Covid-19 (Health): Statements

I welcome the Minister for Health, Deputy Donnelly. He has ten minutes to make his statement, following which we will move to a question-and-answer session. If a Deputy chooses to use four minutes for a statement and questions and four minutes for answers, I will indicate when the initial four minutes are up.

My warmest congratulations to the Leas-Cheann Comhairle on her election. I have no doubt she will serve the office proudly. I am more than happy to do the question-and-answer session in whatever way works for Deputies, be that in taking questions and answers together or responding to all questions at the end of a contribution.

I welcome the opportunity to update the House on Covid-19 and the nation's ongoing response to it. Before I begin, I wish to extend my sympathies to the friends and families of those who have died in recent months due to contracting Covid-19. I know I speak for all Members when I say that all of these people, their friends and families continue to be in our thoughts as we strive to emerge from this incredibly difficult time. This vicious disease has taken an awful and heartbreaking toll in terms of life and in terms of the health of many people who have not died. They are very much in our thoughts at this time. In particular, I pay tribute to those healthcare workers who have lost their lives while caring for others during this pandemic. Healthcare workers have literally given their lives to keep the rest of us safe. Our healthcare workers have played a vital role in bringing us to the point we are at today, where we have been able to reopen the country and step-back most of the restrictions on normal life that had to be introduced in March. We avoided the awful scenes we saw in some countries around Europe, with patients in a lot of distress having to be treated in car parks of hospitals, etc.

As the House is aware, much progress has been made in this country in tackling Covid-19. We have seen the gradual reopening of our society and economy. We were not in a position to move to the final phase, phase 4, of the roadmap, which has been moved forward. This decision was taken following careful consideration of the current status of the disease in Ireland and the recommendations of the National Public Health Emergency Team, NPHET. It is clear from the experience here in Ireland and abroad that a cautious approach is required when dealing with Covid-19 and when reopening our society, communities and economy. The situation deteriorated for several weeks. The number of cases per week over the past four weeks are as follows: week 1, 61 cases rising in week 2 to 93 new cases, in week 3 to 124 new cases and last week to 143 new cases. The average number of close contacts of those infected has grown to more than five per person. The two-week cumulative figure per 100,000, one of the key figures that public health experts look at, was down at approximately nine and rose to 22, such that it more than doubled in quite a short timeframe. As we all know, the R-nought number rose from below 1, which we are all happy with, to between 1.2 and 1.8, which obviously was of serious concern to public health and the wider community. However, I am delighted to be able to report that over the past ten days the situation has stabilised. The R-nought number is down again to somewhere between 0.7 and 1.4. That is the latest information I have as of this morning. The best estimate, I am told, is that the R-nought number is now at 1.1, such that it has come back down again in the last ten days, which we are glad to note. The five-day average is also down again now to 16 new cases per day. Yesterday, it was seven. Contract tracing is working well. We know, critically, where the vast majority of cases are and these people are being contacted. The public health experts believe this stabilisation is linked critically to renewed efforts from the public from around two weeks ago. I thank every person in this country for listening to the public health advice and for the solidarity they have shown. What we are seeing two weeks since that renewed focus by the public is that the numbers are beginning to come down again. This shows that the solution to this pandemic does not lie in the Oireachtas, although we obviously have a role to play, or with NPHET, which is leading us on the advice, but with every family, parent, employer and citizen in this country. We will suppress and beat this vicious virus by acting together.

Internationally, things are moving in the opposite direction, with a significant acceleration of the pandemic. The virus requires only a small window of opportunity to re-emerge. It is critical that we follow the advice here to keep the virus transmission as low as possible. It is also essential that we are able to recommence essential health services, education services and to reopen our schools and social services, which have been paused or curtailed in recent months. This is at the heart of the Government's cautious approach to how we reopen society.

Ireland is, therefore, continuing to operate in phase 3. As the House will know, we paused moving to phase 4. Our retailers have reopened, as has a good part of the hospitality sector. The data and evidence will continue to be reviewed in advance of a decision on the appropriate stance regarding phase 4, which is now due to commence on 10 August. Our understanding of the disease and its characteristics and how it is transmitted is continuing to evolve. Clinicians, scientists and researchers across the world are working to learn more about Covid-19. This is the kind of work that, for example, recently lent weight to arguments in favour of more widespread use of face masks. As Deputies will be aware, face masks are mandatory on public transport. The Government is asking that we all wear them in retail and regulations to make that mandatory are being prepared. The World Health Organization and the European Centre for Disease Prevention and Control have recommended the use of face coverings to complement the other measures that we have become familiar with recently, such as maintaining a 2 m distance from other people, washing our hands frequently and adhering to appropriate coughing and sneezing etiquette. As the House is aware, the Government has responded to this advice with the introduction of the requirements that I have laid out.

The House will be aware that this week a list of 15 countries with similar or better epidemiological situations to Ireland was published. This is to ensure that the appropriate public health measures apply to international travel based on the country of origin from which people are travelling to Ireland. People travelling from these 15 countries will not be advised to restrict their movements on arrival into Ireland. The list will be reviewed every two weeks. If the epidemiological situation in a country deteriorates that country will be removed from the list. For the benefit of the House, the latest information I have is that not a single case of Covid-19 has been recorded as coming from any of the 15 countries that are on the list. Additional measures to strengthen existing arrangements, including the development of an electronic passenger form and a testing protocol for symptomatic passengers are being implemented. However, the overarching Government advice remains as it was. The safest thing to do is not to travel. We are advising people to holiday at home this summer. It is essential that we ensure that all of the sacrifices made to date are not undermined by any complacency with regard to the risk represented by international travel.

Maintaining the rate of virus transmission at the lowest possible level is key to ensuring that we can recommence many vital health, social and educational services. Our public health teams, the HSE and NPHET continue to closely monitor the prevalence of the disease in Ireland and they are endeavouring to suppress it as quickly as possible, wherever it appears. We see a united effort by everyone living in Ireland to maintain the solidarity that has marked the past number of months and to continue to follow the public health advice to keep apart, to wash our hands and, more recently, to wear face coverings on public transport and in shops.

I know the House will join me in thanking every person and every sector for their hard work to date. I encourage us all to keep going and keep this virus at the lowest level possible.

I can assure the House that the Government is continuing to rely on the best available evidence and advice in responding to this pandemic. We continue to prioritise public health and the suppression of Covid-19 with a phased, careful, and step-wise reopening of our society, our communities and the economy. We have seen the rapid re-emergence of the virus in other countries in the course of reopening. We are as a result moving in a cautious fashion and remain committed to tackling this virus wherever it appears.

I wish to speak about political solidarity, something we discussed yesterday in this House. Since the start of this, political parties and politicians in Ireland have been fantastic in providing solidarity and in working together. This does not mean there is no criticism, of course there is and must be. One of the things that marks Ireland’s approach, and which the WHO said is linked to the fact that this virus is suppressed, is that politicians across this House have continued to work together.

I will finish on this point as I know my time is up. I would say to the Deputies in this House that my sense, and I believe their sense, is that perhaps some of that solidarity has strained over the past week or two. If I had a part to play in that, I would like to apologise to the House for that.

I thank the Minister.

With the transition of any Government, there is going to be a period of time-----

I am going to stop the Minister there.

-----where there has to be transition. I will finish right on this, a Leas-Cheann Comhairle.

The Minister will get a chance to come back in but other Deputies will not as their time will be up.

This will be my final sentence, if I may.

I promise the House that the briefings that were provided and the access to the HSE and public health officials are going to be recommenced. They stopped over the past number of weeks and I want to get them going again as quickly possible.

I do not mean to interrupt the Minister but I am going to be strict on time because the Deputies wish to come in and out. If I do not stick to the time, they will not get the chance. Bogaimid ar aghaidh go dtí Sinn Féin. Are there two speakers?

Yes, there are two speakers. I am sharing time with Deputy Mark Ward. We will take ten minutes and five minutes. I will use four minutes to put questions and will give the Minister four minutes to respond. I will then use two minutes for a supplementary question.

I am all in favour of political solidarity in dealing with this crisis in healthcare and with Covid-19 care. That political solidarity has to be underpinned by real solutions. If I was a doctor, nurse or patient listening to the Minister's speech today, I would be very underwhelmed and disappointed because he knows that we are and have been facing, even before Covid-19 came along, an unprecedented crisis in healthcare, with far too many people left on hospital trolleys day in, day out, or having to wait 18 months or more to see a hospital consultant. Covid-19 has caused an even bigger crisis on a scale that we have never seen before. What is facing front-line workers and patients over the next number of weeks and months is scary and dangerous. They have to deal with Covid-19 care, which might increase in numbers, with all the non-Covid-19 care, with all the lost and missed care, for which we will need a catch-up programme, and with the loss of capacity. We heard of one 800-bed hospital in Dublin that will lose 200 beds. It is the same across the State because of the infection control measures that have to be put in place. We are also facing now into the winter flu.

Yesterday we had the comprehensive economic stimulus plan. It did not go far enough for me. There are nuanced differences and we can disagree on some of those but at least there was an economic plan. Where is the Minister’s plan for health services? Where is his solidarity with the doctors and nurses who were on the front line and want to know where the capacity is coming from to enable them to deal with all that missed care and ongoing care that people will need in the time ahead? We all know that it cannot be done unless there is an accelerated urgent injection of capital and spend, with more beds and staff provided in hospitals very quickly.

We need the most unprecedented targeted spend in healthcare over the next number of months that this State has ever seen. That is the scale of what is needed here. Yet, it is not in the Minister’s speech. The scale of the challenge before us is barely even mentioned. Where is that plan and when are we going to see it? The Minister owes it to all those front-line workers.

My second question relates to those staff who have worked so hard and who went above and beyond the call of duty. We know that today we are going to be asked to support a Bill to give pay increases to junior Ministers, and yet all we could give front-line workers is a round of applause, about which many of them spoke on social media. Are there any plans at all to reward those front-line workers with a one-off payment to deal with the pay increases they have been justly looking for, together with the pay inequalities for nurses and consultants in terms of the two-tier system? Where is the Minister’s plan for that? That would show real solidarity for those workers. Has he any plans in that regard?

My third question relates to what happened in nursing homes and congregated settings. We had the HIQA report that showed the challenges faced by nursing homes and the nursing sector, both private and public, in dealing with Covid-19. It was a very damning report. The Minister set up an expert panel which is going to report very shortly as well. There needs to be a proper probing of all of those reports by the Oireachtas. What is the Minister’s view on how that can be done? They cannot be just rubber-stamped. There cannot be just statements in this House on those reports. We have to know what exactly the Government is proposing to ensure we have proper scrutiny and examination of those reports. More important, we need change to ensure that as we go forward older people are treated with dignity, are protected in our nursing homes and are not left behind as they were when this pandemic struck.

Those are my first three questions to the Minister and I hope he can respond to them.

I thank the Deputy for those questions. On capacity, I agree 100% with the Deputy. We are in the middle of a very comprehensive planning exercise to bring in a winter plan unlike any that has been seen before. I agree fully with the Deputy that before Covid-19 arrived here, we had the longest waiting list anywhere in Europe, the lowest number of consultants, the second lowest number of hospital beds and all sorts of other capacity issues, which I am on the record as being critical of over many years. My position on that has not changed whatsoever.

On top of that, there has been a significant increase in the waiting lists because of the pausing of elective care. On top of that again, there is an undiagnosed amount in the community as well because referrals into the system are very low. I received a report this morning from the HSE on the reduction in capacity. It believes there will be a 30% reduction in operating theatres, a 30% reduction in scopes and a serious reduction in outpatient appointments.

The scale of this is like nothing we have ever faced before. Rather than coming in here with something that has not been thought through, what I did as soon as I was appointed was to meet the HSE and the Department and ask them to work together to put a comprehensive plan together and to plug Sláintecare firmly into it because its team have identified a very large number of innovations, some of which have already been brought in, such as e-prescribing. I will be discussing that at length with Members of this House, be that at the health committee or wherever is appropriate to do that.

I agree fully with the Deputy and the reason I did not go into that today is simply because this session in the Dáil was statements on Covid-19. I am very happy to come back to the House or meet the health spokespersons and get into that in much more detail. I fully accept the Deputy’s push there.

On the pay issues, I agree there are agreed pay issues - for example, the nursing agreement from 2019, which not only included pay but an acceleration to safe staffing levels, much of which has not happened yet. Some of it should have happened and some of it did not happen out of necessity because of Covid-19. I met the Irish Nurses and Midwives Organisation, INMO, the Psychiatric Nurses Association, PNA, and SIPTU to discuss these exact issues. I have already spoken to the Department and the HSE about how we can accelerate what has been agreed. Next week I am meeting with the Irish Medical Organisation, IMO, and the Irish Hospital Consultants Association, IHCA, to discuss exactly the same thing for doctors. I hear the Deputy loud and clear and I am giving the same message to the Department and the HSE, that the first thing we have to do is to implement what has already been agreed.

That has not happened at the level that was agreed. On nursing homes, we have the HIQA report and I am sure we have all read it. The good news is that it found that the vast majority of nursing homes were green. They were in compliance across the various measures that were looked at, be it governance, capacity or ability to respond. There were, however, usually between 2% and 3% that were marked red and 2% or 3% that were marked as yellow, where they were not yet ready. We are working with the HSE, HIQA and the Department to see what needs to be done quickly to ensure that that small number get the supports they need. On top of that, I have written to HIQA. The HIQA report was on nursing homes that did not have Covid outbreaks. I wrote last week to ask HIQA to do the same analysis for the nursing homes that have had Covid outbreaks. It could not do so to begin with for infection control reasons. We need the same report for exactly that.

No problem. That is fine. I will revert in writing on the rest.

The Deputy asked me to come back to him. I am trying to stick to his rules. Does he want the two minutes?

I will allow the Minister to continue.

Go ahead, Minister.

The expert report is coming next week. I have not seen it but understand it has a long list of recommendations. The first focus has to be on making sure that the nursing homes are protected. The public health officials are saying, based on how they see this disease work around the world, that we will have a second surge. We hope that it will be low and that it will be localised geographically but we have to be prepared within particular communities, counties and cities for the prevalence rate to go up. The first focus is on making sure that every protection that can be in place is in place.

With regard to the Oireachtas, I am happy to come back to do statements and questions and answers. It is a matter for the Oireachtas but as someone who spent the last three years on the Committee on Health, I imagine that it will take on both the HIQA report and the expert report and looking at them in detail. It is not for me to say but I imagine that will happen. The officials and I will be available for that if the committee so chooses.

We are under time pressure and I do not want to take from my colleague's time. We do not need the Minister to come into the Chamber and agree with us for the sake of agreeing with us. It is okay to agree with us but we need action. The two big challenges facing this country are the economic challenge and the health challenge. We have an economic plan but not a health plan. Today, nurses, doctors and consultants will go into hospitals really stressed, trying to make sure that people can be treated. The Minister talked about miscare. Undoubtedly, people will die prematurely if we do not put the plan in place. This is urgent and we are going into recess next week. Is it the case that we will not see a plan throughout August? I do not think that is acceptable and I urge the Minister to come forward with that plan as soon as possible.

I congratulate the Leas-Cheann Comhairle on her election and appointment yesterday.

More than 14 years after A Vision for Change was published, Ireland finds itself in the middle of a pandemic that is expected to place additional demands on already overstretched mental health services. We have many mental health challenges ahead of us and I was a bit disappointed not to hear any mention of mental health in the Minister's speech. Pre Covid, never mind post Covid, we had long waiting lists to access care, limited out of hours support and no crisis intervention, an over-reliance on acute care for adults and a lack of mental health services in our community. We still have children in this day and age being admitted to adult units for psychiatric care and there is little joined up thinking between mental health and addiction services. We are still over-reliant on NGOs to provide services that the Government should provide. I could go on.

Sharing the Vision is the new kid on the block. It is labelled as a mental health policy for everyone. The document was recently published and it has some good objectives but none of them is costed. The document will not be worth the paper it is written on unless it is financially or politically backed. Will the Minister tell me when this document will be costed and financed? There are 100 recommendations in Sharing the Vision, of which 40 are labelled as short-term, to be implemented with 18 months. When will these be costed? The programme for Government also states that it will examine the appointment of a national director for mental health. When will this examination happen? Will the new national director of mental health report directly to the CEO of the HSE, because it is vital that that happens?

Ireland is facing a tsunami, as has been said by numerous groups including in the Special Committee on Covid-19 Response, of mental health problems coming down the line due to the coronavirus pandemic. Early indications have shown an increase in suicide and self-harm. Data collection on suicides by Irish hospitals was suspended as a result of lockdown, meaning that there are no current figures on suicide and self-harm rates, according to the national self-harm registry. Is the Minister aware of this? What was the rationale behind this decision? There may be a good reason for this but I am wondering about the rationale behind that. Data collection is vital for future policy, as the Minister knows. Will data collection commence and will it be retrospective so that we have figures to influence policy?

We need to develop a 24-7 crisis intervention service and rehabilitation and recovery times within our communities. Mental health does not finish at certain times of the evening.

As the Deputy quite rightly said, we have a new mental health policy called Sharing the Vision. It is a mental health policy for everyone. We must remember that is a ten-year policy that needs a whole-of-Government approach. It does not relate just to the Department of Health. There has to be a cross-sector approach relating to housing and social protection supports. What I like about this policy is that it envisages a mental health system that addresses the needs of the population through a focus on the requirements of the individual. The most important thing in this policy is service delivery. We will establish a national implementation and monitoring committee to oversee its progress, meaning that there will be oversight. The terms of reference for the monitoring committee are currently being drawn up and will come to Cabinet in September. We are looking at an independent chair with various subgroups and different terms of reference.

I will answer the questions about suicide and 24 hour crisis intervention in writing. Much good work has been done during Covid with the move to online services and e-health. Jigsaw was able to move many of its supports online during this time because of all the challenges. I know face-to-face engagement can never be replaced but when we had various challenges relating to Covid, online services worked well and we could maintain many supports.

My party leader, Deputy Kelly, could not join us this morning so he asked me to take these questions. I have not had the opportunity to wish the Minister well in his role but want to do that now. He and his colleagues have a major task ahead. Some of the suggestions that he makes are positive and we will support them, but we will also critique, analyse and provide alternatives to the propositions that he brings forward, as any constructive Opposition party should, especially in the face of the threats that we are facing.

I want to ask the Minister a series of questions in the first few minutes I have. Will he commit, as our party leader, Deputy Alan Kelly, has suggested, to providing the flu vaccine free of charge to everybody in the country? This would be a useful way to protect people from the flu virus and to ensure that our emergency departments are not inundated during the autumn and winter in the flu season.

There is stunning and shocking evidence, as provided by SIPTU and other health service unions at the Special Committee on Covid-19 Response this week, about the levels of infection of Covid-19 for healthcare workers across the system. There was concerning evidence that suggested that healthcare workers were in essence putting themselves and patients at risk through no fault of their own because they were showing up to work while experiencing symptoms, because of their dependence on premiums and allowances, given the low levels of core pay for low-paid health service workers in our public sector. Will the Minister commit that that issue will be addressed in the context of any future potential public sector pay deal that he may be considering?

The rate of infection for healthcare workers is one of the very concerning aspects we have seen over the last months. We have lost eight healthcare workers through Covid-19 since the pandemic started. I extend my sympathies to the family and friends of Dr. Syed Waqqar Ali who fell this week. I say "fell" because he fell in the line of duty. Dr. Ali put the public and his patients first. Clearly he contracted Covid-19 as a result of his work.

I am aware the Minister is developing a compensation package for the families of healthcare workers who have lost their lives as a result of Covid-19. What is the Minister's view on extending this to contracted workers in the health service? At least one such worker, a contract cleaner, lost his life as a result of contracting Covid-19. These workers have no death-in-service benefit so it is important that we extend that to contract workers.

Will the Minister make a clear statement on his view on the classification of Covid-19 as an occupational illness? This would elevate Covid-19 somewhat with regard to the legal framework. It would allow healthcare workers who contract Covid-19 in the workplace to get better healthcare, it would provide a better focus around health and safety procedures in the workplace, it would provide a role for the Health and Safety Authority with an inspection regime and it would also provide access to compensation measures in the normal way that occupational illnesses do. I ask the Minister to consider this. The International Trade Union Confederation has demanded this. The policy has also been adopted by other, analogous European Union member states. I believe that Ireland should follow suit.

Will the Minister please consider a proposal made by the Labour Party leader, Deputy Alan Kelly, which is absent from the July stimulus programme, to provide a €1,000 bonus to health care workers. That would cost some €100 million, which is small beer in the context of the €5.4 billion cash injection announced yesterday. It would be an appropriate recognition of the contribution made by our health service workers during this time. If it was considered, I ask that it would be extended to our nursing home staff who predominantly work in the private sector but who have made an enormous contribution, often in very difficult circumstances during the pandemic, keeping older people safe in very challenging circumstances, as we all know.

Will the Minister give his view on my persistent calls for a commission of inquiry into what happened at Dealgan House in Dundalk? The Minister will be familiar with this case, where 22 residents passed away as a result of Covid-19. I was very taken by the interview of the assistant director of nursing in Dealgan House by Pat Kenny on 10 July. She painted a picture of a very traumatic scenario in March and April when on some days two residents were dying each day. There were traumatised staff and traumatised families running around looking for support from HIQA and the HSE. The cavalry came far too late, in my view. It is a shame that staff, who are still traumatised over their experience, and struggling staff and families, are looking for answers through freedom of information requests and parliamentary questions from Deputies like me who represent Louth and Meath East. The only way we can get to the bottom of what happened at Dealgan House is to ensure we take the approach of a commission of inquiry to look at what happened in its totality and in a holistic way. If we are to learn anything about how we respond to crises such as this we need to front up, get all the information together, get all the key actors in the one room and hold a commission of inquiry-type approach. This could be done under the existing legislation very quickly and comprehensively. Families are entitled to answers.

I thank Deputy Nash for his questions and, while I acknowledge that he is stepping in for his party leader today, for his ongoing work on a lot of these issues.

On the flu vaccine, I will ask for a detailed response to be sent to the Deputy. I have a detailed note here but if I give it now it would take up all the time. Essentially, the advice from the national immunisation advisory committee is being followed. It did not advise the whole country, it advised at-risk groups. I am delighted to say that the HSE has already forward purchased a vast number of the vaccines. The proposal and the plan are that the vaccine would be provided free to the at-risk groups. I have the detail here but in the interests of time I will get it to the Deputy. In addition, there are 600,000 nasal doses, which are for children. A lot of work has been done. The advice from the people who understand this best is to take that approach. It does not mean that the Deputy and I, for example, will not be in the at-risk group, and if needed that he or I should not get the jab. We should. The advice is to proceed as we are. It will be the most comprehensive provision and, obviously, it is being taken in the context of keeping people well and out of hospitals for the reasons we all understand.

I thank the Deputy for raising the pay points and especially of low paid workers. Let me take it away, reflect on it and we will get back to the Deputy.

On infection rates, I was a member of the committee when the Irish Nurses and Midwives Organisation, INMO, gave us exactly these rates. I discussed them at length subsequently with the INMO. The rate described is the percentage of all the positive tests in Ireland and the percentage of these cases that is healthcare workers. From memory, I believe the number given was 43%. The INMO, very fairly, said that when they compared that figure with other organisations around the world it was the highest of any who were involved. I looked at this in detail. The figure is highly variable on what each country tests. If a country focuses on testing healthcare workers and at the same time the community rates are very low, then obviously one will get a much higher percentage. The feeling is that this is what has happened. As important, we have looked at the percentage of healthcare workers who have tested positive. On that metric Ireland is way below and is doing very well by international standards. While there is no acceptable number, compared with other comparable countries we are doing well. I will get a detailed note to the Deputy on how all of that is working.

I shall now turn to the bereavement compensation. It is intended that it be applied retrospectively and across the board to front-line workers. This includes HSE staff, nursing home staff, section 38 and section 39 staff, agency staff, home care workers and agency home care workers. It is very broad. Currently it is specifically for those people who work hands-on with Covid-19. I will take the Deputy's points away about other workers in the system also. We have to do right by anyone who has contracted this disease while working for the State in a healthcare system. I will certainly take it under review.

I am aware the Deputy has raised the matter of Dealgan House several times. My view is that the HIQA report has come in, the expert report is coming and I imagine these issues will be discussed.

When is the expert report due?

Early next week. I will get the remaining information to the Deputy in writing.

I gave the Minister notice of two issues in the House yesterday. The first relates to international travel. Earlier today the Minister said that every protection is in place to prevent the spread of Covid-19. A response to a recent parliamentary question said that almost 62,000 passengers arrived through Dublin airport in the first two weeks of July. Currently, the Department of Justice and Equality is responsible for the follow up with those passengers. I was curious to know the level of follow up. The Minister and the Department of Justice and Equality have made it very clear that in recent weeks, with an increase in the numbers of people travelling, their resources are being diverted into immigration services. When I drew them out on the actual figures, they disclosed that of the 62,000 passengers who have come into the country in the first two weeks in July, the Department conducted follow up phone calls to only 7% of those travellers.

Of that 7%, only half of them actually answered the calls. In the reply the Minister for Justice and Equality stated her Department awaits hand-over of this follow-up process to the Department of Health. Is there a turf war on here? Why is it that the Department of Health has not taken on that responsibility? The low levels of incoming passengers getting follow-up calls is absolutely indefensible. Only 3.5% of international travellers coming through Dublin Airport are answering phone calls. We cannot allow the country to be exposed to that level of risk. When will the Department of Health take responsibility for ensuring adequate follow-up in these cases?

My second question, about which I gave notice to the Minister yesterday, concerns disability services. Earlier in the year, there was an announcement that there was going to be a cut of €20 million from disability organisations. That was pre-Covid. In the light of Covid, we know the fundraising capacity of disability organisations has been devastated. Due to this, there have been major cutbacks in the services provided to the most vulnerable citizens. The Minister's predecessor indicated clearly and gave an assurance that he would reverse that cut. As the main Opposition spokesperson at the time, the Minister gave a similar undertaking that he would reverse the cut.

I am concerned, however, that one disability organisation was informed just this week by its CHO that the €20 million cut is going ahead. Will the Minister clarify absolutely here today whether that €20 million cut is going to be reinstated?

I thank the Deputy for her questions. I am looking to see what led to this 7% level. I do not believe it is acceptable. Deputy Shortall also believes it is unacceptable. There are several things happening. The number of people who are going to be tasked with following up on this is going to be significantly increased. It is not going to be the Department of Health but the Department of Transport, Tourism and Sport. That was what was agreed by the Government earlier this week.

What will help with that is the electronic form. There is a huge amount of work going on in the background to put out a form on an electronic basis. It is already mandatory. Everybody who comes in has to fill it in by law. People are going to be asked to fill it in before they travel. My understanding is it will be two days before they travel.

I spoke to the WHO exactly on these issues several days ago. It stated the single most important thing in terms of people coming into one's country is not quarantine or block-booking hotels but being able to contact people coming in and knowing where they are. That is where the focus is going to be. We are really working hard to get this electronic form into place. A team is being set up in the Department of Transport, Tourism and Sport to make sure that the people who come into the country are called. That is what is happening on the issue. I agree with the Deputy that it needs to be better. A 7% call rate is not acceptable.

With regard to disability services, I cannot give the Deputy a definitive answer right now. It is additional funding that, as she will understand, has to be agreed by the Government. What I can tell her is that I absolutely stand over what I said when in opposition. I did not agree with the cut pre-Covid. I did not believe it was the right thing to do, regardless of Covid. I imagine I am on the record on that and I stand over that. It certainly is not the thing to be doing with all the additional strains the disability services have gone through.

I have asked that the case the Deputy raised is looked into. We were discussing it here last night and we are here this morning. I do not have an answer for the Deputy but I will get back to her about that. My understanding is that it should not be happening. I will be seeking agreement that the proposed cut of 1%, given everything that is going on, is not applied.

Both of these issues are too serious to use the kick-to-touch approach. I did give the Minister notice about these issues.

How can the Minister defend a situation where 62,000 people are coming into the country, many of them coming from countries or states which have high rates of the virus, and that of those only 2,000 are actually followed up comprehensively by the Department of Justice and Equality? The Minister said he was going to find out what is happening. The Department of Justice and Equality is clear. It is awaiting hand-over to the Minister's Department to take responsibility for this.

It is not good enough to say we are going to do something at some point in the future. The numbers coming into the airport are increasing rapidly. In the absence of a proper hand-over to the Department of Health, the country is actually being exposed to high risk. We cannot afford that. The priority has to be to open our schools and open up businesses completely. We cannot continue to have a situation where high-risk situations at our airports are not dealt with. This is going to put everything else in jeopardy unless the Minister and his Department ensure there is proper follow-up. Suggesting that something is going to happen in the future by putting a form online is simply not good enough.

We are also told that next week we are going to be asked to approve testing at airports. Who is responsible for that? Surely that is not the Department of Transport, Tourism and Sport. The Minister needs to give us an assurance today that he is not going to continue to allow the country to be exposed to this level of risk and that his Department will take its responsibilities seriously, get its act together and ensure there are adequate numbers of follow-up calls.

On the second question, it is simply not good enough to say the Minister does not know. Either the €20 million cut is going ahead to disability services or it is not. The Minister has given an assurance previously. His predecessor has given an assurance. On the ground, however, the HSE is telling those organisations that the cuts are going ahead. Will the Minister give clarity to both those issues?

With regard to the second question, the Deputy asked me the same question again. I have answered the question. My answer is exactly what it was five minutes ago. With regard-----

Is the HSE to proceed with those cuts?

I have answered the question.

The Minister did not.

I did. The Deputy may not like the answer but I have answered it.

I am telling the Minister that the HSE is proceeding with those cuts. Is he going to take any action to stop those happening? They will have real implications for the clients of disability organisations.

I agree and I have comprehensively answered the question. I told the Deputy exactly what I will be doing. The answer to the same question is as it was when she asked it the first time.

With regard to the Department of Justice and Equality, the Deputy keeps on stating my Department is taking over the follow-up. It is not. The Department of Transport, Tourism and Sport is taking over the follow-up.


We cannot hear the Deputy because there is no microphone on. Now the time is up. The Minister will have to reply in writing to clarify the specific questions which have been asked.

I am going to move on because this session will be over at a particular time and I want to ensure all Deputies get an opportunity to ask their questions. I call the Deputies from Solidarity-People Before Profit.

I am sharing time with Deputy Paul Murphy.

I congratulate the Leas-Cheann Comhairle on her surprise win yesterday. We were all delighted.

A Deputy

It was not a surprise win.

Well, it was a surprise for a few of us.

I am sure the Minister was seriously alarmed by the HIQA report published on Tuesday. It gave a terrible insight into the challenges and the failures of nursing homes during the public health emergency. I understand from the media that the Covid committee will recommend a review of all deaths in nursing homes.

I read the report this morning. It is damning. In fact, it is beyond damning. One statistic, which I will not cite because it is quite a long section, is that 60% of the nursing homes that were assessed had weak governance and management during the public health emergency. The alarm bells are going off, not only for Deputies but also for the residents of those nursing homes and their loved ones. There must be an urgent review. I hope that the Minister will support this call.

I spoke a number of weeks ago about the St. Mary's Centre nursing home, also called the Telford Centre, on Merrion Road. I sent the Minister correspondence on this issue two weeks ago. It is run by the Sisters of Charity and some of its residents have been there for more than 20 years. At the end of the year, however, the facility is due to close down. That is a terrible shame. The staff are upset by the potential closure and its 35 residents are worried about the situation. Will the Minister comment on its potential closure and give a commitment that the facility will be taken over by the State and run by the HSE? It is a great facility that has existed for more than 150 years, but if it closes down, it will be closed for good. In view of the HIQA report, there has been a juxtaposition during the Covid emergency between the 80% of nursing homes that are run by for-profit companies and facilities such as St. Mary's, which will close down if the State does not intervene. The Minister needs to intervene and St. Mary's should be taken over by the HSE.

I thank the Deputy for raising those points. I read the HIQA report carefully. I understand the Deputy's alarm, but my reading of the document in terms of the level of compliance is different. I am more than happy to discuss that with him after this debate. The report gave a green grade, which denotes full compliance, to 90% plus of nursing homes in respect of the various governance issues. It identified approximately 5% or 6% of homes that needed extra work. We must ensure that we engage with those nursing homes that were graded as yellow or red - not fully in compliance or not in compliance at all - quickly so that we can understand what they need to get up to speed and what HIQA needs to help them do that.

The HIQA report raised a serious issue for the Government and the House, namely, the lack of a regulatory framework for nursing homes. This was one of the main red flags that HIQA raised in its report and the Government needs to work on it. I am certainly working on it. It will be a matter for the House to debate and, I imagine, pass primary legislation on.

I take the Deputy's point. I wrote to HIQA last week to ask that the same review and a thematic review be done in respect of the nursing homes that were not included in this one. The nursing homes included in the HIQA report are those that have not had Covid cases in them. Obviously, the same assessment needs to be done of the other half, which are the ones that have had Covid cases in them.

The Deputy will understand that I cannot comment on individual nursing homes, but I am happy to look into the matter he raised. I was recently made aware of two residential centres in Dublin that, unfortunately, have notified the HSE that they are no longer in a position to continue operating. I am acutely aware of the value of residential care and the HSE is in the process of engaging with these services to ensure continuity of care for their residents.

I have two questions. If it is possible to follow up on the nursing homes issue that Deputy Gino Kenny raised, I will start with one and get an answer.

The Minister underplays the HIQA report. The rate of non-compliance with infection prevention and control regulations was 50% across all nursing homes inspected. The regulation on suitability of premises had a non-compliance rate of 32%. Some 21% of homes had staff shortages. One of the key findings was about how infections got into the homes. It reads: "inward transmission into nursing homes by staff is a key likely source of its introduction to these settings." However, it does not analyse why it got into some homes and not others or the relationship between staffing structures, the use of agency staff and inward transmission of infections. The inadequacies revealed in the report suggest that these problems cannot be resolved within our current for-profit system and that the care system needs to be integrated into the public healthcare system.

I have a general question for the Minister that he might be able to answer quickly before I ask my question on schools. Does he agree that there needs to be a full public inquiry into Covid-19 in nursing homes as well as the structure of the system of care for older people?

I thank the Deputy for his question. To be clear, I do not mean to underplay the HIQA report. We are taking it very seriously and have examined it in detail. The matters that HIQA has flagged are being taken seriously. I accept the Deputy's points on the various details in the report.

Regarding a public inquiry, we have the HIQA report. I have sought an additional HIQA report, which will essentially be the same piece of work but in respect of the other half of nursing homes, which are those that had Covid cases in them. We want to get that information quickly. In addition, I understand that I will get the expert review early next week. I have not seen it and I do not know what the recommendations will be, but my understanding is that there will be a comprehensive range of recommendations covering what has happened and what needs to be done to protect nursing homes in case of the second wave that the public health officials tell us is likely.

I suggest that there is a way for this to proceed. The HIQA report and the expert report will be published and I imagine we will have a session in the Dáil at that point. We could also have an informal session with Deputies, if that helped. It will then be a matter for the health committee, if it decides to look into this matter, to take on the HIQA and expert reports. It can run sessions specifically on nursing homes if it wants. Such sessions are held in public. It is a matter for the Oireachtas to choose whether it wants to kick something off. The Deputy is not suggesting that that should be it, but that there should be a wider inquiry into the issue. I suggest that we wait to see what is in the reports and to hear from the nursing homes, residents and people affected and then determine what the most appropriate course of action is. I am certainly not ruling anything out, but our focus right now has to be on ensuring that the nursing homes, residents and staff are protected. If there is a strong case for a further investigation of some description, we will look at doing so. I am keen to avoid, as, I am sure, the Deputy is, pulling a large number of people away from protecting nursing homes and into an inquiry in a way that could lead to them being exposed. Neither of us wants that.

My next question is about schools and their reopening. We are sitting in a massive venue, which the public pays for, so that we can work in a safe environment. Will the Minister give a commitment that he will not force teachers and students back and endanger communities by having schools return and operate in conditions that are less safe than those in which Deputies work?

The Minister has only a few seconds left.

I will revert to the Deputy in more detail. The very short answer is that there can be no double standards. There cannot be one level of health and safety for us and another for the nation's children and school workers.

We should be moving on to the Regional Independent Group, but I am unsure as to whether any of its members are present.

I beg the Deputy's pardon. Tá sé deacair.

I am up in the cheap seats here at the very top. Ar dtús báire, déanaim comhghairdeas leis an Leas-Cheann Comhairle as a post nua. Is rud iontach é. Go n-éirí an bóthar léi ina hobair agus sa phost as seo amach.

Go raibh maith agat.

I thank the Minister and his team for coming in to update the House on the Covid-19 emergency and the Government's response. I thank him for his compliments to the Opposition this morning. I, for one, will continue to engage constructively with his office and the Government as part of the huge national effort to combat the virus.

I compliment the front-line workers and members of the public for getting what might have been a potential surge in the virus under control in the past fortnight. As the Minister outlined, the figures are moving in the right direction. The R number is coming down, as is the rate of community transmission, and the rate of community compliance is going up rapidly. I was in Dublin city centre last night, in several shops and fast food outlets, and there was not a single person who was not wearing a face covering. It shows that the public is completely on board with this and we should commend them on their compliance.

I agree with the Minister and Deputies on the importance of reopening the schools. Everything in society hinges on the schools reopening in a few weeks. I look forward to the Minister, Deputy Foley, publishing her plan on this next week. I hope it is early in the week so that we have the opportunity to scrutinise it fully before we break for recess.

I have four short questions for the Minister and which I will group so that the Minister can answer. First, how many community testing facilities are operating here and do we have the means to scale up this testing in the event of a significant surge in cases? Second, on laboratory analysis of samples, are we still using the international laboratory in Munich or is all the analysis taking place in Irish labs? If the Minister does not have the information to hand, a written reply would be sufficient.

I will get a detailed answer for the Deputy. I raised the issue of the German lab myself. I understand we are in contract with the laboratory, which was an important measure when we were trying rapidly to scale up capacity. I will ask the HSE for an update. I will give some of the latest figures on testing. We now have capacity for 100,000 tests a week. We are in a positive position of not needing the full capacity, but that is what NPHET recommends we should be able to scale up to. The testing and contact tracing operational resource model has been designed to go up and down. As of midnight on Monday, we have had 574,487 tests with a 5% positivity rate overall. In the past week, more than 51,000 tests were carried out, an average of 7,300 a day. Of the 51,000, 137 tests were positive, which is less than 0.3%, or 0.27%, which is very useful. In 90% of the cases the turnaround time from referral to contact tracing is three days or less. There is an important nuance here. It is not three days or less from when a person refers to when he or she gets the test result. That is down to one day. The three days, which is impressive, includes the person having the test, getting the test result, which is taking an average of 1.1 days, and all the person's close contacts being followed up as well. We should be very proud of the HSE for having done this.

The number of testing centres has gone up and down. Flexibility has been designed in the process. I will get a detailed update for the Deputy on the current status.

My third question relates to contact tracing. How does the Minister anticipate the contact tracing system working in the next few months? Does he anticipate that the contact tracing app will take over or that the manual contact tracing by telephone will continue?

The Government's second priority after schools is to reopen the healthcare system to non-Covid illnesses and conditions. There is a massive backlog. Will the Minister outline in general terms how he sees that happening in the coming months?

On contact tracing, the view expressed by the WHO and international groups is that Ireland is doing very well. Our contact tracing app has been, and continues to be, a great success. The latest figure is that more than 1.4 million people have downloaded it, which is about one third of the target population. It is much higher than many other countries. The team that developed the app told me that because the infection numbers are thankfully very low in Ireland, they thought it would take several weeks for the app to be used to start notifying close contacts who otherwise would not have been told. In fact, the app started working within 24 hours because of the enormous buy-in of the people. I encourage everybody who can to download that app. Every single person who downloads that app becomes part of the front-line response to this. The 1.4 million downloads is fantastic but we need to push this to get it further. It will not replace contact tracing. It is only one part of the system. The team has been significantly bulked up to deal with people coming into the country, for example. Everyone coming into the country will be asked to download the app. They will be asked for a verifiable phone number so that we can contact them. It is mandated by law that they fill in the form about where they will be so that we know where they are and can contact them. The app protects them and everyone else. At the same time we will continue with the really successful work which has been done to date on contact tracing. The app works with the contact tracing team.

I will outline the process. When a person takes a test and it is positive, they will be telephoned with the result and asked to self-isolate, which is what they should do as soon as they are known to require a test. They will be asked if they have the app, as the State holds no record of who has the app or the phone numbers associated with it. If they have the app, they will be asked for permission for their phone to let the other phones know. If permission is given, they will be given a verified code that uploads the information. The number of contacts are examined in terms of the symptomatic time. Those phones are pinged and people are informed they have been identified as a close contact. If those people have provided their phone numbers, they will be called for a follow up conversation. If they have not provided their number, they will be given a phone number that they can call themselves. The app is critically important and very much part of the full contact tracing regime.

The reopening of health for non-Covid is our single greatest challenge. An enormous amount of work is ongoing to protect the country from Covid. The waiting lists prior to Covid were the highest in Europe. The additional list has gone up significantly because non-essential services were paused. On top of that, there is a large undiagnosed care need in the community because referral rates have gone down. The HSE capacity is also heavily reduced in terms of operating theatres, scopes, outpatients and there are much greater pressures on HSE staffing because some of its staff will also have to go off. Furthermore, winter is coming. Putting this very comprehensive plan together is one of the core parts of work to get the services back open and to do so in a way that addresses the deadly serious issue of winter and the need for the system to work.

I am sharing time with Deputies Mattie McGrath and O'Donoghue. I have a number of questions and, given that time is short, I might ask them all together. I begin with the issue of nursing homes and congregated settings. I note, thankfully, that in west Cork to date, and please God it will remain the case, there has been no Covid-19 case in any of the nursing homes. Nevertheless, there is no point skirting around the issue of the community hospital in Clonakilty, where, sadly, many people passed away. I am a member of the Special Committee on Covid-19 Response, as was the Minister initially, and I have been trying to ascertain why the then Minister for Health signed a statutory instrument in 2016 pushing out the deadline for being compliant with HIQA standards of 80% single-bed occupancy in community hospitals. The deadline is now 2021, a delay that must have led to a loss of life in hospitals such as that in Clonakilty and other community hospitals. We often talk about nursing homes and the same may be true of them.

Is the Minister going to do the very same, that is, sign a statutory instrument and push out the deadline further? I would like him to tell me, although I accept he may not be able to do so because I am asking the question on the floor, when Clonakilty Community Hospital will be fully compliant. Works were to commence there but will they do so or will there be a hold-up? We need to know that for the sake of the people who work there and who worked through an horrific difficulty in that hospital. I know they did so tremendously well because I have spoken to patients and their families who told me the staff are very good. Unfortunately, I have noticed in community hospitals a complete lack of beds for elderly patients who need beds. They have been refused them in my constituency of Cork South-West, where there are fabulous community hospitals right out to Schull, Castletownbere, Dunmanway, Skibbereen, Kinsale and Bandon, but there is a need for additional beds. People are waiting in Cork University Hospital and cannot get a bed in a community hospital.

There is also the issue of Bantry General Hospital, something I have raised quite often. It is not mentioned in the programme for Government and I have serious concerns about it. The HSE is doing its best to close the back door on hiring a full-time anaesthetist. Bantry General Hospital is our hospital to protect us from Covid, and I would like to know where it stands in regard to securing an anaesthetist.

Why can there not be community testing for people who need a test, whether because they are flying out of the country or whatever? Where should we send them? Deputies who are contacted about the matter regularly have nowhere to send them. There is a provision if the person is ill, and there is a procedure in that regard through a person's doctor, but not through a person's own channel, which needs to be explored because people are seeking Covid tests before they enter other countries. As for the issue of same-day testing at the airports, I have raised that for two months with the Tánaiste. It is a no-brainer and it should have been worked on. It is a failure.

Local hubs have been mentioned in the context of CoAction and there was a promise that they could be opened. Why is funding not being made available and why has there been a hold-up in that regard, given that it was initially meant to be the case?

I congratulate the Leas-Cheann Comhairle on her appointment. She has made history and yesterday was a great day for women and for the House as she is the first woman ever to have been elected to the position.

When GPs refer people for swabbing and they do not turn up, what can be done? Should penalties be put in place? When people are supposed to turn up for a swabbing but do not do so, there has to be some consequence.

To continue on a point made by Deputy Collins, what are the Minister's plans for engaging with nursing homes, both in my constituency and throughout the country, in which I believe there are 400 of them?

Finally, I raise something that I raised with the Minister yesterday. Can we audit hospitals on the basis of their turnover of staff? Certain hospitals in the country have a massive turnover of nurses and other staff and I want to know why that is the case. Is it that the workplace is not a safe environment for them? There has to be some problem within the structure to explain why there is such a high turnover at particular hospitals in the country. Can we find the problem and help fix it?

To respond to Deputy O'Donoghue, we are acutely aware of the percentages of people who have not turned up for tests. There is a lower percentage of people who have not turned up for a second test, which is also required. My understanding is that people who attend their GP clinic and say they are symptomatic are referred for a test, and that there is a very high compliance rate in such cases because they contact their GP and say they are worried. The rate is lower for close contacts where they do not feel any symptoms. I imagine there are a variety of reasons for people not turning up. The single most important step we can all take as public representatives is to get out the message again and again that while it is an inconvenience if somebody is contacted and told he or she is a close contact, while it is nobody's fault, given that the person could have been sitting beside somebody in a café, for example, and while it may scare people who would prefer not to know the result, we are in this together and everybody really needs to do this.

Engagement with nursing homes is ongoing and I am talking on an ongoing basis with Nursing Homes Ireland, as are various other parts of the system.

With regard to acute hospitals, let me take that point away and revert to the Deputy. It is an interesting question and it is something we would like to know. If existing information is available, I will ensure it is sent to the Deputy.

I might continue responding if I have enough time.

I thank the Minister but his time to respond is up. I call Deputy Mattie McGrath.

Psychiatric and general student nurses have joined the front line and helped out. They paid their way through college by the time they began their placement, which might last eight or ten weeks and for which they get paid. Now they cannot get that because of the circumstances of Covid-19 and there is significant hardship, therefore, on families, especially those who do not get grants.

St. Brigid's Hospital in Carrick-on-Suir is a wonderful district hospital. Three hospice beds there are funded mainly by the people of the community. Respite services in the area are totally closed. The hospital was taken over to accommodate Covid patients but it was not used. We have had promises and promises as to when it will open. I want the Minister to outline a definite date for when those hospice and respite beds will be returned to use. If he cannot do so today, he might do so in the coming days.

What went on in nursing homes was shambolic. There will have to be an independent public inquiry, without the involvement of the State, into what blackguarding went on there. Deputy Shortall and I attended briefings with the Department, the then Minister for Health, Dr. Tony Holohan and everybody else. I wish Dr. Holohan's family well. The Minister, Deputy Donnelly, also attended. The shoe is on the other foot now. We want answers, not waffle. The whole matter of the airports was also shambolic. I class this pandemic as a scamdemic. People are being scammed and deceived. Some 62,000 people have come into the country and fewer than 2,000 have even been asked to fill out a form or been followed up on.

This is disgraceful. We would not allow pubs to open, no more than 200 people can attend GAA matches, and above all, we will not allow more than 50 people into a church. We have had a wonderful holy mass, which I have mentioned previously, at the Holy Year Cross near Clonmel every year for the past 60 years, but it cannot be held outdoors because of the number restrictions. There are usually 500 or 600 people on the August bank holiday Monday morning. It is a wonderful occasion but it cannot happen, yet people can come in from all over the world and there is no testing, no tracing, nothing.

It is a deceit and the people are being conned. I accept there is a new Minister but he was on the other side and he knows. We are being conned. Ordinary people are being told on television to stay in their homes. I heard Deputy Berry talking about Dublin and the compliance with masks. That is great but the airports are a farce. I have been saying this since the first briefing. The Minister attended all of them, along with the then Taoiseach, when we were told we had to be good Europeans and we could not close the airports. Hungary could do it, but the then Taoiseach could do nothing but criticise that country, as the current Taoiseach, Deputy Micheál Martin, has done too.

The people are being fooled. The poor people who own pubs, many of them pensioners who are not getting a penny of any payment, were misled last week in regard to getting stock and were led to believe their pubs could reopen. Now, by the sounds of it this morning, they will not be allowed to open on 10 August either. Anybody can come in from anywhere, whether Saigon or anywhere else, and walk through the airport. Although there is to be electronic tracing, it will be overseen by the Department of Transport, Tourism and Sport. When Deputy Shortall asked a question about that at one of the briefings, no one could tell us who would do it. Nobody is doing it and it is not being done. It is open season for anybody to come in from any hotspot to this country, and that is a disgrace. It is an injustice to our people, front-line workers, staff, the Garda Síochána and everybody who is trying to keep the virus at bay and beat it. The people are being blackguarded and deceived and it is a total scam from that point of view.

Small businesses are being pushed out of business. There are ordinary people trying to live their lives in the country while this blackguarding is going on. It is just unthinkable.

Thank you, Deputy. As there is no time for a reply, we will move to the next speaker.

I raise the matter of capacity as we have seen how hospitals have had to deal with people getting very ill from Covid-19 and going into intensive care units, etc. We still have our need for ordinary surgeries, consultations and treatment of ill people so what are the HSE and the Minister doing in this respect? Will the Minister give us a breakdown of the current position?

It was mentioned recently by Dr. Rita Doyle that the required legislation to allow non-consultant hospital doctors to train to be consultants, which was introduced in the previous Dáil, has not been implemented. It is sitting there waiting to be acted upon. It is the Regulated Professions (Health and Social Care) (Amendment) Bill 2019. Why are we not moving very quickly on that in order to get doctors trained for badly needed consultant positions? We know there are 500 consultant vacancies and 160 registered doctors have finished training and are available for consultant positions. Why is this not being acted upon?

We need at least 1,600 additional consultants, as mentioned by Dr. Anthony Staines recently. We know we need many more beds in the system so how will we cater for that? Will we bring in Portakabins, etc., to try to meet those accommodation needs in hospitals? Could this be done? It is the sort of capacity we must start building before winter. Wherever we can, we must try to maintain the employment of doctors and nurses who came home to answer Ireland's call. At least 200 of them came home but are they still here? Have they been given positions within the health service?

The measures to prevent the spread of Covid-19 include the wearing of masks, washing hands, keeping 2 m distance and coughing etiquette. These form part of the act of protecting ourselves and others. We have set it as public health policy to wear masks on public transport and it will become mandatory to wear a mask in shops. I raised the matter with the Tánaiste yesterday of homeless people who cannot access masks and I thought his response absolutely pathetic. Are they supposed to wear rags around their faces? How do we ensure homeless people can have access to face coverings and ensure people on low incomes can get them? They are expensive but people want to have the best protection possible. It is not good enough to say we do not need masks and all we need is to cover our face. We are supposed to have three layers of face protection in masks if we follow the recommendations.

We are not supplying people with the necessary means to wear masks as part of the health policy. I specifically refer to pensioners and people with disabilities, who badly need good face coverings to protect themselves. Single parents are normally on a low income but masks can be expensive at up to €50 for a pack of 50 blue masks. It can be €24 for three cloth coverings. People across the board need them. We must get masks to the people who need them so they can feel protected by them.

I may come back to the Minister with more questions in a few moments. We know the UK Government has struck a deal for 190 million doses of coronavirus vaccines, including the vaccines being worked on in Oxford and the United States. Has the HSE taken a similar approach in buying vaccines that seem to have good potential? When will the flu vaccine be administered to the general population?

Have hospitals got stock and a store of personal protective equipment, PPE? Have they ventilators if a second wave emerges? The Minister said the percentage of healthcare workers being affected is low compared with other countries but we all know PPE is crucial. Do we have that stock where it can be easily accessible to nursing homes or home help workers on the front line in case of second wave?

I thank the Deputy for those very pertinent questions and I will do my best to go through them. I could not agree more with the Deputy on the capacity issue. Before Covid-19 arrived we did not have enough capacity. We had the lowest number of consultants per capita in the OECD and second-lowest level of acute beds. There were non-safe staffing levels for nurses and midwives. The Deputy and I have spoken together at length about the lack of capacity and even if Covid-19 had not arrived, we would have a massive capacity challenge. That is what Sláintecare is meant to be doing. There will be 2,600 beds and various additional capacity components.

It has become infinitely more important and pressing now because we have lost significant capacity due to Covid-19. The HSE's latest estimates are that the capacity for operating theatres and outpatient appointments could be down by 30%. Our capacity for diagnostics and scopes could be down by more, at up to 50%. In real terms it is like losing three in every ten of our operating theatres and half of our scoping and diagnostic ability, along with three in ten of our consultants who do outpatient appointments. This is at the same time our waiting lists have gone up and we have additional Covid-19 needs, and also while we face a domestic and global recession. The scale of this is unprecedented.

In response, one of my first actions when appointed was to sit down with representatives of the HSE and the Department to say we must put together a plan that is unlike any winter plan we have seen before. It must include many of the elements raised by the Deputy. We must ask what we will do with the temporary community facilities and how we will roll out the flu vaccine across the country. We must consider how to lock in telemedicine and ensure e-prescribing can stay with us, etc. The HSE and the Department is in the middle of putting together a comprehensive plan to address exactly what the Deputy is talking about and more, as we have a long-term capacity problem as well.

We are kicking off what Sláintecare is calling the "citizen care master plan" to consider what level of care is needed, where we are in different parts of the country and what is the gap. This leads to consideration of the workforce, capital, bed and diagnostic plan. There is a much shorter-term piece, as the Deputy quite correctly mentions, which is what we will do right now for this winter to protect people across the country.

On the matter of non-consultant hospital doctors moving to becoming consultants, I am very happy to be wrong but my understanding is there is no current legislative impediment to non-consultant hospital doctors becoming consultants. The Bill mentioned by the Deputy is on the legislative agenda and we are looking for a slot for that. That Bill not being passed is not stopping those non-consultant hospital doctors being promoted to consultant level. That is my understanding but I am very happy to be wrong on it.

There are different issues, including pay inequality, working conditions and professional progression, including missed opportunities. There are fantastic non-consultant hospital doctors but because of the countries they come from, they are barred from progressing to consultant level. That does not make any sense to me. We need to address many issues in getting to the right number of consultants and if there are legislative concerns we will deal with them. My view is that whole-of-profession issues must be addressed.

With regard to face coverings, I will revert to the Deputy in writing with more detail. I know I am out of time but I completely agree with her that there can be no financial burden to anyone accessing face coverings. I will take that message back to the Department today and we will revert to the Deputy on it. I will revert to her in writing on the other issues if she agrees.

The next slot goes to Fianna Fáil, whose speakers are Deputies Jennifer Murnane O'Connor and Niamh Smith. The Deputies have 15 minutes between them.

I welcome the expansion of entitlement to GP services for children from age 6 to 12. I ask the Minister to revert to me on the timescale for that.

One of the biggest issues I have been contacted several times about is the availability of GPs. We have heard from the public health official that many people are not returning for their follow-up Covid-19 test after being identified as a close contact to a case. I want to highlight my experience for the Minister, which is that if someone does not have a GP it is nearly impossible to get one. The requirement to be assigned a GP is three refusals, which is unacceptable. Will the Minister examine that issue because it could be a contributing factor, not to mention how people are expected to contact their GP with symptoms if they do not have a GP? Are we doing everything we can to boost employment in this area? GP clinics in my area of Carlow are full to capacity, and it seems to be getting worse. What does the Minister intend to do to make sure that we get additional GPs?

In the debate last night the Minister mentioned the medical card threshold increase for those aged 70 and over. That is very welcome but a serious issue has been raised by people coming into my clinics, particularly elderly people who have medical cards. Some of them are being charged €15 for a blood test and others are being charged €20. Some doctors are not charging but there is a great deal of confusion about that. I have contacted the HSE and I understand, and the Minister may be able to clarify this, that if a doctor requests a blood test one can claim back the fee from the HSE. If one goes to a doctor seeking a blood test, one has to pay for it. We need clarification on that. Many elderly people tell me that they cannot go in to get the test because they do not have the money. The Minister might be able to clarify that with the HSE and revert to me on it.

I want to ask about carers employed by the HSE. Will there be a widespread mandatory mask protocol for carers dispatched across counties who are treating older persons in non-hospital settings in the community? I have had several calls from constituents who are concerned about that. These carers are doing a fantastic job but some of them are not wearing masks. The Minister knows that carers work very hard, as I do because I know many carers. They might go into four or five houses a day. What plan is in place to offer them supports? It is very important that we give carers working in those front-line services our help. Will specific funding be made available for that?

Furthermore, family carers heard at the meeting of the Special Committee on Covid-19 Response last Friday that it might be January before day services for adult children with intellectual disabilities can return fully. Can the Minister give those family carers more help? Can he tell me what we can do to make sure these people are not forgotten? It is very important. We cannot use the pandemic as a reason to leave anyone in society behind. I am aware that Linda Comerford will hold a major protest outside the Convention Centre Dublin next Wednesday. It it important that we give our support to families. Families have gone through a very rough time in the past few months. They need all the support we can give them.

I read a newspaper article yesterday that doctors are warning of increased numbers of domestic abuse victims being admitted to medical facilities since the pandemic began. We need to put in place as many supports as we can in that area. It is a very serious and worrying problem.

We have been speaking about the importance of looking after people in nursing homes. I, too, want to ask about centres for older people with regard to section 39 organisations. Some people in section 39 organisations in my area of Carlow have contacted me. What measures do we have in place to help care homes that need extra funding through the HSE because everybody has been affected by this? It is very important that we make sure that we put funding into the areas where it is needed. The Minister might revert to me on that.

I am aware that the UK is doing a lot of what is called home testing. In rural areas in particular where there is no transport people are finding it difficult to travel to see a doctor. Are we considering putting some plan in place that will see Ireland start to do home testing? We all know that Covid-19 will be with us for a while so it will be important to have plans and support in place. I thank the Minister. He has two and a half minutes in which to respond with answers to my questions.

I thank the Deputy. Her questions were being put quicker than I was able to write them down so I ask her to bear with me. I will revert to her in writing on the ones we cannot reach.

In terms of GP expansion and capacity, we brought legislation through the House last night to expand free GP care for children from the age of seven up to and including those aged 12 years. It is being done in three phases: six and seven year olds, eight and nine year olds; and ten, 11 and 12 year olds. However, we have to be very careful that it is done at the same time as capacity is increased for GPs. I put something online last night saying we had just brought the legislation through the House and the response from GPs, who had not heard the debate here, in which we went to great lengths to provide assurance on this, was very negative. They were saying, "For the love of God, you cannot just increase demand without increasing capacity". Our message is that we agree 100%, and we will be discussing these issues at length with the IMO and GPs to make sure they are done hand-in-hand. When it is done, however, it will apply to 300,000 boys and girls in the country. That is something everyone in the Oireachtas should be very proud of as we will all have to sign off on the money required to make it happen, but only at the same time as capacity is increased.

With regard to the follow-up on the Covid tests, I agree that the numbers are lower than we would have hoped. It is for close contacts. There are myriad reasons people are not turning up. Quite a number are turning up for the first test but not for the second. We need to look into that. All of us as public representatives need to get the message out that it is critical that we download the app and that if we are contacted as a close contact we have to take it seriously. This is literally a life and death situation and all of us need to do our best. I agree it is inconvenient. It is not a particularly pleasant test and many people are afraid. They prefer to avoid it, and I understand that. All of us understand that but it is one of those things that we simply have to do together.

Day services for people with intellectual disabilities are a crucial element of the health service and the community care that we have to get back open as quickly as possible. I raised that directly with the HSE officials this week and I can assure the Deputy they are on it. They, and we, are acutely aware that there is no time period that is quick enough for these children or adults. There is no time period that is quick enough for their families because they are desperate, and they have been through so much. Respite and day services were closed down. It is complex from a Covid perspective. The HSE is working organisation by organisation to get them opened as quickly as possible. We are doing what we can, and every effort will be made, but I fully acknowledge that the situation for many adults, children and their families is very difficult.

I congratulate the Minister, Deputy Donnelly, and the Ministers of State, Deputy Butler and Deputy Feighan, on their new roles. I know the Minister and the Minister of State, Deputy Butler, very well. If they bring the same vigour, enthusiasm and energy they brought as Opposition Deputies to their portfolios, and I have no doubt they will, we can look forward to a very busy and proactive team in the Department of Health.

I will use the few minutes available to me to have a brief question and answer session and I would appreciate it if the Ministers would respond as I put the questions. My first is to the Minister, Deputy Donnelly. I have spoken previously about the major concern about contact tracing, particularly in the Border counties. He is aware that, thankfully, as a result of the Good Friday Agreement, we have an invisible, seamless Border that people can move fluidly across from one county and one jurisdiction to another. However, the Covid pandemic has raised deep concerns, particularly for residents living in Border towns such as Castleblayney, Emyvale and Ballybay, who see people frequently visiting the North.

The reopening of public houses has led to people making frequent visits to such establishments in the North of Ireland and to residents back to their home towns and villages. The feedback I am getting from residents relates to their curiosity about how contact tracing works. I am aware that there has been good collaboration between the two jurisdictions. I ask that the Minister talk for a few minutes about this collaborative approach and how effective contact tracing has been in the Border region.

I thank Deputy Niamh Smyth for her congratulations. I assure her that the work rate has not diminished since we were in opposition. It is fair to say that it has increased substantially.

I thank the Deputy for her question on the Border counties. This is a profoundly important matter. It affects the Border counties most severely but it is a question for the whole island. There is absolute agreement that the best approach is an all-island approach, because this disease does not care a damn whether it is north or south of the Border. No Border controls will be put in place so there will be free movement of people all around the island, as is right and proper. That will continue.

What is the Government doing? I have spoken at length with my counterpart in Northern Ireland, the Minister of Health, Robin Swann, MLA. The deputy chief medical officer is in regular contact with his counterpart and was talking with him at length this morning. Many of these issues will be discussed at a meeting of the North-South Ministerial Council in Dublin Castle a week from today. The members of the HSE team that developed the app have been in communication with their counterparts in Northern Ireland. The app has been designed to be deployed as an all-island app. It is quite rightly up to the Northern Ireland Assembly to decide if and when to deploy it. I hope to see it deployed throughout the island, and if possible adopted by many more countries, to allow a very tight contact linkage. There might be different versions, but I hope there will essentially be a single app with very tight contact tracing. The response in this area and in many others should be aligned as tightly as possible across the island. That is to everybody's benefit. There are obviously complications but that is what we are working towards.

I thank the Minister. I remind him, though I know he is very much on top of his portfolio, that Cavan-Monaghan was the worst-hit area in the country by number of Covid-19 cases. With that in mind, the area requires particular attention.

I would like to direct a question at the Minister of State, Deputy Butler. Covid-19 has presented huge mental health issues for the young and the old. In Cavan and Monaghan we have some amazing volunteers who run voluntary organisations like SOSAD. My own town has the Bailieborough Mental Health Organisation. These organisations are all run on a voluntary basis. Organisations like that and constituencies like mine need State funding and comprehensive support for the volunteers working on the ground. Jigsaw does amazing work throughout the country. I know the Minister of State has met representatives from that organisation in her short time in office. I would love to see Jigsaw come to County Cavan and County Monaghan. Unfortunately, we have had very high rates of suicide in the two counties. Could the Minister of State outline her vision for that? For fear of running out of time, I would like to pass a little message to Deputy Donnelly from Castleblayney Care Housing Association, particularly from Ms Sheila Cumiskey, who has spearheaded that amazing organisation, as the Minister knows. The association was delighted to receive him some time ago. Its members have asked me to relay their congratulations to him. They have big plans for their second phase of operations with Drumillard and its residents association, and they look forward to the Minister's help and support in bringing it to fruition.

I thank Deputy Niamh Smyth for her question. Jigsaw is the national centre for youth mental health. It reduces pressures on specialist child and adolescent mental health services. As we all know, early intervention is of key importance for anyone who has mental health challenges. Jigsaw provides supports for those between the ages of 12 and 25. One thing that I really like about Jigsaw is the fact that a young adult or teenager can refer himself or herself to the services. He or she does not have to be referred by parents or a GP, although those referral pathways are also open.

New services will open in Thurles, County Tipperary, and Bray, County Wicklow, before Christmas of this year. That is very welcome. This will mean Jigsaw will have approximately 65% coverage throughout the country. I will speak to the Deputy about expanding the services in the area she has mentioned. Expansion will be considered in the light of the evidence underpinning specific proposals. I would be happy to meet the Deputy afterwards to discuss this matter. As she said, I spoke with Dr. Joseph Duffy last week. He is doing phenomenal work and I commend the work of Jigsaw, especially during the Covid-19 pandemic, when a lot of the organisation's services were moved online because face-to-face interventions could not proceed.