please clarify the position regarding the MLU in Cavan? What is the reason that bookings for the Cavan MLU have been stopped from 1 June onwards? Why was there no consultation with women locally? Will the Minister give assurances to not only keep the MLU open in Cavan but to adequately ensure its promotion going forward, particularly as the level of support that Cavan has received is considerably less than the MLU in Drogheda? The national maternity strategy needs to be rolled out and a cornerstone of that is to increase the number of MLUs operating in the State. That needs to be a priority for any future Government, particularly since many highly experienced Irish midwives have been forced to emigrate. Now is the time to bring them home and enhance maternity services in Ireland for all expectant mothers.

I also have a question on cervical smear testing. Ms Naomi Thornton Ryan has started a petition to request an immediate reinstatement of this testing. She has no way of getting the petition to the Minister and so asked us to raise this with him today, to seek a commitment to reinstate cervical cancer screening as soon as possible on her behalf and the 31,000 other people who have signed the petition.

I will start with Deputy Tully's questions. I thank Naomi. In the interests of time, I think the Deputy will have heard my comments in the House earlier but I will revert to Naomi directly too. The Deputy is dead right that services have to be developed in line with policy. This House and the Government set policy. The policy is that there should be more MLUs in Ireland, not fewer. The people responsible for the delivery of the health services need to follow the policy. There was no discussion about the closure of this facility with my Department, and this facility will not be allowed to close, because it is against the wishes of this House, which supports the national maternity strategy. I have made it very clear that I have asked for a full report through the national women and infants health programme. My Department does not support it, they do not support it and the INMO does not support it. I will meet the INMO tomorrow, and specifically midwives from Cavan. I suggest that we have a meeting of Oireachtas Members from Cavan-Monaghan on a cross-party basis next week. I will be in touch with the Deputy about that.

Deputy Martin Browne kindly said that I could respond in writing on the range of issues raised relating to Tipperary, St. Brigid's, Carrick-on-Suir, Cashel, St. Michael's, Nenagh and Limerick. I will respond in writing about each of those. I need to return to Government with a start date for the CervicalCheck tribunal, but I am happy to share with this House that I would like to see that start around the end of this month. I need a Government decision on a commencement date.

On the issue of playgrounds, I find it somewhat frustrating that nobody in this House raised any concerns about opening golf clubs. In fact, everybody asked me to open more golf clubs quicker and to let people drive across the country to go to a golf club. Everybody is upset about opening a few swings and slides. I think it says a lot about our value system in this country and the lobby group that golf clubs have versus the lobby group that children have. Parents supervise their kids. They do not want the local authority to become mums and dads to their daughters or sons. They just want the local authority to clean the slides and swings, and keep an eye on the place.

I thank the Minister for the work that he has done over the past three and a half to four months, and I also thank his Department officials and all front-line workers for the volume of work and the way they have provided care in a difficult situation.

I wish to ask the Minister about the protocols concerning the swabbing of patients who come into hospitals, with respect to outpatient clinics, patients who are admitted for care and those who require surgery. What will be the procedures for all hospital admissions from now on? I refer also to those patients who will be admitted to private hospitals from 1 July. What relationship will exist between private hospitals and the HSE as they continue to reduce the incidence of the virus?

The second issue I want to touch on is the development of elective care facilities and hospitals, three of which have been identified in the Project Ireland 2040 programme. One of those is in Cork. I raised this recently at a meeting of the Special Committee on Covid-19 Response. We still have not identified a site. I fully accept that a lot of things were parked in the past three months because priority was given to providing care to those who had contracted coronavirus. We need extra hospital capacity now more than ever. When can we proceed with identifying the site and going through the planning process for the Cork facility and the other elective hospitals?

I thank Deputy Burke for his compliments to the officials in my Department, the HSE and our incredible front-line staff. It is very kind of him. People have been working extraordinarily hard. He raised the important issue of the testing strategy for hospitals, that is, who is to be tested, the criteria for being tested and what we do about the testing of staff and patients. Those are key questions. I understand the clinical adviser for acute hospitals in the HSE has drafted a paper on this. It was first discussed by the National Public Health Emergency Team, NPHET, last week. Either it is meeting to consider the matter further as we speak or the meeting has just ended. I expect to have some answers on NPHET's decision shortly. It made a decision on the testing of nursing homes last week. This week we are returning to the issue of hospitals, including both public and private hospitals. I will revert to the Deputy when I have been updated on the NPHET meeting after this session.

On the issue of elective hospitals, as the Deputy fairly acknowledges, a lot of things were put on hold to deal with the Covid-19 pandemic. The executive director of my Department's Sláintecare office is now prioritising recommendations to a new Government on how to kick-start several elements of Sláintecare. That will obviously be a matter for a new Government with a new programme for Government. I am here in a caretaking capacity to decide what to proceed with next, but I would certainly like to see the hospital in Cork move forward. Cork is an area that really needs capacity, as Deputy Burke has pointed out to me on many occasions. That will become more rather than less important in light of the need to deal with Covid-19 alongside non-Covid-19 care.

This morning, Dr. David Nabarro of the World Health Organization advised that all patients coming into hospitals should be tested. I ask for this advice to be taken into consideration in the preparation of that final paper.

There has been a large number of queries about the opening of hairdressers and barbershops in Limerick. I have met these traders several times and I will meet them again later this afternoon. They want certainty about when they will be able to reopen. Earlier is obviously better. Can the Minister provide an update on the process? I understand it will be considered by NPHET. When will this happen? When does the Minister expect a decision in this area? Apart from the concerns of the hair salon and barbershop owners, the Minister will appreciate that multitudes are going around with hair down to their knees. It is one area that people want to get back to, in Limerick in particular.

I assure the Deputy that I will appreciate my barber all the more after this. The Ceann Comhairle was possibly too generous to Members of this House when he described everyone as very well kept.

I was certainly not in the Chamber at the time. I know this is a serious issue, especially for the people for whom this sector provides a livelihood. This industry employs many people in towns, villages and cities across the country. As with every other industry, it wants certainty about when it will be possible to get back to work. I also know that for many people getting their hair done has a mental health element as well. Many of our older citizens get their hair done every week, not because their hair needs to be done every week, but because it is part of feeling good about ourselves. I acknowledge the health and well-being aspect of doing that as well.

As Deputies will be aware, there was a plan to have a phase 3, 4 and 5 of the roadmap. It has been recommended by NPHET, however, that it could be possible to do that in two phases rather than three. We are now looking at what belongs in each phase and NPHET will provide guidance to the Government on that. I presume it may have started consideration today, and it is likely the Government will consider this matter next week. I hope, therefore, that by the end of next week, we will have a direct answer to the question as to what phases each of the remaining sectors will fit into.

I welcome the decision to select Sligo and Dublin as the first counties for the new antibody testing. I had an unusual request last week from a constituent who wanted to know when social dancing in Ireland could return in the context of strict guidelines. She stated that it is a great form of interaction, exercise and mental well-being. I told her I would ask the Minister when he believed social dancing could return.

It is social dancing as opposed to any other kind of dancing.

Or socialist dancing.

Ironically, it is my Fine Gael colleagues who are throwing the most challenging questions at me today, between barbers and social dancing. I will have to revert to Deputy Feighan and his constituent on that matter. Under phase 2 of the plan, people are able to socialise again, while being asked to keep a distance. It is safe to dance as long as it is possible to stay 2 m away from the other person.

I welcome the news that we will soon have clarity on when hairdressers, barbers and beauticians will be able to reopen. That will be fantastic news for jobs and for people throughout my constituency.

The public have been reassured throughout this crisis by the flow of information coming from the HSE, NPHET, the Minister and his Department. Releasing data on the number of cases by county made it clear this crisis affected every part of our country. The HSE went one step further and released approximate locations for every reported case. This confirmed to any sceptics that we needed to follow the expert advice, regardless of which village or town we live in. We are, thankfully, now in a very different phase of the crisis and the number of new infections is dwindling.

Will the Minister commit to publishing data on the number of days since there has been a positive diagnosis for Covid-19 in every county in Ireland? Will he also commit to updating those data weekly? That level of detail would reassure counties free from Covid-19 that their efforts have borne fruit and provide hope to other counties that if we continue to follow the public health advice, we will be on a path out of this crisis.

Deputy Higgins is entirely right that the flow of information and data is our friend and ally in this pandemic. We have to keep bringing people with us and explain why we are asking them to make such serious changes in their lives and bear with serious restrictions. The Deputy is also right that we are now seeing several counties that have not had a case in several days. I think County Sligo leads the league table and has been without new cases for 22 days, from the information I saw yesterday. I think County Kerry might have reached three weeks. There are several counties that, thankfully, have not seen a case in some time. That is one of the reasons we are asking people to stay local, so that by the time we get to phase 2, we will have further weakened the grip of this virus on many parts of our country. I will certainly ask the Health Protection Surveillance Centre, HPSC, if it is possible to do as Deputy Higgins suggested. It is a very sensible and helpful suggestion.

I acknowledge the work of the Minister, his Department, the HSE, NPHET and all the front-line workers who have brought us to this happy day. It is wonderful to be able to talk about things such as hairdressing and dancing. That is very encouraging compared to where we were some months ago.

At the outset, I acknowledge the work of Women's Aid, the National Women's Council of Ireland, NWCI, the rape crisis centres and women refuges. While vastly under-resourced, they are working to deal with the fallout from Covid-19 due to gender-based violence. I attended a seminar this morning and listened to harrowing stories of violence towards women and children. It is important that we acknowledge the vital work of these organisations from a health and mental health perspective and to ensure, whatever parties are in government in some weeks, that these organisations are adequately resourced to do their work.

With regard to testing technologies, we currently seem mostly to be using reverse transcription polymerase chain reaction, RT-PCR. What other testing technologies should or could be used? Are more efficient testing technologies being used in other countries?

I have heard of a number of incidents where dentists are in some cases no longer able to take on medical card cases due to the cost of PPE. This cost is not recoupable to dentists under the medical card scheme and if this is the case, it is contributing to poor health outcomes for medical card holders, many of whom are in need of urgent dental treatment following the easing of restrictions. One dentist, in responding to a medical card patient, said that the cost involved in buying correct PPE to protect staff and patients and the extra time, investment and labour involved in providing a safe environment for all has overwhelmed the dental profession. Is this the case? If so, it needs to be corrected as a matter of urgency. Is funding an issue? The world's largest plane landed in Shannon Airport yesterday, delivering PPE. Perhaps some of that could be used to help the dental profession.

What are the Minister's views on the letter signed by 1,000 academic and scientists in regard to crushing the curve? It seems to make a compelling case given how painstakingly close we are to eliminating the virus in Ireland. The notion of opening everything up and being in a position to open our schools and colleges fully is surely where we want to be instead of 20% opening, partial opening of cafes, and no live music, arts or cultural gatherings. Should more consideration be given to this and should we look towards New Zealand given the hard work we have put in to get to this point?

The Minister has addressed the issue of face coverings, and it has been discussed on a number of occasions. I ask that he, in any public awareness campaigns, place a specific focus on homemade face coverings, because they are useful. I am aware that Dr. De Gascun was not terribly supportive of it at the Special Committee on Covid-19 Response on Tuesday, but there are many templates available to make them. I have them hanging beside our keys in the hall. They should become a part of daily life, putting them into the wash in the evening and including them as part of our routine.

One of the side effects of the crisis is that many couples have had to postpone their wedding celebrations, with many having rescheduled to the end of July and August. The guidance provided by the Government is that small weddings could take place in phase 4 from 20 July and larger weddings in phase 5 from 10 August. Presumably, when coming up with this guidance, the Government had some approximate numbers on what "small" or "larger" meant. The Minister will appreciate that planning a wedding takes some time, and telling a couple at the start of phase 4 on 20 July they can have a wedding of 25 people will be of little use. If he cannot give an indication today on what constitutes a small or larger gathering, can he at least give a date by which the Government will provide this detail? The Government has seen fit, since 8 June, to allow more than 25 mourners at funerals. It would be fitting to give couples this certainty.

My own town of Kilkenny is twinned with a municipality in Italy called Formigine, and I was talking with its mayor, Ms Maria Costi, last week. They were at the epicentre of Covid-19 in Italy but were able to host weddings in the town hall last week. Weddings are a fantastic and happy occasion, so guidance on that would be useful.

I thank the Deputy for his kind words. There are a couple of important issues. With regard to domestic and gender-based violence, I thank the organisations that have been doing incredible work alongside An Garda Síochána. I visited the National Ambulance Service some weeks ago at the height of this pandemic and they were experiencing an increase in calls related to domestic violence. For many of us, our home is a place of safety and well-being. For some people, sadly, when they close their own door it is anything but. I share the Deputy's views that the next programme for Government and the Oireachtas has a huge body of work to do in supporting those organisations. A broader conversation is needed on consent and how we raise our kids, and there is a big societal issue as well, but perhaps that is a discussion for another day.

The issue of other tests is one we always considered, including more rapid tests. NPHET, commissioned HIQA, as the Deputy will be aware, to do a health technology assessment to examine the alternative diagnostic approaches for the detection of Covid-19. These alternative approaches included an antigen detection test, the detection of antibodies and other rapid tests. Work is currently under way internationally to validate the analytical performance of the different diagnostic tests.

Until that clinical performance becomes clearer, we cannot recommend them but we are always keeping that under review and the Deputy is right to raise the matter.

On the issue of personal protective equipment, PPE, and dentists, I met with representatives of the Irish Dental Association on 8 May and 15 May. My officials met with them on 26 May. My Department is continuing to engage with them and I spoke to the CEO of the HSE yesterday about this. The Deputy referred to the aeroplane, the world's largest, landing in Shannon. It is a stark reminder of the situation we are in that the biggest aeroplane in the world only contained enough PPE for 12 and a half days, or three and a half days at the height of this pandemic so far. That gives one a sense of the scale of the situation. We need to have a conversation about PPE as we go forward and who is responsible for providing it and the likes. We are continuing to engage with dentists but I accept it is a real challenge for them and I would like to see us help.

I read the letter from the 1,000 scientists and academics. I am not sure that they are all scientists and academics but it was a letter from 1,000 people, including many eminent scientists and academics. When one reads that letter, we are not as far apart as perhaps has been suggested. What they suggest is to keep following the public health advice, crush the curve, do everything to get as close to zero as possible and not to rush things, which is sensible. That letter also highlighted the all-island approach which is very important. I had a quad meeting with the First Minister, deputy First Minister, health minister and Secretary of State for Northern Ireland, as well as the Tánaiste, this week. We must continue to ensure we are as closely aligned as possible and that is a big part of the approach we must take.

I fully agree with the Deputy about homemade face coverings. To be clear, the view of the National Public Health Emergency Team, NPHET, is that homemade face coverings have a value. That does not apply in a hospital setting where, obviously, we need medical-grade masks for people working in the health service and other settings but it does apply for the Deputy or me getting onto a bus or train, or going into a supermarket. The idea is that a mask is not a magic shield and does not stop the wearer getting the virus but it does make it harder for a person's droplets to transmit to me or vice versa. The mask catches droplets and there is clear value in that. It is an additional hygiene measure, not an alternative. It is also a visual reminder and aid to all of us. The view is that homemade masks have a role. We have put up videos as to how to make them and they can be made with socks and T-shirts. They need to have certain layers and the likes. We need to extend that awareness campaign beyond social media and get the message out through more traditional advertising forms.

The question of weddings is a hard one. People plan the happiest day of their life for a long period of time. It is a big day and a considerable amount of work goes into them. The arrival of the pandemic has meant that the best laid plans have been thrown up in the air. We have stated, as the Deputy rightly said, that 25 people can attend a funeral but that only relates to the church part of the service and not to the reception afterwards. We are not yet at a point where we can recommend the gathering indoors of more than six people. I hope that if we keep this pandemic in a good place we will be able to provide clarity on the matter. My intention, and I have been clear with NPHET on this, is to be in a position where we can answer that question when we publish the next iteration of the roadmap, the contents of phases 3 and 4. Even if it is bad news, we need to let people know so that they can make their own decisions. I have said publicly, in an effort to be helpful, that we are a fair while away from it being safe to carry out the traditional wedding of 100-odd people in our country.

It is a week since I asked the Minister the following question so I am sure he has the answer this week that he did not have last week. I was deeply worried by that but I told myself that the Minister has been working hard so I should give him a chance. In the phases outlined by NPHET, the analysis shows that the team and the Government make decisions based on five criteria, one of which is secondary morbidity and mortality. I asked the Minister last week what modelling the Government has done that it can share with us regarding morbidity and mortality rates for non-Covid-19 healthcare and deaths and the impacts that has on people's health. Given that is one of the five criteria, modelling of that sort is being done day-to-day and week-to-week because otherwise the decision-making methodology is flawed. I hope that is not the case because I agreed with the decisions that were made in the most recent phase. What modelling is being done? How many people are being affected across services? What is the impact on morbidity and mortality by healthcare area, geography and age profile? I am sure the Minister has all that information for us this week.

Truthfully, I do not have that information but I get what the Deputy is saying and I have a way of getting the information for him. I submit a report to the Government about phasing every three weeks and I will see what I can share with the Deputy on that matter in writing. I will also share it with the House. We do look at the different categories. So far as secondary mortality and morbidity are concerned, and the Deputy will agree with me on this, those are very hard at this stage to detect with any degree of certainty.

The longer it takes to resume certain services, the greater the impact would be on secondary morbidity, which I think is the issue the Deputy is getting at. I do not want to eat into his time. I have seen a draft of the resumption of non-Covid care plan from the HSE. The HSE very kindly shared a draft with my Department. There was a meeting between my Department and the HSE yesterday on this. The final version will go to the HSE board, probably next Wednesday, and will be published by the HSE. I am telling the Deputy this because within that, quite a bit of analysis has been done on the loss of care from Covid, that is, what we are losing out on today in terms of services that would have been provided. I should be in a position to share that with the Deputy next week.

I am very concerned for two reasons. First, criteria have to be based on something. This fifth criterion, what is it based on, if the Minister can actually tell us? He has made decisions but he cannot tell us what quantitative or qualitative data he is using to make such decisions. That is very worrying. These are the five criteria locked in stone, and for this one we have no quantitative or qualitative data that the Minister can share. Second, on the HSE plan, why are we waiting? This has been going on for a month now. I have been told the plan is going to be published. Last week, the Minister said it was going to the HSE board. The Taoiseach also said it was going to the HSE board. It has not gone to the HSE board. The independence of the HSE board is something I have raised here on numerous occasions. I have concerns. Is the issue trying to link up this plan with potential changes in the next phases as regards 2 m versus 1 m? There is an impact on health services in that regard. Is there a concern that they do not want to publish the plan because the volume of services will be so low that the public will really understand how deep a crisis we are going to have in non-Covid healthcare provision? Why is there such a delay? Why have we been promised for the past four weeks that a plan was going to be published? My colleagues and I used to question the HSE on this. That was all dropped politely a few weeks ago. We were told about this before it was dropped but we still do not have it. Where is it? What is the delay? What modelling is being done? What statistics, qualitative and quantitative, are being used? It is all very shady and deeply concerning because we have no transparency here.

Whoever is the Opposition and whoever is the Government - it is a fluid situation at the moment - there should be a regular meeting with the HSE. I would not like to see that dropped. I thought it was quite a useful engagement and would support ensuring that it happens again. What I am saying to the Deputy is that we already know there are impacts in terms of secondary morbidity and secondary mortality from Covid. We just talked about it in respect of the potential risks of domestic violence. We have talked about it in connection with mental health and screening. At this stage, it is very hard to be definitive about the scale of all of that because it is very much interlinked with how quickly we can get the services recommenced and how we can continue to keep the virus down. That is the point I was making.

The HSE board is independent and is doing an excellent job. It is a very good board.

The HSE is developing what it calls a framework document called Service Continuity in a Covid Environment: A Strategic Framework for Delivery. It exists. It has done that. It is right and proper, though, that it interact with my Department on this from a policy perspective, making sure it is aligned with policy and with the service plan. It may require us to amend the service plan because levels that the HSE legally committed to delivering in terms of services may not now be deliverable. There is a lot of work already under way. The HSE intends to publish the plan next week.

Is that definite?

That is it. I understand the final version is going to the board of the HSE on Wednesday. As the Deputy reminded me from day one, it is the HSE's plan to publish. I make the point that non-Covid care has resumed in many areas. I am not going to read out a long list and eat into the Deputy's time. That can be seen in the fact that there are far fewer vacant beds in our health service this week than there were last week.

In the case of University Hospital Limerick, the situation is awful.

Some of my questions on cervical cancer have been asked. The Minister knows I wish to know when the tribunal will start. I have spoken to all the advocates and I do not buy the plan to bring back screening. It does not make sense to delay cervical cancer screening until the end of the month and I see no reason it has not already commenced. Clinicians have told me there is no reason. I quoted Dr. Doireann O'Leary earlier. GPs can do smear tests and GP practices are engaging with people full time. I do not understand why those who do screening cannot do so. It is a big problem.

Earlier, the Taoiseach took on board two of my suggestions relating to a vaccine for everyone in the country and face coverings. He made commitments to consider them, which I appreciate.

The capital plan has obviously been impacted. I have asked many questions on various projects. When will the Minister publish a new updated capital plan? Will he do so in the next couple of weeks? I seek the status of the national maternity hospital, the children's hospital and various projects around the country. I re-emphasise the need for a new maternity hospital in Limerick.

Has the Minister considered legislation or an order relating to the wearing of face masks in settings such as public transport? How many doses of the flu vaccine are on order? The HSE needs to prepare to ramp up supply if it is to be given to everyone in the country. A time lag is involved in that. What is being done regarding the HPV vaccine? I have long been a passionate proponent of the need for a second dose. There must be a plan to ensure the period between the two doses is not so long as to make it unusable.

For five weeks in a row, I have raised the matter of people with intellectual disabilities. I am convinced that the 1 m and 2 m social distancing recommendation will be key for many services outside and inside the health sector on 29 June. People with intellectual disabilities, children and adults, are really regressing. Can we get services to them soon, please?

The capital plan will fall to the new Government. It will have to make some big key decisions on the capital plan. There is only so much we can do in this interregnum. We have pushed the boat out on A Vision for Change because it was important but at some point the new Government must take over. Of course there will have to be revisions to capital plans.

I thank the Deputy for his advocacy on the flu vaccine. He was very effective on this and we will see where it brings us. I will ask the HSE to ensure that it is able to order sufficient samples.

I fully accept the Deputy's bona fides on cervical screening. It will be one of the first screening programmes to recommence. I continue to engage weekly with the national screening service.

On intellectual disabilities, specifically children, I hope the Minister for Education and Skills and the Government will have positive news on some supports for those families tomorrow. Based on my engagement with organisations, there should be restart plans for adult services by the end of this month.

I have given the Minister notice of my intention to raise an urgent and serious matter with him today. It concerns the brain tumour research study proposed by Beaumont Hospital and Genomics Medicine Ireland, a commercial company that intends to use the DNA from brain tissue samples obtained from tumour patients. Research in this area is critically important but it should be carried out under the auspices of a State body, which ensures appropriate regulation, transparency and public buy-in with a specific public benefit remit. Ireland is an outlier in not taking such an approach. It is proposed that these samples would be used to create large DNA databases to which access will be sold for commercial purposes. This project raises huge ethical, privacy and public interest issues. The proposal was comprehensively rejected by the Health Research Consent Declaration Committee, the body charged with making decisions on these key issues.

However, a subsequent appeal of this decision was, puzzlingly and worryingly, upheld. The handling of this issue by the State has been questionable, to say the least. Under the proposal, GMI is not required to obtain consent from patients or the families of the deceased. Instead, against all best practice, an opt-out arrangement was agreed with a limited requirement for newspaper advertising and a deadline of tomorrow, 12 June. As the Minister is aware, that period has coincided with Covid-19 and because of that public awareness of this significant proposal is very limited. Therefore, given all of the concerns and big question marks around the probity, data protection and ethical aspects of this proposal, I am making an urgent appeal to the Minister here today to extend tomorrow's deadline for patients and their families to opt out in order to ensure adequate public awareness. I hope the Minister will accede to this request.

I fully agree with the last point the Deputy made and when I received her letter, yesterday I think, I immediately set about seeking to see if I could do as the Deputy asked, which was to mandate that there would be an extension to the notice period for the reasons she has fairly articulated. I am informed that the regulations do not permit me, as Minister, to amend the decisions or vary the conditions. However, I want to say very clearly on the record of this House that I believe the deadline should be extended. I note that the Health Research Consent Declaration Committee very kindly sent me a copy of the letter it sent to Deputy Shortall where it outlined the process. I believe it sent the letter today. It has now also written to the people involved in the project highlighting this issue and ascertaining if they would amend the time period. They should amend the time period. I support Deputy Shortall in her call in regard to this. I do not want to eat up the rest of the Deputy's time explaining the public health tests that would have been applied, the independence of the group etc., but the principal point the Deputy makes is that where there is an opt-out rather than an opt-in, there is a greater burden on those carrying out the research to make sure that everybody who wishes to opt out has the ability to do that. I think Deputy Shortall's concern is that that may not have been the case and I share her view in that regard.

The Minister has not explained why he cannot extend the deadline. Given that Beaumont Hospital is a State-funded body, will he undertake to pick up the telephone to the hospital today to speak to the person or section responsible and request very seriously that the deadline be extended? There are lots of questions around this entire project. I have serious concerns about it but the most urgent aspect is that the deadline needs to be extended. Will the Minister undertake to do that today?

I will. I will undertake that my office will make contact today with the HSE and Beaumont Hospital to outline our view. I could say more but in the interests of time I do not think the Deputy would wish me to. The health research regulations do provide for an independent and diverse health research consent declaration committee and an independent appeals panel, which has to have regard to the evidence before it, and it sets the safeguards and the time limits, and the regulations do say that I cannot intervene in any of that.

Time does not permit anything further on this-----

I will write to the Deputy on the matter.

-----but I do have serious concerns about that panel and I will return to this issue when time allows because I think it is of the utmost importance.

There is another point I want to raise. A couple of weeks ago I raised with the Minister here the funding crisis facing many disability organisations for various reasons, Covid obviously, but also resulting from the €20 million cut that took place earlier this year in January. Two weeks ago in this House the Minister stated:

Being blunt and honest, they will not be in a position to achieve [this cut] and I have made that clear to them. We need to look at how we can formalise that and provide them with peace of mind in that regard in the coming days.

That was two weeks ago. Does the Minister now have clarification and hopefully good news on that?

My view remains - and has been conveyed to the disability organisations, to the HSE and to the Department - that that saving, or call it what one will, is not achievable in light of Covid. My Department is currently, as we do on a number of matters, engaging with other Departments. I truthfully hope to be able to bring the matter to a successful conclusion very shortly but I do not believe that 1% can be achieved this year.

I want to provide them with the peace of mind of a letter confirming that. I cannot say to the Deputy today I have it but I am really very close.

I take it from what the Minister is saying that it sounds like good news-----

We are getting there.

-----and that €20 million at least will be reinstated. I hope I am correct in that and that there will be news soon.

The third issue I want to raise is the question of Citywest. The HSE is paying at least €25 million for the use of the Citywest Hotel and Convention Centre as an isolation facility and field hospital and it has the use of that facility up to the end of October. Earlier, the Minister referred to the long-promised HSE roadmap. I am concerned that we are running out of time in the arrangement with the private hospitals. There are beds there that should be completely used to best effect but Citywest also should be. We are paying good and substantial public money for it and we need to utilise that facility. Thankfully, we did not see the surge and the intended use was not required, although I would like to get further information on what the isolation rooms were used for. The reality is there is a hotel now with 756 bedrooms in it and there are also 300 beds in the field hospital. At a time when there are long waiting lists for all kinds of health services, there are more than 1,000 beds being paid for which are lying empty. Can the Minister tell us how will the Citywest convention centre be used, given that it is under the control of the HSE until the end of October and how will the field hospital of 300 beds there be used? Can the Minister combine that with the roadmap from the HSE and the capacity within private hospitals at present? Can the Minister ensure that that massive costly facility is utilised to the maximum?

It is good, as the Deputy says, that we have had low use of it so far but I take the point it is not sustainable that this continues to be the case. The low occupancy rates to date are a direct impact of the public health measures we had. I remember standing in what would have been that field hospital in Citywest with the Taoiseach and the CEO of the HSE, thinking "It is great we have it but I hope we never have to use this."

We do, as the Deputy rightly says, have use of this facility until at least the end of October. A decision has to be made by 23 June as to whether to extend that beyond that date. The Department has been preparing for all potential scenarios and there have been talks between the Department, the HSE and the Department of Public Expenditure and Reform in relation to alternative site uses in the event of a low surge requirement, which we now have, and there is due to be an alternative use strategy presented to my Department by the HSE next week. I accept we have it until the end of October. There has to be better use. We also need to make a decision on whether we will need it through the winter period and that will very much depend on how compelling is the case the HSE puts forward in terms of what it will use it for. It is a hotel. Largely speaking, it is not a clinical environment. When it comes to step-down facilities and providing people with convalescence and the likes, we often do not have enough capacity. That, to me, seems like an option worth exploring but next week the HSE is due to present its alternative use strategy.

Does the Minister accept that there is considerable potential for making progress through the waiting lists if these facilities that we are paying for are used properly? One sees it often in the private sector where somebody goes in for elective surgery, he or she is only in for one night or possibly two nights, and then goes in to another facility, which is often a hotel. We should be maximising the use of that. It is shocking to see facilities like this lying idle at a time when so many more services are required for people on waiting lists.

I now call on Solidarity-People Before Profit.

I am sharing time with Deputy Barry.

I have raised on a number of occasions my disquiet at the fact that the Minister decided to go through recruitment agencies, such as CPL, to recruit staff for the health service during the pandemic. I refer to the 70,000 people who bravely volunteered for the Be On Call for Ireland initiative. I asked a question recently of the Minister which was passed on to the HSE about the cost of using CPL and agencies like that.

Would the Deputy refer to it as a recruitment company, please?

Recruitment agencies. I simply did not get an answer. I got other answers but not the answer about how much it cost. What I was told, which is fairly extraordinary, is that of the 70,000 people who applied for the Be On Call for Ireland programme, 111 have been recruited.

That is pitiful. It is against a background of a dire need for increased staffing for Covid and non-Covid care, where we were already in a chronic situation in terms of capacity with poor levels of staffing before Covid, and we have additional needs. These agencies have managed to recruit 111 people. Some 663 people are job-ready and available for employment when they are required, which suggests we are deliberately not employing people even though they are qualified to do the job. We are just sort of keeping them on hold, which is extraordinary. Insofar as there was an explanation as to why we had gone through these agencies, it was because it would threaten the stability of the existing HSE payroll structure, which is just nonsense.

Will the Minister shed any light on this pitiful failure by these agencies, the refusal to recruit people through Be On Call for Ireland, and that bogus explanation as to why we use these agencies in the first place?

The Deputy certainly deserves an answer in respect of the cost of using a recruitment firm and I will undertake to get that answer for him. I had not directly seen the query but now that the Deputy has brought it to my attention, we will follow up on that and revert to him.

When we talk about HSE recruitment, Be On Call for Ireland and the like, we have to look at the total number of people who have been hired through the different doors and routes. I do not want to use up all the Deputy's time but, for example, some people who have applied for Be On Call for Ireland might also have directly applied to the HSE's national recruitment campaign, which hired 1,412 people. We hired 1,082 student nurses and midwives as healthcare assistants, that is, not as students but as healthcare assistants. We hired 80 additional medical scientists, we rehired 98 other people, and we hired 926 new doctors. We have 1,976 people who have been successful at interview for Be On Call for Ireland and will now be placed.

When I add up all the figures I read out, it brings me to a total of 4,574 additional people who have been hired or are in the process of being placed as a result of our recruitment campaign. Thankfully, we have not needed everybody in the way we thought or feared we might, but we will still need additional people for non-Covid care.

The agencies' pitiful failure, and leaving not recruited hundreds who are qualified, is inexplicable, as is the Department not outlining the cost.

I have a question about St. Mary's Centre on Merrion Road, run by the Sisters of Charity, who say the centre will have to close because it is unable to meet the HIQA requirements. This is a centre for the vulnerable and elderly where there were no Covid cases, which suggests it is not a bad place, yet the charity is saying the centre has to close because it cannot afford to come up to HIQA requirements. It is unacceptable that the Sisters of Charity, for reasons best known to themselves, will close a nursing home for the vulnerable, the blind and the elderly. For whatever reason, that should not be allowed to happen and the State should step in and take over that nursing home.

I have visited St. Mary's Centre and I know it. I will talk to the HSE about it and revert to the Deputy in writing.

I want to ask the Minister about the Covid-19 crisis and the question of mental health. A recent article in The Irish Times entitled "Ireland facing a 'tsunami' of mental health problems", cited international evidence to show that the pandemic has served to intensify the mental health crisis in other countries. In the United States, for example, 45% of people with suicidal thoughts recently had explicitly linked them to Covid-19. Maynooth university and the centre for global health at Trinity College Dublin recently released the first wave of the Irish Covid-19 psychological study. The survey found 41% of respondents reporting feelings of loneliness, 23% with clinically meaningful levels of depression, 20% with clinically meaningful levels of anxiety and 18% with clinically meaningful levels of post-traumatic stress disorder. A recent article in The Irish News estimated that Ireland was among the top 20 countries in the world most likely to experience a surge in mental health cases as a result of the pandemic.

All of this comes on top of circumstances in which mental health services are already creaking at the joints from pressure from demand in the context of underfunding. For example, in the child and adult mental health service, CAMHS, there are 2,200 on the waiting list according to the last figures we have, which are from 2019. In my area, Cork–Kerry, there are 162 who have been waiting for the services for a year or even more.

Are our mental health services fit for purpose? I do not mean in any way to question the work of the staff, both the paid staff and volunteers, who do heroic work, but even heroic work does not necessarily cut it when a mere 6% of the public health budget goes towards mental health services. This contrasts with the expenditure in many European countries, which spend at least double that or more. As a result, there is considerable over-reliance on the voluntary and charity sector, a sector that is uniquely exposed to this crisis. An example is the way in which fundraising has been affected. We saw what happened with Darkness into Light. Charities are expecting to lose income in the order of up to 40% this year, and 54% of charities are concerned they may be unable to continue providing services for more than six months. What we have is a genuine double whammy. On the one hand, there are underfunded services that were already creaking at the seams before Covid and that are now hit with a funding crisis, and on the other hand there is what was described in the article, namely, a tsunami of mental health problems. This adds up to a really difficult situation that cries out for urgent action by the State.

I would argue two points, in particular, the first being that there is a need for an immediate doubling of the State's mental health expenditure as a first step. Second, there is a need to establish an Irish national health service that fully integrates the voluntary and charitable sectors.

Will the Minister comment on the mental health crisis we are facing as we move out of lockdown? Second, what is his position on the two issues I have raised, namely, the need for radical increases in expenditure and the need for a public health service to cover mental health?

I thank Deputy Barry for raising this important issue. I am conscious that people watching this debate, like all others, could be experiencing mental health challenges. There is support available. There is a very useful website,, that can direct people to the supports. I would encourage anybody in need of supports to reach out.

The Deputy was right to highlight this matter. A very serious mental health challenge will emerge from this crisis. People have lost so much certainty in their lives and so much that they had hoped for has now been cast in doubt, at least temporarily. That is why I took the unusual decision, during an interregnum last week, or this day last week, to ask the Government for permission to publish the new A Vision for Change, Sharing the Vision, our new ten-year mental health policy. One would usually wait for a new Government to do this but every Deputy said we should get on with it and publish it. The document will be launched formally by the Minister of State, Jim Daly, tomorrow. Key to the policy — this is my advice to the next Government and this Oireachtas — will have to be the implementation structure. That is where the last document, A Vision for Change, fell down. It will be a matter of the implementation structure and, possibly and respectfully, an Oireachtas mental health committee.

I agree there is a real challenge associated with this. Next week we will be launching a crisis text line, Ireland's first ever 24-7 crisis text line, aimed particularly at younger people with mental health issues. We have provided some additional funding. The Deputies will have noted the additional funding for Pieta House, €114,000 more per month to provide 300 additional counselling hours a month for high-risk clients, in addition to some funding for extra online supports. It is about more than that, however. It will be about how we deal with a whole-of-society mental health challenge arising from the Covid pandemic. I do not disagree with much of what the Deputy said.

We shall move to the Regional Independent Group. I call Deputy Tóibín.

One hundred and twenty-four days have elapsed since the citizens voted in the general election. That democratic vote has been parked for what is now one third of a year. We are experiencing an unprecedented democratic deficit in this State.

Many people outside the Leinster House bubble are shocked at the slow pace of the seemingly never-ending negotiations that now seem to be stalling and getting nowhere. I am using a couple of seconds at the start of my contribution again to urge the parties currently involved in negotiations to speed up the process and make a decision rapidly. It is a very dangerous position for many reasons.

We owe front-line workers a huge debt of gratitude because of the work they have been doing and a similar debt to the public for adhering to the requests from medical experts and pushing down the incidence of the disease to a manageable level. Some significant sections of Irish society have been left behind, however. There is no doubt that children with special needs have been left behind. Elderly people in nursing homes have similarly been left behind while staff in those homes have been crying out for personal protective equipment, oxygen supplies and extra staffing. There is no doubt that people in direct provision centres have been left behind, as well as workers in meat factories and hospital staff.

A section of society will probably suffer most from what is happening but we could do something radical about it right now. It may be the case that people who have had their health services suspended or stopped because of this Covid-19 crisis could be the section of society most affected by it. They are not included in current daily statistics but I have no doubt that they will be included some day.

Deputy Alan Kelly asked both a few minutes ago and last week the level of forecasting and modelling done by the Government to identify morbidity and mortality arising from the lack of health services in so many areas. He got no answer today in the same way he got no answer last week. I can provide the answer. There is absolutely no modelling or forecasting being done. I asked the HSE that question three weeks ago and it indicated it was involved in no such forecasting or modelling of the level of morbidity and mortality arising from a lack of services.

I have no doubt that at the start of the crisis, we saw a shocking wave emerging from Europe and coming in our direction and it was necessary to prepare all the hospital services to be reoriented to this crisis. Given the figures we have seen throughout society, there is absolutely no excuse for us not to try to reorient back the services, as best we can, to the areas they are needed.

I raise the matter of cancer screening. I spoke to a woman this morning who was meant to get a skin cancer test done in April to check if there had been any changes in her skin but that was postponed until June and the appointment has now been put back to December. Obviously, many people in such a position will find themselves materially worse off from a health perspective by the end of this year and into the next year.

We in Aontú have been highly vocal in repeatedly raising the issue of cancer screening. A decision was made in March to cancel breast and cervical cancer screenings but was the Minister involved in making that decision? When asked, the HSE indicated this happened on foot of Government advice. Did the Minister know a decision had been made on cancellation of cancer screening services? Why did the Minister not tell the House about that decision? When I looked back on the press statements made by the Government, that information is not there. Will the Minister answer those questions first?

Yes. First, the Deputy does not need to tell me that it has been 124 days since the general election. I thought, come what may, after the general election life would move on and we would have a Government but I have been barely home since. I am well aware it has been 124 days since the election. The Deputy engaged in talks but there is a great irony in that many people in the House did not darken our door or talk to anybody about forming a Government. Perhaps they should reflect on that, rather than attack those us trying to continue in government while trying to form a new Government. We are well aware of the need for a new Government and this country needs that new Government quickly.

The Deputy makes a fair point in highlighting a number of groups of people for whom this pandemic has been particularly challenging.

Lockdown is tough on everybody but it is not equally tough. What this global pandemic has done, and it is a global pandemic, is highlight the inequalities that exist in society. I have a bit of advice for the next Government and for this Oireachtas. We would want to get serious about tackling those inequalities. When it comes to the fact that so many people in this House wrote-----

I am sorry, Minister, but a full minute has gone and none of the issues-----

The Deputy has raised children, residents in nursing homes, direct provision, meat factories and highlighted the inequalities in society-----

The question was what was the Minister's knowledge about the decision with regard to-----

-----and I would like to talk about them. I have not received a letter from anybody in this House asking me to open a playground but I received many asking me to open golf clubs. That says a lot about our values as a society.

In regard to BreastCheck and CervicalCheck, and any attempt to create a conspiracy theory in this regard, let us remember what we told people: "Do not leave your house. Stay at home". We suspended all non-Covid care other than the most essential in line with the National Public Health Emergency Team's decision to pause all services, which I think was on 27 March. It was a decision made by them. The decision was the right decision. A similar decision was made in Northern Ireland, New Zealand, Scotland, England and Wales.

The Minister had no involvement in that decision.

NPHET made these decisions and I accept their advice in full. I support them 110%-----

-----but let us not create revisionism here. The idea that we would be telling women who were not sick to go to health services at a time when we were petrified everybody would get very sick from Covid-19 is ludicrous.

A good chunk of my time has been taken by the Minister. I am not sure I have got an answer to the four specific questions I asked but I will move on to the next section. We know from a document that was referenced in yesterday's Irish Daily Mail that up to 200,000 women are waiting for screenings. The chief executive of the National Screening Service, NSS, has warned that when the screening restarts the capacity will only allow for approximately 50% of the number of people to be able to be screened with regards to the pre-Covid levels. That is deeply worrying because not only do many people have this long wait, it also means that by the time we get through that backlog many months will have passed. What measures has the Minister taken, or will he take, to make sure that we have the necessary capacity to address the cancer screening backlog that has arisen?

I have a couple more questions on that. The last statement from the National Screening Service website was updated on 5 May. It is not acceptable that many women are sitting at home deeply concerned with regard to their well-being and these delays. I would be grateful if the Minister would ensure that the NSS publishes updates on its website more frequently so that people could get clear information on it.

A good deal of information is emerging with regard to nursing homes and care homes here. There is a long list of decisions that were made which have led to those who are most vulnerable in our society being the most exposed in this crisis. I cannot think of another situation in the history of Ireland where more people died in institutions. Care champions have echoed a request by Aontú recently for a full public investigation into what happened in nursing homes. Will the Minister commit to a full public investigation here today?

The women of Ireland will be reassured that the measures that will be taken in respect of the NSS will be taken in line with clinical advice rather than my political views of the world. I have already told the House today that by the end of this month the NSS will outline the restart dates for each of the four screening programmes. I fully agree with the Deputy that it is not acceptable that the website has not been updated since 5 May. I know they have been engaging with the Irish Cancer Society, the Marie Keating Foundation, the 221 Plus group and the National Women's Council but I agree that website should be updated.

Regarding the issue of nursing homes, the villain here is the virus. We have a virus that has killed more than 400,000 people across the world and it is a virus that is extremely infectious. When it gets into residential settings it can be extremely difficult and deadly for people of a certain age. When this pandemic is over there will be a time to reflect on all the measures we put in place and, indeed, the lessons to be learned, and there must be lessons learned from a pandemic. I note what Dr. Nabarro told the Oireachtas Special Committee on Covid-19 Response today, chaired by Deputy McNamara. He said that when it comes to Ireland and care homes, our numbers are very honest. That is a reflection of what he might think of the numbers in other countries in regard to the counting of fatalities in nursing homes. He also said that in all of the countries he studied he had never seen a wider circle of inclusion in terms of what is included in Covid-19 statistics on nursing homes.

On behalf of the Rural Independent Group I call Deputy Danny Healy-Rae. Is the Deputy sharing time?

Yes, five minutes each for myself and Deputy Mattie McGrath. As the Minister knows more than anybody else, people throughout the length and breadth of the country have put their shoulder to the wheel in fighting this pandemic.

I know great strides and efforts have been made with regard to contact tracing and testing but it is an area in which we must keep upping our game. We must achieve a quicker turnaround. There are still cases of people getting tested and then waiting considerably too long for their results. We need quicker turnarounds. I ask the Minister to make a statement on that issue.

With regard to hospital waiting lists, because of what has happened, both our private and public hospitals have been shut down for the very important ordinary routine work hospitals have to do. We already had massive waiting lists for cataract treatments, hip and knee operations and all of the other procedures that need to be undertaken but they are now really backed up. We need to start dealing with that job of work and getting through those lists. There are people at home today who are going blind or who are in severe pain while waiting for hip and knee operations. I ask the Minister to make a statement as to how we can better use our hospitals to get through the lists more quickly and in a more timely fashion than ever before.

I was very thankful to him for something. We are in a very unusual position in County Kerry in that we have a public hospital and a private hospital, both of which are excellent and which are in sight of each other. We are one of only a few places in the country in that situation. I was personally very thankful to the Minister for meeting with the excellent manager of the Bon Secours private hospital in Tralee. At that meeting, we discussed many different methods by which the two hospitals could work together in a more connected way. I would like the Minister to expand on that. I want the HSE to work on that and to make those hospitals work better because I know that they can. I ask the Minister to make a statement in that regard.

Everyone in the country is complimenting our healthcare workers, and rightly so. I want the Minister, however, to do a very special thing. It is an unusual thing to ask but I want him to stop praising our nurses and other healthcare professionals and instead to start paying them. I want them to be paid the money they are owed. I want the pay agreements that were in place to be honoured. I ask the Minister to specifically make a statement explaining why catering staff, who are very important people, have not had a pay increase for 12 or 13 years, because I cannot understand it. If we do not have catering staff working in the kitchens, hospital will not function properly. It is not right or proper. The Minister knows how much inflation has increased over the past ten, 12 and 13 years. Those people have not got €1 extra in pay in all those years. That is wrong. I want the Minister to make a statement on that.

I also want him to clarify the situation as regards beauty and hair salons. I asked the Taoiseach about this matter earlier this afternoon. I would like the Minister to elaborate. What is the Government now saying to the proprietors of beauty salons, hairdressers and barber shops? When are they going to be allowed to open and to function properly?

If we do not open them soon, I will have to borrow the Deputy's cap because-----

I will give the Minister one. That is no problem.

It would not contain the hair.

-----it is getting harder to stick our hair down every day. There is, however, a very serious point here. There are many people who want to go back to work and make a living and who employ people in every town and village. As I said earlier, there is also a mental health aspect to this issue. There are people, particularly older people, who get their hair done once a week not necessarily because they need to but because it makes them feel good. That is also important. The Government is now considering what will go into each of the remaining two phases - and we hope it will be two phases. We will take the advice of NPHET in that regard. It is likely that Government will make a decision on the matter at our meeting towards the end of next week. I will keep the Deputy informed.

The Deputy will understand why I do not intend to stop praising healthcare workers, but I take his point. They want more than applause and platitudes. I have had some very good meetings this week. Two were with the INMO, and one was with SIPTU. I will have another with the INMO tomorrow and one with the IMO. Recognising these staff will be a job of work for the next Government.

The issue of catering staff is an important point. I was made aware of a pay agreement that was not being honoured. I believe it related to a private sector arrangement. That was a disgraceful act. I take the Deputy's point but it will fall to the next Government to resolve any pay issues. Some 124 days on from the election, we are hopeful that a new Government will be formed.

May I write to the Deputy with regard to waiting lists? He is not wrong. With regard to testing and tracing, there has been significant progress on turnaround times but he is right; we should never get complacent.

We have to keep doing better in this regard. I will keep in touch with the Deputy on it.

Deputy Healy-Rae might bring a spare cap with him next week for the Minister.

A sun hat would be more appropriate for the Minister. We will have plenty of sun.

We need definite answers about St. Brigid's Hospital in Carrick-on-Suir. We are told that the staff were needed in Cashel. The Minister can correct me, but I understand more than 74,000 people applied to work in HSE front-line services - fair dues to them - and only a paltry 140 or so were employed so why do the staff of St. Brigid's have to go to Cashel? I am delighted to see Cashel open. The Minister visited it with me and others and he saw its pristine state. Some €22 million had been spent on it. Now it is reopened. We are delighted and we send good wishes to the patients who moved into St. Patrick's, the staff, their families and all the care workers. However, what will happen post Covid-19? Will it be kept open as a hospital? There should be no more lame excuses that it was not fit, that people could not go up the stairs and whatever else. That cannot be allowed.

I refer to BreastCheck, the cervical smear tests and all the other tests. People are waiting anxiously. We see the Minister's former leader advocating for the hospice, and fair dues to him. People with prostate cancer have been advised to check and have tests such as bowel smearing, but all that has stopped. People are getting worried and sick. The stress of it is making them sick. It is compounding the mental health issues, and they must be dealt with. Early intervention services have just been abandoned for the past three or four months. They were bad anyway, but they are vital to children and to adults with disabilities if they are new cases presenting. We had difficulty last year opening St. Rita's in Clonmel and we want to have an assurance it will open this summer.

July provision is going to start; it must. Let us picture a family who has a young man or woman at home with severe and profound disabilities. These people have been in contact with me. Thankfully, some of the soccer and GAA pitches are open this week and they can go there for a limited time. They need that. They were incarcerated for three months and did not even get to have a trip on the bus with their siblings. That routine was very important to them. Will the Minister respond on that?

I have also asked about mental health. The Minister mentioned mental health and us not getting our hair cut. Mine is not growing much anyway so I might have to get the 10:10:20 for it. I know barbers whose mental health is suffering. Their job is to get up for work, the banter, the service and the customer. Customers are being dealt with in the black market. It is simply appalling and the black market is expanding all the time. William Walsh in Clonmel has set up his salon. One goes into something like a telephone box and one is disinfected going in and leaving. There are gowns and everything else. He is a very professional man and he needs to get back to work. Work is his therapy and it is what he wants to do.

On the private hospitals, we had to sign up and I supported it, but the contract should have been changed this month. If it had cost money, so be it. Let them get back to work. I will not even talk about Citywest Hotel. It is an appalling vista to have that amount paid for an empty building and a field hospital. We thought we would need them. Thank God, we did not, so we must get them back to work and in use. The queues are getting longer. I plead with the Minister to do that. I also plead with him to insist with NPHET tomorrow to let barbers and such places open. That includes the pubs. Let them go back to 1 m because they cannot survive and they might not reopen.

The Deputy makes a valid point about barbers. I have been listening to them in the media recently and heard about the big efforts they have been making to adapt their premises. I heard them talk about bringing one or two customers in at a time. They are going to great lengths and I hope we can make progress on this. As a Government, we must consider the public health advice and I have outlined the timeline in that regard. On pubs, we have been clear about the types that might be able to open, which is those that effectively operate as restaurants. However, let us be clear. Nobody wants to have the pub or restaurant where there is a big outbreak of Covid-19. That is not good for business either, and it is not good for the health of people in the community. We have made much progress and saved many lives so we cannot go backwards. It is a balance. Good, strong public health policy will help our economy, businesses and people, but I have heard the Deputy's comments on that.

I hope we will have news tomorrow on the July provision. I also hope that it will be broader than just the traditional July provision and that my Department and the HSE will also play a role in providing therapies and supports for the reasons the Deputy outlined in terms of early intervention services. I hope to have good news in that regard tomorrow.

I will always prefer to stand here as Minister for Health and take flak for the private hospitals and Citywest Hotel not being as busy rather than stand here and wonder, first, why we did not have them, second, why we ran out of ventilators and, third, why we did not have a field hospital. Thank God we did not need them. If we had to pay some money for that safety net as, effectively, an insurance policy, it was worth every cent. Most taxpayers in the country will agree with that. However, we now must look at the strategy for the future because we are in a different place.

I have already commented on screening. I should point out that anybody who has symptoms should come forward and not wait for a screening test. If somebody has a symptom of cancer, the health service is open today. He or she should ring the GP today.

I will write to the Deputy about St. Brigid's.

I want to zone in on the private and the public hospitals in Galway and their underutilisation. I welcome the decision to review the contracts in question at the end of June. I have raised it many times already.

The Minister described the virus as a villain. I do not think it is helpful to contribute human characteristics to a virus. A virus is a virus. It is a matter of our reaction to that virus and how we deal with it. The Minister spoke about highlighting inequality. Many of us have highlighted inequality repeatedly in this Chamber, pointing out its effects on health, the effects of no housing on health and so on. In March, when we started our journey on this pandemic, I highlighted the letter that most of us received from Fórsa on the appalling conditions of primary care facilities which are not fit for purpose.

Merlin Park hospital in Galway was set up in 1950, thanks to the work of Noël Browne and his small team. In this context, it is interesting that it was set up as the first dedicated TB hospital. It is now practically empty. I have pointed this out to the Minister. Its rehab centre has been shut down. Not alone has its rehab been shut down, the patients were put into the private Bon Secours Hospital. When I asked the Minister on the last occasion about this, he gave me some figures and said he would come back to me about the Galway Clinic, Doughiska. That has not happened, unfortunately. I understand the Minister is busy but he might come back on that.

Last week, in the course of representations, a person, who has given me permission to raise his case today, ended up in Limerick hospital because of fog and so on. He could not get back into Galway. Why? There was no bed in Galway. We have all these contradictory stories. I have a letter here actually still confirming no bed. I think things are changing today.

We have Merlin Park half empty. We have Doughiska with a 20% occupancy. We have Bon Secours filled with public patients from the public hospital. These are all contradictions. We have the front pages of the Galway Advertiser encouraging people to go into hospital but then we have no bed available. I am finding it difficult to get my head around it.

What in God's name is behind the decision to shut down the rehab unit in Merlin Park hospital? The Minister might recall the whole debacle over two operating theatres in Galway. I read out letters from consultants, not known for their radicalism, speaking about a catastrophic situation and a catastrophic orthopaedic waiting list with unimaginable suffering. That is the context in which we are shutting down Merlin Park.

I like to think I try to fight inequality as well. I think we all do in our own way. Certainly my comments describing the virus as a villain related to the fact that sometimes in this place there can be a culture of blame, such as blaming NPHET or blaming the HSE. From my experience, everyone has been working 24-7 to do their very best against the challenge of the virus.

I offer my sincere apologies that we did not revert to the Deputy on her specific query on Merlin Park hospital. We will, of course, do that.

On the Deputy's legitimate point about the reopening of services and why are we not using them, the HSE's non-Covid care plan, which is being worked through with all the hospital groups, is due to go to its board for final approval next Wednesday and to be published next week. I take the point we need to get many of these services back up and running. I also, by the way, believe that the Merlin Park site could well be the home of the new elective hospital that Galway badly needs. That will be a matter for the new Government. We will have the HSE's non-Covid care plan next week which will be about turning back on some of the non-Covid services including those-----

It took years to make the rehab unit state of the art. My own family benefited from it. It has been closed down to benefit the private hospital to justify the Minister's contract that we never saw because it is commercially sensitive. To try to understand this, really it is like something from Kafka. We put its public patients into a private hospital. It is mind-boggling. I am not here to blame but I am certainly here to have a better public health system, as well as better public housing. That simply is not happening, however. We have more of a language that is twisted and turned.

How do I explain to people in Galway that the rehab unit in Merlin Park is closed down while some of its patients are in the Bon Secours Hospital? By its own admission, the Bon Secours Hospital is not set up as a rehab centre. We have nurses from Merlin Park going into University Hospital Galway every day, going from ward to ward with no sense of building up a relationship with patients.

I have five seconds left so I will leave it. I have made my point and the Minister might come back to me about the specific issue.

On 19 March 2020, this House gave the Minister draconian powers. We debated aspects of them. Like all draconian powers, they were circumscribed and limited to specific circumstances. They were, by order, to declare an area or region in the State to be an area where there is known or thought to be sustained human transmission of Covid-19, or from which there is a high risk of importation of infection or contamination with Covid-19 by travel from that area. When making such an order, under the section the Minister was required to have regard to the Chief Medical Officer. On 7 April, having sought the advice of the Chief Medical Officer, the Minister declared that the State, being every area or region, was an area where there is known or thought to be sustained human transmission of Covid-19. Exactly six weeks later, on 19 May, the Chief Medical Officer, sitting just behind where the Minister is now, told the Special Committee on Covid-19 Response, "In broad terms, we have effectively extinguished it from the community in general, right across the country."

On Tuesday, Dr. Cillian De Gascun and Professor Philip Nolan, both members of NPHET, accepted that there are areas in which there is neither known nor thought to be sustained human transmission of Covid-19 at present. If that is the case, what is the basis in law or in fact for the existence of the affected areas order in respect of those specific areas, which the Minister made on 7 April and which forms the basis for further restrictions? The Minister joked about Kerry and Sligo at the start of this session being areas where there has not been transmission for a long time. Clare is another area where there has not been much transmission for a long time. I accept that in a small country like Ireland, it is very difficult to differentiate one area from another, but merely because it is difficult to differentiate does not make it lawful to impose restrictions if the legal basis does not exist for those restrictions. Has the Minister recently sought the advice of the Chief Medical Officer or the Attorney General for the ongoing restrictions, which state that in each and every area and region of this State, there is known or thought to be sustained human transmission of Covid-19? If there is not sustained transmission, there is not, in my respectful view, a basis in law to maintain restrictions.

I accept that there are distinctions between areas and this is very difficult in Ireland. One of the most basic aspects of the rule of law is that public officials should exercise their powers in good faith and not exceed their powers. It is very important that we are sure of that. The Minister mentioned funerals and said the new regulations allow up to 25 people to go to a funeral. I looked at those regulations, which are the Minister's regulations. There is only one mention of the word funeral, and that is to allow persons who provide accommodation to accommodate people going to a funeral. There is no restriction on any religious activity in these regulations. I expect it is because any restriction on religious activity may be unconstitutional. Public health is not a basis to restrict worship in Ireland. In theory, we have always operated a separation of church and State in this country. It is certainly provided for in the Constitution. There are limitations on what a Government can do to interfere with worship in this State as provided for in the Constitution. I urge the Minister to move away from laws which are unenforceable. It slipped out into the media that the movement restrictions in these regulations are not, will not or cannot be enforced by An Garda Síochána.

The Minister should move towards addressing the general health regime. The Minister says help is available for people who have mental health issues. In the mid-west, after 2 a.m., there is no crisis nurse in University Hospital Limerick to deal with mental health patients who arrive. There is none at any time in Ennis. During the general election, we had a boy who was moved from Ennis to Limerick and back, and went on social media, desperate for help.

That situation has only been exacerbated by Covid-19. The Minister knows this himself; I am not telling him something he does not know. We desperately need to move into these areas. There is a boy in Clare whose parents had to go to the High Court to get an order so that he would receive electroconvulsive therapy, ECT. He has severe autism and needs this treatment to prevent his deterioration. They got that order from the High Court on 23 April but they are still waiting. I have not brought this to the Minister's attention previously but I will pass the specifics on to him.

Lastly, we agree on the need to move our care for our elderly away from congregated settings in nursing homes and towards an alternative path of home care. However, home care assistants have not been paid in respect of cancelled hours since the beginning of June.

I appreciate that. We are disincentivising people from working in an area in which we need more people.

That concludes statements by the Minister for Health and questions and answers on Covid-19.

Perhaps the Minister could reply by correspondence if there is no more time.

I am more than happy to respond in writing.

Sitting suspended at 4.15 p.m. and resumed at 4.35 p.m.