Special Committee on Covid-19 Response Final Report: Motion

Deputy Michael McNamara

I move:

That Dáil Éireann shall take note of the Report of the Special Committee on Covid-19 Response entitled 'Special Committee on Covid-19 Response – Final Report', copies of which were laid before Dáil Éireann on 8th October, 2020.

I thank the Business Committee for scheduling a debate on the final report of the Special Committee on Covid-19 Response, which I had the honour of chairing earlier this year. Before commencing with the recommendations, I would like to thank all members of the committee. There were 19 of us who worked through the summer. I see that the Minister of State, Deputy Butler, and the Minister for Health, Deputy Stephen Donnelly, both of whom were members of the committee before they were appointed to office, are present and I thank them. They were replaced on the committee by other Deputies. I thank all of the members of the committee for the courtesy with which we generally carried out our work. It would be wrong to say that there was unanimity on everything - that is not the nature of a committee which has representatives from all parties and all groupings in the House - but there was a unanimity that we would proceed in a collegiate and courteous manner. That was reflected right up to the end, which I, personally, am happy about.

There were a number of recommendations agreed. Obviously, different members of and different political groupings on the committee had a different emphasis with regard to the recommendations but at the end of the day, it was a consensus document. Even the Acting Chairman, Deputy Durkan, who was a member of the committee, would have an emphasis on certain recommendations over others but that is the nature of a committee and we agree a consensus document at the end of it.

There is a tendency in this House - I am sure it is not unique to this Legislature - to have committees look at various issues and then say that they have been examined and we will park them. I think everybody will agree we certainly do not have that luxury with Covid-19. It is the issue which dominates every sector of Irish economy now and will continue to do so for the foreseeable future.

The best way to proceed is to outline in brief the recommendations of the committee. The first recommendation was:

That a public inquiry be established to investigate and report on all circumstances relating to each individual death from Covid-19 in nursing homes. Draft terms of reference should be presented for consideration by the Joint Committee on Health by the end of 2020.

It is obvious that time is ticking in that regard, if we are to proceed in that regard. That is clear to me, and I think it was clear to all committee members. As Chair, one of the more difficult things that I had to do was not to have an emphasis on individual deaths or on individual nursing homes in which there were deaths because clearly there is a huge void in people's lives and they need and deserve answers as to what happened. It was not the role of the committee to look into that in anything like the detail required. Obviously, it was not the role of this committee to make findings of fault with regard to anybody.

It may be the case that there was not fault but equally it may be the case that there was. We, as a Legislature, need to ensure those answers are provided to grieving relatives. Of course, we know a lot more about Covid-19 now than we did then. Any investigation must look at what was known or ought to have been known at the time particular decisions were made. This includes decisions around discharging large numbers of elderly people in particular from acute hospitals into nursing homes. We cannot judge actions by what we now know, only by what was known or ought to have been known at the time.

A second recommendation was that a review should be undertaken into the impact of privatisation on Ireland’s nursing homes to ascertain its impact on nursing levels, expertise and qualifications of staff, medical and other facilities available in older people’s care settings and the adequacy of funding to deliver optimal outcomes. In that regard, it is important that that review take place to see what the impact the of undoubted increase in the size of the private sector has been. It is also important to bear in mind that there were no disproportionate deaths. Each death was tragic; as somebody who lost a relative at the start of this year in a nursing home, thankfully before Covid-19 arrived, I know what the void in one’s life is like. There was no evidence before the committee and it was specifically probed for, of any sort of disproportionality. The proportion of deaths in private nursing homes versus public nursing homes was pretty much the same as the proportion of residents in private nursing homes versus public ones.

The third recommendation was "That the State develop a system of testing and contact tracing with a turnaround time for testing that does not exceed 24 hours, and immediate tracing ... thereafter." I will allow anybody else to speak on this issue because, unfortunately, we as a State have not succeeded in that regard. Contact tracing in particular has been problematic and it was raised repeatedly at the committee. There were three reports released before the final one, one of which was an interim report on testing and tracing that was released just before the summer vacation at the end of July. This issue was highlighted in that report. There was also an interim report on nursing homes which highlighted that we need to move away from a care model of people being cared for in congregated settings and towards a model of caring for people in their communities. Covid-19 has shown up all of the structural weaknesses of society, from problems we have in the education sector with regard to the infrastructure of our schools etc., to the fact that we have an over-reliance on congregated settings. I do not expect that will be solved overnight but policy needs to be oriented in that direction as we move forward.

In parallel there was also an expert group looking at Covid-19 in nursing homes established by the then Minister for Health, Deputy Harris. It produced a report which came up with broadly similar recommendations to those the committee had in its interim report. Indeed, the committee's fourth recommendation was:"That an implementation plan be drawn up for the recommendations contained in the Report of the Covid-19 Nursing Home Expert Panel with a requirement for six-month progress reports to the Houses of the Oireachtas."

There was a further recommendation that the Government make provision for a statutory sick pay scheme to cater for low-paid workers such as those in nursing homes and meat plants, and make Covid-19 notifiable disease. It is important to say that Covid-19 is now a notifiable disease but the first matter is one on which considerable progress remains to be made. I am aware the Government has said it will look towards establishing statutory sick pay by the end of 2021. The Labour Party has been instrumental in pushing that and I thank Deputy Duncan Smith for attending the debate tonight.

There was a recommendation that:

A full review of the regulatory frameworks in respect of HIQA and the HSA should be undertaken and include the adequacy of both the powers of and resources available to each body to carry out reviews. The review should also establish the precise ground under which regulations were removed that required (i) the ‘person in charge’ of a nursing home to have formal gerontology qualification and (ii) the requirement for the presence of a registered nurse on duty at all times ...

A further recommendation we looked at in the interim report was that a medical officer be appointed in respect of each nursing home because there are medical officers in respect of some HSE facilities though not all. It is almost an accident or a curiosity of their history and how they evolved. In some nursing homes there are various residents who are still under the care of their GPs. That GP has a duty of care to his patients but only to them, rather than to the broader community. That is something that is important in the context of a pandemic and may have broader ramifications in treating influenza. Thankfully, the nursing home in which my mother passed away has, to date, avoided Covid-19 but every year a number of patients die of influenza. What we learn from Covid-19 does have repercussions for the treatment of other respiratory ailments.

The seventh recommendation was that "The State should phase out support for facilities where residents do not have adequate self-isolation facilities and it should accelerate the capital works in all publicly owned facilities to ensure that all residents can live in self-contained units." That is an important thing, as is the fact that moneys are paid in respect of new residents in nursing homes which have failed HIQA quality control standards.

There is another recommendation which is very important. It calls for: "An ‘Inquire, Record and Report Inquiry (pursuant to section 7 of the Houses of the Oireachtas (Inquiries, Privileges and Procedures) Act 2013)’..." into the operation of meat processing plants, including "the use of agents to procure workers, to include the State’s response in terms of protecting workers, [and] ensuring necessary food supplies to the general population, as well as ensuring fairness for primary producers". This is because we know that at that time, meat plants were a hotspot of Covid transmission in Ireland, as they were in every other country. It seems we in Ireland have a unique relationship with meat plants, a sort of light touch regime. The Minister for Health may not agree with me but that is certainly my view on it and we need to look at its operation throughout this.

The following recommendation is a very important one, namely, "Data relied upon by NPHET, its modelling code, as well as international evidence relied upon in making its recommendations ... should be published in full and a peer review commissioned." The purpose of this is not to undermine NPHET in any way. However, NPHET is all about science, and we are told that this is all about science but the essence of science, be it the establishment of a vaccine or be it a modelling code, is peer review. The editor of The Lancet came out with a quite interesting tweet regarding some of the very recent developments on vaccines which could herald very good news but until they are peer-reviewed, we do not know.

Those are the main recommendations.

Minister for Health (Deputy Stephen Donnelly)

I thank first of all the Chair, Deputy McNamara, and the members of the Special Committee on Covid-19 Response for their very hard and diligent work over many months throughout this year. The committee’s work has been invaluable in gathering information, questioning witnesses and in promoting a greater degree of understanding of this new virus.

I am sure the House will also join me in thanking the many witnesses who made themselves available to the committee to assist it in its work, particularly in the context of the very difficult circumstances everyone has been labouring in this year. I thank the committee's secretariat which has the onerous task of making us all look good. We do our best to help it with it but I have no doubt that in this case the secretariat worked as hard as it always does in supporting members. I note that while I was a founding member of the committee I sadly did not make it onto the Facebook page for the committee. The Minister of State, Deputy Butler, and I have been disappeared by the secretariat in the report but I certainly thoroughly enjoyed my time on the committee.

When the committee commenced its work in May we in Ireland were slowly coming out of the first wave of Covid-19, which had a very substantial impact right across the country and as we all know it led to a very significant loss of life, particularly amongst our older population. As the committee submitted its report in early October we were starting to see an increase in cases emerging again.

Thankfully, however, the measures that have been taken and the lessons learned during the first wave of the virus have enabled us, as a country, to drive down the levels of infection once more. In fact, we are seeing more than a 90% reduction in fatalities in the second wave compared with the first. This means that for every ten people who tragically lost their lives in the first wave, one life has been lost in the second. By any measure, while every single loss of life is one too many, that level of life saved is an extraordinary improvement. I pay tribute to our healthcare workers, our nursing home workers and every family and person who has done so much to keep people safe and alive. Seeing more than 90% reduction in the level of fatality, which ultimately is what it is all about, is not down to any one person or group of people; it is a nation working together, shoulder by shoulder, to look out for each other and keep each other safe and it has worked incredibly well and the nation deserves thanks for that.

With regard to our healthcare workers, I have just come from a visit to St. Vincent's University Hospital where I met the critical care, emergency medicine and laboratory teams. These people and the dedicated professionals and healthcare workers throughout Ireland have been working night and day. They have been innovating, learning and adapting at incredible speed in response to Covid. I acknowledge once more the work they have done.

It is clearly very important to focus on what we can do better but it is worth reflecting on the fact that we, as a nation, have managed to suppress this virus in recent weeks. Our numbers have increased in the past week, and that is something we all need to work on, but right now we still have the third lowest rate of Covid per 100,000 population anywhere in Europe. For every 100,000 people in Ireland, 114 tested positive in the past 14 days. Many European countries are seeing multiples of this. In France it is 789 and in Austria it is 1084. In Italy, which suffered so terribly during the first wave, it is 799. A number of European states have seen their hospital systems at maximum capacity and some countries have had to send patients to Germany for treatment when their own critical care resources were exhausted. In Switzerland, the number of people in intensive care now from Covid is higher than it was during the first wave. By any international standard, the people and healthcare workers of Ireland have done an incredible job in adapting and learning how to push this virus back and keep each other safe.

The rise of the virus, of course, is why the Government has taken such extensive measures throughout the pandemic to limit transmission when it was required in order to ensure that we protected lives. We did not have a situation in either the first or the second wave whereby our hospitals and critical care units were overrun. However, many families here have been scarred by the pandemic and I want to take the opportunity to recognise their loss and pay tribute to them and to recognise those who have lost their lives. As of yesterday, and as we all know, the number of fatalities from Covid-19 exceeded 2,000. That was a very sobering moment. As well as this very large loss of life, while some of those who have acquired Covid are alive, they are suffering from what is called long Covid. Our understanding of this is still evolving but the medical literature is replete with information on the lingering and often debilitating effects of the disease.

The report of the special committee contains a number of recommendations for the future design and provision of care for older people and I have to say it is a very welcome development. A significant proportion of those who died were nursing home residents. I have met some bereaved families and I know many of them are looking for answers. I am sure they are all looking for answers. They deserve answers. Many factors have to be considered, I am looking at the best way to get them the answers they want, need and deserve. Many of the challenges identified in the committee's report are reflected, as its Chairman said, in the nursing home expert panel report published in August. Immediately following the publication of the expert panel's report the Minister of State and I moved to establish the implementation committee, and this includes an interagency oversight team and a reference group. Work is progressing on the implementation of the recommendations and I acknowledge the leadership role the Minister of State is taking on this absolutely essential work.

It is important to appreciate that approximately half of our nursing homes, and the Chairman of the committee made a similar point, have remained free of Covid-19. Recognising the difficult landscape that Covid 19 has presented for long-term residential care settings, a series of enhanced measures have been agreed to support these settings and they are being actively monitored and implemented by HIQA and the HSE. Clinical guidance, personal protective equipment, PPE, staffing, serial testing, infection prevention and control, training and quite considerable financial support have been provided to the public and private nursing home sector. In addition to public health outbreak control teams, multidisciplinary clinical supports are in place at community healthcare organisation, CHO, level through 23 Covid-19 response teams, as well as outbreak control team, which respond to outbreaks as they occur.

The committee's report also very rightly focuses on testing and tracing and there was an interim report to this end. The more we work to push for the most extensive, quickest and comprehensive testing and tracing system the better. Our testing programme has expanded considerably in recent times and we are now up to a capacity of 140,000 polymerase chain reaction, PCR, tests per week which, by international standards, puts us right up there as one of the highest in the world. So far, there have been 1.8 million tests and we continue to undertake serial testing of all staff in nursing homes and food production, while also performing mass school testing where it is deemed appropriate. The number of contact tracers has risen significantly and from mid-September to now we have seen an approximately 2.5 to three fold increase. I want to see contact tracing being as quick as possible and as deep as possible, in terms of forward and backward contact tracing, so we can identify as quickly as possible the sources and deploy the outbreak control teams, find who is affected, support them, get them tested and isolate them.

Most encouragingly, as colleagues are aware, we have seen the emergence of very positive results on at least two of the vaccine candidates in development. I caution everyone, of course, as the public health experts keep cautioning me when I get excited by the results we are seeing, that a good deal of work, including some clinical validation from our own side, still needs to be done before we fully understand the effectiveness of the vaccines, for how long they may provide immunity, whether their effectiveness differs in different age groups and so forth. For now, we have to rely on the tools immediately available to us, which are the use of face masks, social distancing protocols, respiratory hygiene and complying with the other public health measures. These still remain vital. If we do these things it gives us the best chance of continuing to suppress the virus. I urge all Deputies to continue to promote the public health messaging that is so important. I recognise the work and advocacy everyone here and every Deputy has shown and continues to show in an all-Oireachtas approach to supporting the public health measures and I thank them all very much.

Deputy Jennifer Murnane O'Connor

I replaced the Minister of State on the Covid-19 committee when she was appointed to her role. I thank the Chairman of the committee who did an excellent job.

While I welcome the report, we have been a little premature bringing the work of the committee to a close. We could probably have done with it being in place for longer, particularly in light of how things are with the virus. We have seen Covid-19 cases increase as communities reopen, even though we are in lockdown. I am troubled to see the rise in the number of cases. The Minister referred to this matter.

I am especially concerned about the figures suggesting that funerals could be the super-spreader event. My heart breaks for those who have had to watch from afar as their loved ones got sick and passed away from this lethal virus. They have not been able to celebrate the life or mourn the death of their loved one, surrounded by family and friends, as is so typical of an Irish funeral. The virus has stripped us of a vital part of our grieving process. If someone in our community passes away, we all want to show them the respect they deserve and we want to be there for their funeral. Of course, we want to take precautions by wearing masks and so on but, for Irish people, it is part of our culture that we always go to funerals and we like to be there to support people. That is a big thing for us.

The Chairman went through the data and I have been going through them myself. The data on contacts and outbreaks are forms of information which we should have in a safe place in order to investigate them, and that place is the Special Committee on Covid-19 Response. This is why I wonder whether we should have kept the committee going, and perhaps the Minister needs to consider this. I found the committee very informative when we were learning so much about this disease, but we still have a lot to learn. I welcome and applaud all of the advances which have taken place in regard to vaccines, and I want to especially mention the Irish companies and scientists working hard in this area.

We know we will be living with Covid but we cannot live with lockdowns which threaten our economy, although the number of cases is still rising. In a few weeks, hopefully, we will move from level 5 to perhaps level 3 or level 2, although we are not sure yet what level it will be. For me, the biggest issue dealt with by the special committee was testing and tracing and the speed at which this could be done, which was the greatest concern for all of us. The Minister said that the quicker testing and tracing is done, the better. Given the outbreaks in nursing homes and meat plants, we need to make sure we also have outbreak management. We need a management team and we need to be stronger on that issue because it is so important we do not have big outbreaks like those that happened before.

We cannot afford another lockdown. If this one does not work, we risk losing businesses, losing the public and losing lives as well. One issue I found challenging in the committee was access to information, and I know the public found this too. We have had huge challenges. While this report can only make recommendations based on hindsight, I know all of us will agree we were all learning. The figures today are horrific, with 2,000 people having died from Covid and many families affected by that. Even where people got Covid but did not pass away, thank God, many are severely affected and have pains and aches, and they are not able to work. The side-effects of Covid have been very difficult and people are struggling.

We are living in a different world. All of us in the House have a duty of care to the Irish people and a duty to come in here and work together. The worst that can happen is if we do not work together to find solutions. We need to work as a team and do our best to make sure we do not have any more deaths from Covid. That is the one thing I have learned from the Covid committee. We were an all-party group and I believe we worked well together. We were there to make sure we did our best to support the Irish people, to give as much information as possible and to try to help in any way we could. We were all contacted by businesses and by different groups. The economy was affected and businesses came to us, telling us they were not going to survive. We had to be very careful on that issue. We have to make sure that, when we get a vaccine, which I firmly believe we will, we are in a situation where the economy survives and we have jobs for people. We have to be very careful of that.

I thank the witnesses who came before the committee and gave us the best information they could. Covid knows no boundaries. Covid does not know political parties. Covid does not know us and we do not know it. However, the one thing we have learned from Covid is that we live from day to day. Every day, I listen to the news to get the figures to know how many deaths there have been and how many are linked to certain areas and to my own area of Carlow. That is the way our life has gone. As we are trying to live with this, we have to try to live with it in a way that ensures people are not affected by it. That is the duty of care we have.

One of the biggest Covid issues for me was the hospital appointments missed, the disability services that were not open and the respite that could not be attended. There was such a knock-on effect. Nonetheless, all of us in the House were trying to do our best in our contacts with Ministers and in trying to get the information out there. Perhaps we need to look at our messaging and advertisements, and to see if we can be more proactive. However, I know everyone is trying to do their best. All of us in the House are trying to work in our constituencies to make sure we can help with regard to information. Whether it is for a pandemic unemployment payment or otherwise, all of us are trying to make sure we do our best.

Mental health is an issue I am concerned about in the context of Covid-19. Many people I have spoken to recently are very down and very affected by this. We do not know what is going to happen. Hopefully, when we move out of level 5 to lower level restrictions, we can get back as much normality as possible. Christmas is coming and we have to be positive for the people of Ireland. We are in level 5 for a reason, and that is to make sure we save lives. This is what the Covid-19 committee was about. It was about information and asking people to take self-responsibility. All of us in the House and outside it have the responsibility to make sure we play our part and do our best to ensure no one we know in our areas dies.

Everybody has gone through such an horrific time. To me, 2020 will be remembered, in my time anyway, as one of the worst years in history, when we were trying to learn about and deal with something we never thought would come. Earlier in the year, we were all getting ready for a general election. We then got elected and then Covid came, a disease that none of us knew anything about. All of us on the committee played our part as best we could to engage with our own areas and constituencies, while working at a national level through the Ministers to make sure we delivered what we could. This is about information and recommendations, but if we learned one thing from this, it is that all of us are here to represent the people of Ireland. We need to do that in unity. We need to work together to make sure we have no more deaths in Ireland and that we look after the Irish people.

Acting Chairman (Deputy Bernard J. Durkan)

I call Deputy David Cullinane, who is sharing time with Deputies Louise O'Reilly and Mark Ward.

Deputy David Cullinane

I welcome everybody to the Chamber and, in particular, the Chairman, Deputy McNamara, who did a very good job over the course of the months that the committee sat. I cannot say I agreed with everything the Chairman said before, during and after the publication of the report, but he was a very diligent Chairman. It was a very useful committee that sat at a very important time, and it played a very important role in terms of guiding the work of the Oireachtas at a crucial time. I commend the Chairman on his work and all of the committee members.

It is important for us to say it is too early to look back yet. There has to be an element of look-back but the virus is still present, contagious and spreading and the cases are still too high. Next week, we will have a debate in this Chamber on where we should be after 1 December in regard to restrictions. I welcome the debate but it has to be said that it will come before NPHET advises the Government. That will be key, in my view, to determining what we should do or not do. People want a good Christmas and they deserve the very best Christmas we can give them, but we also have to be honest that it is not going to be the same as last year or the year before. It is going to be different but let us make it the best one we possibly can. However, that will throw up all sorts of issues, which I am sure we will debate next week.

When we look at Covid, and take a step back and look at the committee's report, there are lessons we will have to learn and changes that will have to be made. I want to deal with a number of issues and my colleagues will deal with others. The first is nursing homes and the whole issue of care for older people and the elderly. We saw there were real problems in nursing homes right across the State. Far too many people died in nursing homes, some in very tragic circumstances where they did not see their families before they died.

We know that issues relating to clinical governance and the lack of adult safeguarding protections that I believe we, as an Oireachtas, should advance and which I spoke to the Minister about need to be delivered upon. Many reports have been done on nursing homes and we have to implement the recommendations. We will also have to consider setting up processes that will allow families to get closure by finding out exactly what happened to their loves ones in nursing homes. That will be an important part of the future when we progress.

We should also learn lessons about hospital capacity. We were caught in terms of ICU and acute bed capacity because the recommendations made in 2009 on ICU and hospital capacity were not implemented. Let us make sure we never again get into the situation where we do not have enough ICU capacity. I know we never got to a stage where there were not enough beds but we sailed far too close to the wind in that regard.

Public health departments and specialists came front and centre, possibly for the first time in terms of how the public saw the work that they do. They do very important work. There are equal pay issues that need to be addressed, both for medical scientists and public health specialists. That is an important area.

On test and trace, we will have to look at a permanent unit that will examine how we respond to a pandemic. We are not out of the woods yet. This virus is still around but, hopefully, the vaccine will come on-stream and at some point we will be out of the woods. We may be presented in the future with a different type of virus that might be better or worse in terms of the impact it will have on society. We need to be prepared for that and learn all the lessons we most certainly have learned on the back of this pandemic. Truth be known, we are still learning.

On the Covid vaccine and the number of different trials, I share the Minister's enthusiasm but also his caution in that regard. There is a good deal of work to be done. The regulators have to certify the different formulas and types of vaccines being pursued. What has been presented is good news. The efficacy rates are very high, if the press releases are to be believed, but there is much work to be done. This will be the most ambitious vaccine ever distributed in the history of the State. We obtained 1.3 million doses of the influenza vaccine. This will be multiples of that, at least 3 million and possibly 4 million. It will raise distribution and administration issues. Are GPs and pharmacies equipped to be able to roll it as quickly as it will need to be rolled out? Do we need to consider pop-up centres, for example, across the State, as we did with testing? Do we need to train staff to make all of that happen? Those are the questions the high-level task force being put in place needs to deal with to make sure the infrastructure is in place because the Minister knows that, in all the current trials, most of the companies have already produced the vaccines. There are billions of doses across all of those companies so as soon as they are certified, it will be a case of giving the green light and it will be all systems go. We need to be prepared for that. I hope to debate that issue with the Minister in the time ahead.

Deputy Louise O'Reilly

I will refer briefly to a number of issues but I will start by thanking the Chairman, the secretariat and all of the staff who oversaw the implementation of the special committee and brought us together in a very challenging time. In the early days, it must have been very tough for them to figure out the logistics of how we would meet but they did it and facilitated what I believe to be a very important committee.

I will highlight a number of issues and focus on areas of particular difficulty as we move into the next phase, one of which is the restarting of non-Covid care. We can all agree that Covid-19 exposed many of the challenges and deficiencies in the health system. I will touch on three issues - direct provision, waiting lists and, briefly, the issue of image-based abuse. Potentially hundreds of women and girls have been impacted by the leaking and sharing of images of them online without their consent. We know that will have a serious impact on their mental health. We see references in the report to the impact of the suspension of ongoing support services. We know that Women's Aid has a help line, 1800 314900, which is extremely important and operates 24 hours a day, but those women will need ongoing support. I want to put that issue on the Minister's agenda so that a facility can be put in place to ensure the mental health supports that are needed can be provided both while the Garda investigation is ongoing and in its aftermath.

I want to focus on the restarting of non-Covid care. The waiting lists the Minister and I discussed on many occasions in this House did not go away. If anything, we know they got much worse but I was shocked by how bad things had got when I was sent a letter from one of my constituents. It is a referral letter from the HSE and it says:

We received a referral for the above mentioned child to our Early Intervention Team. This...was discussed by our referrals committee and we are accepting your child for an intake assessment...

At present there is a 44 month wait...

This is a young child in Donabate who needs an urgent intervention. He has been assessed as needing early intervention. It is a bit of a joke to call it early intervention if the child has to wait 44 months for it. These are the challenges that will have to be faced. The family fully understand the impact Covid-19 has had on the health service and waiting lists but I want to be able to tell them there is a plan in place and the 44-month waiting time referred to in the letter can be significantly improved upon. We cannot continue to call it early intervention while children are left waiting for 44 months. All of that time is lost when this child needs support to be able to engage in school and in the community when we get back to some sort of normality. What will normality look like to a child who has to wait 44 months before early intervention takes place? As I said, we should stop calling it early intervention.

One of the other issues we raised as a committee was direct provision. I raise an issue that made my blood run cold when I heard it. Yesterday, in Balseskin reception centre, a man asked for mental health support. He was put out. He slept outside last night. Today, thanks to one of the people from the fantastic group known as Fingal Communities Against Racism, an ambulance was called at 2.30 p.m. The ambulance did not arrive until 6 p.m. This man is severely distressed. One of the issues we discussed as a committee was the particular challenges faced by people in direct provision. We all agreed that it was awful and that changes had to be made. We all shook our heads. Collectively, we decided that this was not good enough and for a very brief period, people actually thought about the lived experience and the reality of what it is like for people living in direct provision. I thought I knew a little bit about it but this has shocked me.

I hope we can learn the lessons contained in the report. I fear we will not but I genuinely hope we do and that we can take what we have learned and use it to build something better post-Covid.

Deputy Mark Ward

I join my colleagues in thanking the special committee, its Chairman and all the staff who were involved in producing this report. While I was not a member of the committee, I was able to attend its meeting on mental health.

Covid-19 has highlighted all the frailties of years of underfunding and mismanagement across Departments, be that housing, health, small business, transport, education, community infrastructure and so on. I could go on. There is not a debate in this Chamber on any issue that does not raise the impact of decisions we make here on people's mental health. Covid-19 has shone a spotlight on the shortcomings of our mental health services. The Minister does not have to take my word for that. He only has to read the statements of the witnesses who appeared before the special committee's meeting on mental health.

What the report fails to say is that during the special committee's meeting on mental health, the CEO of the Mental Health Commission said that the mental health system in Ireland is not fit for purpose and is out of date. He went on to tell the committee members that there is a need to invest properly in community services and to stop making excuses. Other witnesses told the committee that we need to start investing properly in services for children or they will not improve to the degree they should at this stage and that mental health needs should be put higher on the agenda.

This is a damning indictment of how mental health services have become the Cinderella of the health system. We are 14 years on from A Vision for Change and have moved on to Sharing the Vision. Ireland now finds itself in the middle of a pandemic that has placed additional demands on already overstretched mental health services. The Covid pandemic is a time of worry, anxiety and concern and it can add to existing mental health conditions or cause people to experience mental health issues for the first time. My phone has not stopped since this morning with people concerned about the impact Covid is having on their mental health, housing, waiting lists and other issues.

This system was already at breaking point prior to Covid. We had waiting lists to access care, limited out-of-hours supports and access to crisis intervention, an over-reliance on acute care for adults, a lack of mental health services in our community, children still being admitted to adult units, an increasing use of restrictive practices and an over-reliance on NGOs to provide the services that the Government should provide in the first place.

We need to develop at 24-7 crisis service and rehabilitation and recovery teams in the community. That would address the issue that my colleague, Deputy O'Reilly, raised. Mental health issues do not finish at 5 p.m. on a Friday and magically reappear at 9 a.m. on a Monday morning. We need to place mental health on the same level as physical health. For example, if one cuts one's head and goes to the emergency department, one will receive the appropriate treatment and aftercare that one needs when and where one needs it. However, if one presents at the same hospital with an issue that is going on inside one's head, one will not necessarily receive the same treatment. The follow-up care is often non-existent and too many people are falling between the gaps.

Next Thursday, I will be introducing Second Stage of the Mental Health Parity of Esteem Bill 2020, which aims to address the balance between physical healthcare and mental healthcare. Parity of esteem between mental and physical health will provide a holistic, whole-person response to everyone in need of care and support, with physical and mental needs treated equally. The relationship between physical and mental health is such that poor mental health is linked with higher risks of physical health problems and poor physical health is linked with poor mental health. If this change in attitude happens at the Minister's level, it will filter down to all levels of society and we will see the stigma often associated with mental health conditions lessened. We need to break the stigma once and for all. The effect of integration of mental health services with physical health services is particularly important. This Bill will place a duty on the Minister for Health to promote health parity to ensure that all organisations in our health system meet parity obligations regarding mental health. Next Thursday, I hope that all parties and none will support the Bill moving to Committee Stage.

Deputy Duncan Smith

I thank the clerk to the committee and the secretariat for all the support that they gave us. It was my first committee in this House and it was a learning and hothousing experience for me. I thank the Chair of the committee, Deputy McNamara, who chaired the meetings throughout the committee's lifetime. It was very fair. We operated under tight time and speaking constraints. Not only did members respect that but if people were deep into questioning, the Chair was good at allowing time when needed and pulling it back. None of us, however experienced Deputies may be, have experienced a committee that operated under such tight time constraints.

I will pick up on the story that Deputy O'Reilly told about Balseskin direct provision centre. It is partly under the Minister for Health's remit and partly under that of the Minister for Justice. That matter was brought to my attention today. I rang the centre and said I am a Deputy for the area, said that I understood there was a gentleman outside who was in distress, and asked how I could help. I was not adversarial because I knew there was a gentleman in a crisis situation outside. I was told that whatever happens outside the gate was nothing to do with the person in the centre and to ring the International Protection Accommodation Service, IPAS. I rang IPAS and got a voice message service that did not take any voice messages.

As Deputy O'Reilly said, thanks to the work of Fingal Communities Against Racism and people related to that group, an ambulance was called and eventually that gentleman was taken into our health system. Hopefully he is getting the care that he requires. Not only did that highlight a failing of our direct provision system, it highlights a lack of care. I know that in Ireland, if people knock on someone's door when in distress, someone will call an ambulance and help. To think that one would knock on the door of an institution funded by the State and that someone would not even make a phone call for an ambulance is distressing. I am getting away from the substance of the debate, which was not my intention, but it is worth raising and I would appreciate if the Minister could bring it to the attention of the Minister for Justice.

Deputy Murnane O'Connor raised a point which I have been reflecting on in the last number of weeks about whether the committee finished its work too early. I felt that the committee should have ended at the time and am on record as saying it, but perhaps I had a naive view of what the sectoral committees would be able to do with regard to Covid. I regret that the committee ended because we are finding it difficult, amid the Dáil schedule, to keep a focus on the different elements of Covid that continue to dominate our lives and the lives of our citizens and country. We still have space for the committee. One cannot put the toothpaste back in the jar, as they say, but that is a reflection I have since the committee ended its work. It is a reflection on the great work that the committee did. I learned a lot from my colleagues on the committee about rigorous questioning, getting information and compiling a report. The recommendations in this report should not gather dust.

A microelement of this is about the aviation industry. We had an aviation task force that delivered results and recommendations about the aviation industry in July. Those recommendations were not acted on. The recommendations in this committee report are much fuller, broader and deeper, and need to be acted on. The Minister knows that. I am glad to see that the Government seems to be picking up the baton on sick pay. Nursing homes have been mentioned. There is a deep sense that work needs to be done as per the recommendations of this report. I hope that is undertaken as and when it is appropriate, and in as speedy and sensitive a way as possible.

On testing and tracing, what happens in early 2021 will be key. I was encouraged by what the Minister said about resourcing testing and tracing. He mentioned that we will have a two and a half to threefold increase in that. I hope it is enough. The Minister mentioned forward and retrospective testing, an area on which I think we will need to focus in early 2021. When we come out of level 5 and go through December, whatever way December and Christmas go, which we will debate in the next week or so, January and February are key. We are all getting a sense that level 5s and lockdowns will become increasingly difficult to endure for many people. It will become increasingly difficult to keep a sense of discipline because people have lockdown fatigue. That is a fact, which was mentioned at the start of this by the Chief Medical Officer and the previous Minister for Health.

If we can get our testing right, resource it properly, and get testers into towns, villages, meat plants and direct provision centres when outbreaks emerge, and do retrospective testing to go after those people who have been in contact, including with pop-up testing centres, we can beat this and keep things open. Whether places of worship, businesses or sports, that whole gamut will need to come back in 2021. We need to ensure that public health remains at the centre. If we resource our testing and tracing regime appropriately in 2021, we will continue to place public health and the health at the nation at the centre but also allow other things to open and stay open in a fuller capacity. It is not as simple as that but that is a core element we need to focus on. The Labour Party will support any moves that the Government can make to resource testing and tracing as much as it can. The independent scientific advisory group, the Zero-Covid Island group as it has been called, has done much study.

I do not agree with everything they say but they have done some really solid work on testing and tracing that should be examined and taken on board. I thank all of my colleagues on the committee, the Chairman, the clerk and the secretariat.

Deputy Paul McAuliffe

I will be taking Deputy Devlin's slot because Deputy Alan Farrell is unavailable for his slot. As a result, my slot with the Acting Chairman will fall with the result that the Acting Chairman will receive an extra five minutes.

It was a privilege to serve on the Special Committee on Covid-19 Response. While all reports have to be read in their context, which can often be difficult given the passage of time, even this report with the short period of time since it has been completed is difficult to read because of the speed with which that context has been changing. It is worth reminding ourselves of that context.

The first time I spoke in this Chamber was on 5 March. At that stage we had eight confirmed cases, and one of community transmission in the North. A local school in my area had just closed and there was widespread fear if not panic in the community. That panic was not quite understood by other communities until the following days and weeks, when that fear would spread. On that occasion, I said that we must approach Covid-19 as we would a war and that all the resources of the State, beyond those needed in peacetime, must be brought to bear to deal with it. Interestingly, when Deputy McDonald followed me in that debate, she rejected my assessment. She said that we were in uncharted territory but not in a war. It demonstrates the difficulty that all of us had in predicting what was to come, which is the context of this report.

The ninth recommendation of the committee, which relates to "Data relied upon by NPHET, its modelling code, as well as international evidence relied upon in making its recommendations", is an important one. We have asked much of the Irish people. The vast majority of people have adhered to and abided by our requests. It is paramount that the evidence used by NPHET in making its recommendations is made available. That is not to undermine NPHET but rather to support it in its recommendations. The decisions made by the last Government in what we might call chapter 1 up to July, and the decisions made by the new Government in what we might call chapter 2 which we are still in, have all been about protecting lives and livelihoods. It has been a difficult balance but it is one we have got right. It has resulted in Ireland being in the third best position of any EU member state in how we have handled coronavirus, which is worth repeating because we do not give ourselves credit for it. Yet it has been very difficult. We must now consider what chapter 3 will look like and when it will begin. When I put that question to Dr. Glynn at this committee’s hearings in September, he accepted that if the virus is to be with us for longer than six to nine months, we will have to review how we live with it. In the same way, we restricted activities and facilities in the initial stages of the AIDS epidemic before moving to a situation where we had education and safe practice.

The tenth recommendation in the report deals with the communication of restrictions. Each time we go into the world, there is a risk. As we head into the world of this virus, we are concerned with managing that risk. Initially, activities were judged on whether they allowed social distancing. We then moved to a different phase in which some activities were not permitted, even though they allowed social distancing, because they involved mixing different households or bubbles. That brings us into very difficult territory where we are making judgments about what is a good or a bad activity. That is always a dangerous space for government, and one that governments never want to be in. As in chapter 1 and chapter 2, we are in that space as we seek to save lives. If we have to live with this virus for a longer period, and I hope we do not, perhaps we will be better off guiding people to have a prescribed number of contacts, or a prescribed level of social contacts, and allowing them to apply it. Having a meal in a controlled environment is safe for me, my wife and my two children. If I have a meal with four different people from four different households, and we are not wearing masks, it is not safe. The risk is not the meal or the restaurants - it is the mixing of the households. It is an impossible thing to legislate for or even control, but it is the secret to returning to normal life.

Different people choose to do different things in their lives. If this virus stays with us for a longer period, and I hope it does not, I worry that we may end up with the difficulty of the State dictating what is a desirable activity. I know that is not the intention of any Member of the Dáil, any member of the Government or any member of NPHET as we unravel the advice. If the virus is to be with us for several months, we will need to give people more discretion in how they spend their own social contacts rather than the Government deciding how they spend them.

I commend this report to the House. I commend the Chairman and all the members of the committee. I look forward to its recommendations being implemented. Most importantly, I look forward to seeing the impact that this report, and the evidence we have gathered, will have on how we live with this virus. Let us hope that we will have to live with it for a short time rather than a long time.

Deputy Cormac Devlin

I thank Members for bringing this report to the House this evening for statements. It is too important to pass without such a discussion. I thank Deputy McNamara for his chairmanship of the committee. I thank all the committee members from across the House who contributed so much over the many meetings we held. I thank the witnesses for their insight, experience and expertise, which was invaluable in informing the committee and its report and in informing the public who watched intently the various discussions around Covid-19 and the challenges it presents. I thank the secretariat and the staff of the Houses of the Oireachtas for facilitating all of the meetings. I would say that the Special Committee on Covid-19 Response brought forward a pathway for this House to create the other committees of the House, such as the standing committees. It showed a way of facilitating those committees, even through level 5 restrictions like those in place today.

I especially thank my party colleagues who served on the Special Committee on Covid-19 Response from the start on 7 May. I thank the Minister, Deputy Stephen Donnelly; the Minister of State, Deputy Butler; the Minister, Deputy Foley; and Deputy John McGuinness for their contributions to this 108-page report. It is important to remember that the committee met 67 times in public session over a 30-day period, receiving 275 submissions since 19 May. This allowed the Oireachtas to prepare for future committees to be facilitated by the House. It was an invaluable committee because it gave focus to the various issues and sectors impacted by Covid-19 at the time.

Sadly, at the time of the report, we had lost 1,800 mainly older people to the virus. Thankfully, as a country, as a society and as a Government we have learned much more about this virus and how to live with it, and we have published a plan for living with Covid-19, about which we have spoken previously in this House. The attention paid to the testimony of witnesses at the time was quite moving. It captured the attention of the public and indeed the media. It was an outlet for people to ponder questions and considerations at the time of the first wave of the pandemic. Little did we know we would see ourselves back here so quickly at level 5, but it illustrates the pace and infectious nature of this virus and the need for us to take heed of that.

The first of the 11 recommendations, which is correctly No. 1, relates to nursing homes. This was the single most discussed issue at the committee and is rightly noted as such in the report, especially since older people in this category accounted for 56% of all deaths from Covid-19 up to the time of the publication of the report. Since the committee ceased its work, I have put questions to the HSE on the resources being given, particularly around nursing homes. I am sure that resources and attention is being given to that cohort as we speak. The committee's recommendation that "a public inquiry be established to investigate and report on all circumstances relating to each individual death from Covid-19 in nursing homes" is being examined by the Joint Committee on Health at present.

The committee's second recommendation covers the need to review "the impact of privatisation of Ireland's nursing homes". There will be many more challenges going forward but the issue of nursing home and residential care for the elderly and how that may arise in the future, pandemic or no pandemic, will involve many different Departments.

Unlike then, but thankfully now, many hospital appointments and services continue to be offered. During the first wave, this was one of the main issues the committee discussed. I am very happy that, in the current wave, we have seen a total change regarding health services. This is not to say that everything is perfect, because there are problems. Community services, such as orthodontic services in my constituency, are affected by particularly long waiting lists. We need to address these if there are going to be further restrictions.

I wish to highlight some of the other recommendations, including on testing and tracing and the report of the nursing homes expert panel. Recommendation 5 concerns the statutory sick pay scheme. In that regard, the social protection payments are assisting.

Recommendation 6 relates to a regulatory review of the framework of HIQA and the Health and Safety Authority. That is an important element because, pandemic or no pandemic, we need to ensure both organisations are not crisscrossing each other, that they are fit for purpose and that they can implement any required changes to regulations or legislation.

Recommendation 7 is about shared residential facilities, such as direct provision centres. This needs to be tackled, irrespective of a pandemic. Recommendations 8 to 11, inclusive, deal with many issues, such as meat-packing plants and, as my colleague Deputy McAuliffe referred to, the data relied upon by NPHET, which comprise an important aspect.

Let me put in context where we are today. The initial report from the Department of Health on 11 March stated that there were 43 confirmed cases of Covid-19, with nine new cases on that day. Tonight, there are 429 confirmed cases and yesterday there were 379. We are now obviously on the right trajectory, as the Minister said, but it is important for all of us in this House and the general public to adhere to public health guidelines in order that we can drive these numbers down. I heard one of my colleagues say that the committee should have sat for longer but the body of work done was significant. It was a privilege for me, as a new Deputy, to have served on it. It is important that we all focus on the need to reduce the numbers, reduce our amount of social contact, take personal responsibility and adhere to the public health guidelines.

Deputy Ruairí Ó Murchú

I have said a number of times here that Covid has been absolutely dreadful. In addition, it has shown up certain weaknesses in society, particularly in the areas of healthcare and housing. It has put a strain on a system that was already strained.

I thank Deputy McNamara, the secretariat of the committee and all the members, including some of my Sinn Féin colleagues. The committee dealt with work during a particularly rough period in our history. It dealt with what none of us would have anticipated when we were elected to this Dáil. We are far from being through the woods. The number of cases is too high. While we may have lower numbers than many places throughout Europe, they are still too high. Unfortunately, we have had over 2,000 deaths, which we never wanted to happen. This has obviously meant pain and considerable loss for very many families.

I want to deal with recommendation 1, on the public inquiry into the deaths in nursing homes. A valid point is that we need to conduct our inquiry without a retrospective look based on what we now understand about the transmission of Covid-19 and dealing with it. It will not come as any shock to the Minister that the issue I am going to talk about is Dealgan House and the unfortunate loss of 22 of its residents, resulting in great anguish for a large number of families. I am aware that the Minister has met these families. I welcome what he said in his speech in the sense that he is looking for a formula or mechanism - I do not want to put words in his mouth - for giving people the answers they need. That is vital. It is important that it happen as soon as possible. Obviously, the families' ask is for a public inquiry. They have been very tenacious and have had multiple meetings with multiple groups. They have obtained freedom of information releases that have made national newspapers and national news. I refer in particular to information they garnered from the HSE. An awful lot of this is disputed. I welcome the HIQA report into Dealgan House that mentioned some very positive aspects in respect of elder care. That is to be welcomed. If there are improvements regarding elder care, we will all support them but it is absolutely necessary that there be an investigative mechanism to give people the answers they need and ensure we learn everything that needs to be learned because there have been worries about several nursing homes.

I welcome conversations I had with representatives from the HSE. They spoke about the HSE now having a better set-up for communication, line management and dealing with issues in nursing homes. On some level, that is an acceptance that there were difficulties but it is very positive.

Recommendation 2 relates to the impact of privatisation. We all have a changed view on healthcare. It is a lot easier to sell the idea that we need universal healthcare that is free at the point of delivery from the cradle to the grave. We acknowledge that there are difficulties with privatisation in that we do not necessarily have the staffing ratios and skill sets we would want. These matters need to be addressed. What we really need to do is ensure that recommendation 4 is implemented. It concerns the recommendations of the expert panel on nursing homes. Implementation is required as soon as possible.

We have a difficulty in the sense that we have opted for a residential solution in respect of elder care. We need to give people the facility, whether through home care packages or other measures, to avail of care within the community, where suitable. We have a great number of difficulties and need to deal with them. Covid-19 has shown up a number of these and we need action as soon as possible. I ask that the Minister speak to the families about Dealgan House as soon as is practicable.

Deputy Bernard J. Durkan

I am also privileged to have served on the committee. I thank all involved, including the secretariat, the witnesses and the Chairman, with whom I had very little dispute. The only point on which he and I disagreed, which was unusual for me, concerned the definition of "experts". I still hold the view that the definition of a true expert is the one who knows when to call in the experts. I believe we had them and still have them. NPHET did a remarkable job, coming from a standing start in circumstances we knew very little about to deal with a raging, voracious virus. It is still raging in the way it was, or even worse.

Those who criticise what happened in this jurisdiction should look at what happened in all the other jurisdictions that were held up as examples of best behaviour and best practice. Unfortunately, they did not stand up. Most, if not all, of the counter-evidence did not stand up. The Ceann Comhairle will recall that the advice in adjoining jurisdictions was that the virus would dissipate after it had gone through the community. It did not and still has not. Many more people have tragically passed away. We have seen this in our own communities, and we will continue to see it.

At the beginning, I knew very few people who contracted the virus. Tragically, the ones we knew about were the ones who passed away. They died in very difficult circumstances in which family and friends could not be at their bedsides.

Yet, I know many people, hundreds of people now - like everyone in the House - whose families have contracted the virus. That tells me one thing. This virus is voracious, insidious, invasive and ongoing. If we want evidence, let us look at the way it was treated in the United States. People decided, for what reason I do not know, that it was not a threat and that it would go away. It has not gone away. It still will not go away. It is getting worse.

The example of New Zealand was held up. That country had a second devastating upsurge. Severe action had to be taken. The whole country was completely in lockdown. It was the same in Australia and other countries across Europe.

We should give credit to our people in this country, especially those on the front line in the health services. We should give credit to everyone involved, including the Minister, the previous Minister and the nurses and doctors who were on the front line. We should give credit to An Garda Síochána, which is on the front line as well. I had a discussion with the family of a garda in recent days. In the course of an altercation or disturbance, the garda was infected with the disease. I presume he was deliberately infected. The family are isolating at present. I acknowledge the work done by those in the front line who took their responsibilities seriously and took a good deal of criticism as well, let us face it. However, they did their job.

At this stage the debate has taken a new course. This was always going to be the case. We have to balance the issues, including the economic, social and health issues. Each has to be balanced against the others. This is a serious matter for all of us as members of society. We can use all the evidence we have. We can say that if we had more testing, we would have solved the problem. That is not true. In fact, we can test as much as we like. If people do not observe the rules in terms of distancing and social engagement to a reasonable extent, then we are in trouble. We can test as much as we like and as often as we like but it will not stop the virus from going ahead.

What do we do now? Everyone wants to celebrate Christmas - we all recognise that. My advice is that we need to think carefully about the degree of celebration that goes on. I agree there are certain commercial outlets and smaller shops in our provincial towns and villages that could open, since only small numbers will ever be in them in any event and they have the space to ensure distance. I believe we have to reward some of those businesses by giving them scope to participate in commercial activity provided they can guarantee social distancing and observance of the rules and guidelines. It is the same with restaurants and pubs and whatever. Unless there is an absolute guarantee that they can do that, we will be held up to ridicule. If politicians make a decision that allows further spread of the virus and another lockdown or shutdown, then we will be blamed for it. That is a fact of life. Those of us in Kildare had a double whammy because we had an interim lockdown as well. I believe it was valuable in the sense that it shocked us into realising that this thing had not gone away, and it has not gone away.

I will offer my words, for what they are worth. I know what the pressure will be on now. Everyone else in the House has received telephone calls and emails every day. Some of them are highly critical of our administrators and some are critical of our advisers. The reality is that if we do not want to take the advice of our scientific advisers, then we may not, but there will be consequences. We all know now what the consequences will be. We have had an illustration already. More than 2,000 people have already died. There are those who said at the beginning that it would not be serious and that people could recover from it. People can recover, but they can die as well. People can be left with a permanent mark or impact on their health. We need to realise and wake up to the fact that we can do what we wish if we want to, but the point is that there are consequences. Are we prepared to accept those consequences if we avoid and disregard the scientific advice?

We all know who they are. We have all watched them and worked with them before. I believe they are excellent and have done an excellent job. They are on a par with the best in the world today. That cannot be disputed. They were ahead of the posse in many cases. They identified the rate of infection and what it would be like. They anticipated everything and did their job. It is now a matter for us to follow up. If we decide to have a reopening of part of the economy to the best of our ability, then it has to be on strict grounds of compliance with the regulations. We now know that if we are in company with a group of people, only one of whom was in a similar situation with people who were carriers during the previous fortnight or three weeks, then we will be infected as well. We might as well realise that. It is a fact. There may be those who will say that on the one hand we might and on the other hand we might not or there is a chance that we might not. There is a chance but it is a slim chance.

I believe that fear generated a great deal of respect for our scientists in the first place. We were all fearful that we could be next. That applied to families and everyone. There was strict adherence. Then, after a while, we became complacent. Familiarity became the basis of contempt. That is not a basis and should not become a basis for our attitude in future.

I hope that families throughout the country can have a festive celebration. We all strive for that. It is not necessary to wallow in it. It is possible to socialise and have family reunions or drinks or whatever, but we have to recognise that we had better be careful that we do not paw each other to the extent that we will be spreading the virus to the ends of the earth. Then people may all go home to their respective homes either in the country or outside it. Then they and we have the ability to get it or they have the ability to spread it.

I acknowledge the work of the Chairman and the members of the committee I worked with. I acknowledge the work of the medical experts who we criticise so readily and the Minister whom some others criticise regularly. We all get criticised for the things we do or that we fail to do when we should have done something and what we should not have done at the time we did it. All in all, a great deal of credit is to be taken by those in their respective authorities for the work that has been done so far. I hope they will continue to be successful.

An Ceann Comhairle

Thank you, Deputy Durkan, for those words of wisdom.

Deputy Claire Kerrane

From a social protection perspective, Covid-19 has done two things in recent months. It has put a spotlight on the adequacy and effectiveness of our social welfare rates. It has shown how, very quickly, one Department can make major changes. As soon as Covid hit, two things became clear. People who had lost their jobs could not live on €203 per week. We could not expect a person out sick from work to wait for six days before accessing social welfare supports. In fact, the pandemic unemployment payment, PUP, when introduced in March, was set at a rate almost 75% higher than the regular jobseeker’s payment of €203. That in itself is recognition of the inadequacy of the €203 payment. That issue really needs to be looked at in respect of our social welfare system as a whole and how, at the least, people who rely on the social protection system should be protected from poverty. That should be a basic aim but it is one we are not meeting.

I wish to raise again the workers who were denied the PUP based on age. It is age discrimination. It is a great shame that when we start providing supports, especially in the midst of a global pandemic, we do so based on age. I raised this issue with the Minister for Social Protection, Deputy Humphreys, when this report was discussed at the committee some weeks ago. The report states that 23% of taxi drivers, as an example, are 66 years and over. People working beyond pension age in many cases are doing so because they cannot afford to retire and live on a non-contributory State pension. Yet, they were cast aside in March when they lost their jobs and had to close their businesses. To add to that, they were excluded from the enterprise support grant of up to €1,000.

The same can be said for young people at work, especially those who worked to make their way through college. So many worked weekends, but there should have been some mechanism to give them a percentage of the PUP and make that support available to them. The payment of arrears due needs to be accelerated. There are people who waited weeks for the PUP due to issues. When they eventually got it, they just got a week's worth of payment. That has left people owed money and those arrears need to come into effect very quickly. The closure of the PUP, which I raised with the Tánaiste earlier on, to new applicants at the end of the year needs to be postponed to provide certainty for workers should there be additional restrictions in January. I know nobody wants to see that but some workers will be worried over the Christmas period about the new year and we need to make sure the PUP is there for people should they need it. Further plans to cut the PUP in the new year should also be abandoned.

I noted, having raised the issue of the taxing of the PUP with the Minister for Enterprise, Trade and Employment, Deputy Humphreys, in committee last week, that the Government have gone out of their way to backdate tax owed on the PUP in the Finance Bill this week. When the PUP was introduced in March, it came in under an urgent needs payment, which is not taxable, yet through the Finance Bill people will be taxed right back to March. It is a great shame that the same effort does not go into taxing banks and vulture funds that goes into taxing ordinary people who will face a tax bill, some of which they did not expect.

Going forward, when we look at returning to education and returning to work for many people whose jobs may not be there when we come to the end of this pandemic, we need to make that as easy as possible. I am dealing with someone just now, for example, on jobseeker's who came back about eight months ago from New Zealand, wanted to get through on the vocational training opportunities scheme, VTOS, had 147 days of the qualifying period and needs 156. We need flexibility in the system when we are supporting people back into work or education. We need to do everything possible to support those people. There has been some flexibility shown in relation to the PUP but we also need to see that for jobseekers. Anyone who is willing to take up a scheme or a course should be able to do that easily and we should not be putting roadblocks in place. I hope that flexibility will be there for those people hoping to return to work or education after this.

Deputy Bríd Smith

It was hard work but a very interesting experience being on the committee. I thank everybody who made an appearance before us because we heard some really telling reports. There are many things we did not look at, least of all the schools because they had not returned and we did not have the experience of the return. Maybe there is a case to be said for looking at them in future.

For me, one of the most important things to come out of the committee was the public inquiry into what happened in the nursing homes. We should remind ourselves that, up to the time we issued the report, 985 residents had died having contracted Covid-19, but what is interesting about that figure is that it is 56% of all the deaths in the State. That is totally disproportionate because that group comprises 0.65% of the population. That says something to us. It was a trend around the world that older people were more vulnerable, the virus sought the vulnerability in people, and it exposed all the weaknesses in our public services. It certainly exposed, I believe, the weaknesses in our care of the elderly. Much of our time was taken up in looking at that, but the recommendation for a public inquiry to be established has to be taken very seriously by the Department of Health and any preparation to begin that needs to be undertaken without delay.

The second part of that and linked to it is the privatized nature of the care of the elderly in this country. We changed within ten to 12 years from having 80% of elderly care services in public control and 20% in private control to the precise opposite. That was a shocking move but it was accelerated and encouraged by tax incentives and the idea that there was profit to be made - and all these homes in the private sector were for profit - out of the industry looking after the grey sector of our population. That is pretty disgusting and I think they deserve better.

The worrying thing is that there are many parts of this country where there are planning applications currently in process and they are not just for individuals like Mr. and Ms Smith or Murphy down the road to open homes, but for multinational corporations to invest in the care of the elderly. Companies like Bartra Capital Property have planning applications in for hundreds of beds in premises that they want to use for care of the elderly, not because they love them but because there is a great deal of money to be made out of it. One of the recommendations in the report is that we should look into moving into a publicly funded model in the community and, if we are serious about it, then that is what we should mean and planning applications like that should not be granted. They should be halted because that is not the future for the care of the elderly.

As I said, the systemic weaknesses in the provision of all our public services were highlighted: childcare, schooling, transport. All of these systemic weaknesses had been in the system for years but it took a pandemic to highlight them. That is part of what we are seeing here, particularly when it comes to workers' rights. We did a lot of work around the professions in the care of the elderly and in the hospitals, including nurses, care workers, cleaners and so on, but also in the meat plants. It has been revealed that 80% of workers in nursing homes who were engaged by agencies have absolutely no access to sick care provision or sick care leave. We had people forcing themselves to go into work because they had no sick pay to rely on, knowing that they were either symptomatic or not feeling well or that infection was in the workplace, when they should be isolating. Many of them, because of the low-pay regime and the lack of provision for workers' rights, were living in overcrowded, congregated settings where they were sharing homes with many people. This is especially true of the meat plant industry, and one of the recommendations we have made here is a study of that industry to see at what level it operates, how it exploits workers and the need to implement a mandatory sick pay scheme.

People have complemented Deputy Varadkar for putting out to public consultation how we do a sick pay scheme. I do not think that is good enough. We need to have a mandatory sick pay scheme for companies who are making vast profits and agencies who engage nurses and care workers and are making vast profits, and we need to do it sooner rather than later, as we are facing into a further spike in this pandemic. For that reason, I will bring a Bill to the House in the next week or two which will be all about mandatory sick pay schemes being forced on meat plants and those who use agency workers, particularly migrant agency workers who have no provision to access a sick pay scheme or cannot move employer.

Healthcare workers have borne a huge burden and thousands of them are positive and are endangering their families because they have to go in and out to work in an environment where Covid is rampant. A court order was given today in County Kerry to close down a nursing down in Listowel, so shocking was the report from HIQA of the carry-on in that nursing home. I hope that is not typical but it happens. Care workers have to work in these settings and they are not being protected. When the nursing homes sector complains about HSE poaching, this is unfair to workers. Workers should have a right to move to better conditions and better pay, and that is what is going on. They are moving into the employment of the HSE because it is better, with guaranteed pay rates and sick pay.

I will say a word on tracking and tracing. It is totally inadequate. We have seen the employment of trackers in recent weeks where they were offered zero-hour contracts and have no sick pay. The laboratory scientists are taking ballots for strike action because they have industrial relations issues outstanding. They have to be dealt with. We cannot afford to have any of our trackers or tracers dealt with except with absolute respect, given such conditions that we can recruit and retain them and move to a strategy described by somebody as being like a fire brigade: where there is an outbreak, they move in, track the virus and they crush it. If we think fires are a danger, we should surely think this virus is a danger and be in a position to use the restriction period to invest in those much-needed areas and to move quickly to crush the virus wherever it rears its ugly head. It is happening now in nursing homes.

An Ceann Comhairle

Deputy Pádraig O'Sullivan is sharing time with Deputy Eoghan Murphy.

Deputy Pádraig O'Sullivan

I acknowledge the work of the Minister of State, Deputy Butler, in the early days of the Covid committee.

She was one of a number of Deputies who were promoted. I then took up the mantle, which gave me my first opportunity as a new Deputy to experience the work of a committee. I am grateful for being one of the first substitutes on the committee.

I will move on to serious business. Yesterday, the death toll from the virus surpassed 2,000 lives, a sad and sobering milestone for the country. Despite the positive signs regarding a vaccine, it is too early to be excited. As other Deputies have indicated, there is much ground yet to cover and many more decisions that require careful deliberation.

As of 8 a.m., 285 Covid patients were hospitalised, of whom 33 were in ICU, with an additional 29 hospitalisations in the past 24 hours. Figures from the Health Protection Surveillance Centre, HPSC, show that the number of virus outbreaks nearly doubled over the past week compared with the previous week. There were 1,027 clusters this past week, up from 572 the previous week, and the number of outbreaks in private houses more than doubled to 954 from 443. There were 20 workplace outbreaks, but the number of school-based outbreaks declined from 24 to ten. Among the total number of workplace outbreaks during the pandemic, 89 have been in food and beverage facilities while 55 have been in meat, poultry or fish processing plants.

I quote these statistics not to scaremonger or delegitimise the significant efforts made by all stakeholders, but to convey that this virus is still prevalent and as deadly as ever and still requires people to be cautious in their activities and to take all necessary precautions when they have to go to work, travel, go to school or whatever the case may be.

The report examines the State's response to Covid-19 as it evolved from early 2020. It undoubtedly highlights specific areas that require ongoing oversight and accountability, which will now be scrutinised by the various sectoral committees of the Oireachtas. I sit on the education committee, and already we have had regular interactions with key stakeholders about how we deal with the virus in schools and ensure that they are as safe as they can be for our students. As recently as this morning, various school staff representatives conveyed their concerns to us about ventilation in schools, social distancing measures and the health of staff and students.

A key finding of the report was that the State became overly focused in February and March on preparing acute hospitals for the oncoming pandemic and failed to recognise the serious risk posed to our most vulnerable people, who were in our nursing homes. The report succinctly details how there were delays in reacting to the deteriorating situation in nursing homes, especially in the provision of PPE and the replacement of staff. Indeed, some of these concerns occur to this day. While major efforts were made by nursing home staff, there are unanswered questions as to why some nursing homes were free of Covid while others were severely impacted in terms of deaths and sickness among residents and staff.

The report's first recommendation - to investigate and report on all circumstances relating to each individual death from Covid-19 through a public inquiry - needs to be followed as quickly as possible. There must be accountability for relatives who lost loved ones in these circumstances. Failure to provide them with answers would only exacerbate the pain and suffering already being experienced by their families.

The main theme running through the report relates to preparedness. This will be necessary as we learn to live with Covid-19, which will be with us for some time to come until we find and supply an effective vaccine. The State will experience periodic peaks and troughs in the incidence of the virus and it is necessary that our public health authorities be given every tool available to react to these fluctuations. The committee was unanimous, in that if we are to avoid further lockdowns, a highly efficient and effective testing and tracing system is a prerequisite. We must strive to do more. Turnaround times need to be improved constantly and new forms of testing need to be considered. Everything needs to be kept under constant review. The State must aspire to facilitate ongoing, uninterrupted serial testing in all congregated settings.

The report highlights the vulnerability of some of our low-paid workers and the need to provide for adequate sick pay entitlements for all. I welcome the Government and Opposition's unanimity in pursuing this goal. It is agreed that many workers attended work in congregated settings, meat factories, direct provision centres and so on out of fear that being absent from work would lead to a loss of income. We need to ensure that adequate sick pay provision is one of the first measures that we implement on foot of the lessons learned during the crisis.

Recommendation No. 7 in the report is that adequate self-isolation facilities need to be a prerequisite in all care settings. Capital works in all publicly owned facilities need to be expedited to ensure that people can live in self-contained units and restrict themselves in communal settings if and when necessary.

Meat plants emerged as significant infection hotspots. While the meat industry is highly regulated in terms of food safety and hygiene, meat factories have highlighted that, just like nursing homes, the same level of regulation and protection does not extend to workers or their conditions of employment.

It must be acknowledged that this crisis has been unprecedented. It has posed a relentless number of challenges to us as a State and to wider society. Emergency legislation, restrictions, lockdowns and other measures might not be palatable, but it needs to be acknowledged that all stakeholders have endeavoured to do their best throughout. We must constantly appraise our performance during the pandemic in a non-partisan, collegial manner. I thank the Chairman for ensuring that spirit prevailed throughout the committee's deliberations.

Deputy Eoghan Murphy

I thank Deputy Pádraig O'Sullivan for sharing his time. I thank the committee's Chairman and other members for the important work they did at a critical time for this country. I also thank the officials who helped them in that work, including the compiling of such a detailed and good report.

I wish to make four points about the report. First, it is important that the committee worked concurrently with our experience of the pandemic. For major events such as the one we are still experiencing, we need at-the-time reporting, investigating and recording, but we also need work that reflects on what happened after some time has passed. In this case, the first piece of work has been done by the committee.

From my experience of the banking inquiry, that key witnesses had different recollections was interesting. I am not just referring to key events that happened in the course of the banking crisis and the bailout. Rather, they could not remember the sequence of meetings and who might have been present for certain decisions. Sometimes, they had a difference of memory on the decisions that were taken. That happens. With the passage of time, memories change. As such, it might be useful to conduct an oral investigation now with those who were key players when decisions were taken during the first phase of the pandemic. I was a Minister in that Government, and I have to jog my memory to try to remember the sequence of certain events and decisions from only six months ago. Such a recording would be useful - it would not be for publication, or perhaps it would be published years from now - to better inform future decision makers.

Second, I did not get to follow every committee meeting, so something was not clear to me from reading the report, that is, the extent to which the committee examined the structure of the State's response to the pandemic. I do not mean the decisions that were taken, but the forums or structures within which they were taken. There was a Government decision on the best way to deal with emerging crises like pandemics, acts of terrorism and severe weather events, namely, the National Emergency Co-ordination Group, NECG. I have spoken and written about this issue previously. It is worth understanding now why we did not go with the NECG model, which was the recommended, tried and tested model, and instead went with a different model for making decisions. By the way, this is not a criticism of what we did at the time. The decision making process worked well then. However, it would be useful to know why we did not go with the prepared response, as it were. It would be useful to ask whether that response would be a better structure for those future decisions that must be taken in this pandemic. That would be a good piece of work to do.

Third, why is the committee no longer sitting? We are still living through Covid-19 and trying to react to and manage the pandemic in our society. Our citizens are still suffering not just the direct consequences of the virus, but also from some of the decisions we have taken to protect them from that virus. Why was the committee not sitting when the Government introduced the new five level structure for dealing with the pandemic so that it could have a proper and detailed look at the structure? Why is the committee not sitting now so that it could undertake a proper examination of potential alternatives to managing Covid into 2021? Why is it not doing some of the heavy lifting that needs to be done in terms of preparing us for what we hope will be a freer life post level 5 lockdown? I understand that the committee did important work and reported on same in a timely manner, which was excellent, but there is no reason for it not to be still sitting and asking some of these questions concurrently with the pandemic so that we could have the at-the-time, on-the-record reporting and investigation.

Fourth, I wish to make a point relating to one or two of the recommendations in the report. Some of them refer to the inquiries Act or to making an inquiry under that Act. I made this point in a separate forum this week. As someone who has experience of the Act, given that I was on the banking inquiry under it, it needs significant amendments.

Work would need to be done to amend the Act so that a future inquiry would not run the risks the banking inquiry ran at certain points, such as not completing its work. Amending the inquiries Act is not a small piece of work. I imagine, in particular given the current working arrangements, it would take six to 12 months. If inquiries are to be held under the Act in the future into things that have happened over the course of the past 12 months, that work should be done so that people can be prepared to sit on those inquiries in the future.

Deputy Patricia Ryan

I too would like to thank the Chairman and members of the committee for all of their work and allowing me to speak at some of the meetings. It was important for me to do this, particularly at a time Kildare was the only county in lockdown so that I could share the experience of my constituents. Covid-19 has turned our world upside down. We watched as strange situations like not being able to hold our loved ones or shake hands became the new normal. My hope is that we will never consider changes like this in any way normal.

A positive from the pandemic is an increase in the number of people who are walking and cycling in our communities. We need to do all we can to ensure that this becomes the new normal and keep the momentum going so that those who can leave their cars behind for short journeys are encouraged to do so.

I pay tribute to the front-line workers who kept everything going, especially in the dark days of the early summer when no end to this crisis was in sight. This crisis has shown us the importance to our society of not only doctors and nurses, but retail workers and the entertainment and events industry that kept us entertained on social media, in particular during the initial lockdown.

Our older people were disproportionately affected by this pandemic, especially those living in nursing homes. I echo the first recommendation of the committee's report, namely, that a public inquiry be established to investigate and report on all circumstances relating to the individual deaths of Covid-19 patients in nursing homes.

We need to ensure that we learn from the past. We also need to reduce our over-reliance on private nursing homes by ensuring more public nursing homes are developed, as alluded to in the second recommendation in the report. When announcing changes in restrictions,s we must also consider mental as well as physical health, in particular for older people. They were told to cocoon. For some reason, they felt that they had been promptly forgotten about by the Government.

I urge the Government to pull out all the stops to ensure this Christmas is as normal as possible under the circumstances. Nobody does Christmas like Ireland, and we need to ensure that this special family time is preserved and everyone is given an opportunity to join in and enjoy it safely.

An Ceann Comhairle

I hope the Deputy has her Santy letter in the post.

Deputy Pauline Tully

I have.

Deputy Matt Shanahan

The Covid special committee did a lot of good work. I pay special thanks to the Chairman, Deputy McNamara, and the secretariat. I would also like to highlight my colleagues on the committee who were elevated to office, including the Minister for Health, Deputy Donnelly, the Minister of State at the Department of Health, Deputy Butler, and the Minister for Education, Deputy Foley. I am not sure where Deputy McGuinness went, but we certainly felt his loss from the committee.

With regard the original proposition of the committee on the day it was formed, I said I wanted to be part of a committee that would be constructive and look forward. I understood very well, as most people did, that there were significant failings in the Government and social response at that date but I felt we needed to keep looking forward because, as a number of Members said, we are not out of this yet by a long way.

I would like to highlight some of the challenges that were discussed in the committee. Early on we were faced with the PPE issue. Great credit must go to private industry in Ireland, which liaised with and opened supply chains in Asia to the HSE to get PPE into the country.

We must, of course, acknowledge our front-line staff and the heroism they displayed despite a significant lack of resources, some of which could not have been envisaged. We also know the issues that arose in nursing homes, which were highlighted again during this debate. This was a new learning experience. Nobody could have foreseen what happened. We tried to prioritise ICU beds and perhaps that led to a failure to transfer people from hospitals to nursing homes without having adequate testing in place.

With respect to testing and tracing, I would like to mention Ireland's call, which was a huge response from Irish people at home and abroad. Expats returned to Ireland. We had more than 70,000 responses and it was a great shame that we did not utilise the people that responded to that appeal. I am not sure that more than 800 or 900 people were employed as a result of it. It was a significant bank of goodwill that we should have used, and we should continue to use it.

I would also like to highlight the meat factories which, as has been said, have major difficulties with convection, conditioning and temperature. The issue of congregated settings arose in direct provision centres and factories.

I refer to an extraordinary deal that was done in the early stages of the pandemic with private hospitals for surge capacity. It is a pity that the Minister for Health is not present or I would remind him how strident he was in calling for that deal to be examined. Significant bed space was booked that was not ultimately required but the elective capacity available in private hospitals was not booked, which was definitely an own goal on the part of the Government.

Other elective work has been deferred. The committee examined travel and transport, including public transport issues, which led us to the issue of mask wearing, something we should have been doing from the start. I asked for masks to be required at the end of March.

Tom Parlon from the construction sector told us that there would be a 40% increase in the cost of building the children's hospital. He might be proven right after all, if the current evidence is to be believed.

It was important that we produced a interim report on the July stimulus. There are many good initiatives in the stimulus, to which everybody contributed. To be fair, the Government and Minister for Finance took on board some of what was said.

We have learned a great deal about NPHET. Deputy Murphy, who has left the Chamber, alluded this to the fact that it was in place. I voiced my frustration in the committee quite a number of times, not necessarily with NPHET but with the way in which access to it is provided. Dr. David Nabarro from WHO stated lockdowns are not a good step. At the moment, we are going against that conventional advice but perhaps we are doing so because we have to. I believe that we are doing so in large part because we do not have adequate testing and tracing or rapid testing in place. The Minister has left the Chamber. I asked him some weeks ago whether we could provide a platform for industry to engage directly with NPHET. There are significant numbers of thought and business leaders and their opinions could have been heard.

In respect of rapid testing, the Tánaiste was before the enterprise committee yesterday and spoke about the HIQA report into some rapid testing measures, including antigen testing, which I raised with NPHET almost five months ago. He said it appeared that, according to HIQA statements, it was not that efficacious. That is extraordinary. How many antigen tests were examined in a pool as opposed to some of the specifics?

We produced interim reports on testing and tracing, nursing homes and stimulating enterprises, all of which was valuable work. We also asked where we are now. I hope that the Government takes on board the committee's recommendations. I agree with Members who said that it is a pity that the committee has been disbanded. We probably need it now more than ever. Significant expertise was built up by Deputies and other senior experts in the committee. It would be good to have that level of interrogation of our state of readiness at the moment.

There are Covid pathways in hospitals, which is very good from the point of view of managing and trying to defend against the introduction of disease. However, that has happened at a significant cost in terms of delays to other elective treatments. We heard about people who are waiting on operations, in particular those who are awaiting diagnostic tests for cancer. That is something that needs to be moved up the chain of importance in the HSE. We must defend against Covid, but we must also find ways to deal with diagnostic cases. I asked the Minister to consider increasing the hours available in our public hospitals where there is large capacity after 4 p.m. to carry out diagnostic tests and imaging if we can find the wherewithal with the workforce to do that.

Beyond that, we also examined the future economic outlook. We have taken on unprecedented levels of borrowing and also have unprecedented levels of mandated unemployment. We need to think about what the economy will be like when we get out of this.

The experience of a large proportion of our private indigenous and smaller SMEs - I remind everyone in the Chamber and anybody watching the debate - is completely at odds with what is happening in the public sector. These people have been furloughed and indebted, and have experienced significant reductions in their pay. They are not able to get out and socialise or open their businesses. We must reconsider increased special measures, particularly for that sector, where a number of businesses have fallen through the cracks of the stimulus provided.

Most of all, we need social solidarity. We need to consider these further supports for the critical sectors while, at the same time, reflecting that we must get on top of the disease. Testing and tracing is the key. We will have to bring in rapid testing because it is quite likely, despite all the optimism, that vaccines in any numbers will not be here before April at the earliest . We are going to have to deal with the issues of Covid for a long time. It is the responsibility of everybody in the House and every citizen to try to ensure that this lockdown is the last we impose on the people. We must find a way of living with and managing Covid, and keeping businesses some way able to operate, even in a very small way, as Deputy Durkan noted. We must allow people in small businesses and private mom-and-pops to be able to get some income into their stores and to get some of their lives back.

Deputy Fergus O'Dowd

I welcome the debate and congratulate Deputy McNamara, on his performance as Chairman of the committee, his fairness and the way he dealt with the issues. I also pay tribute to all those families who have lost loved ones in nursing homes or outside them to Covid-19. The Irish Times today published the pictures of 100 people who are deceased. Some of those families have contacted me. It is a deeply difficult moment for them and we have to acknowledge that.

I acknowledge the fantastic work that nurses and home care assistants have done in nursing homes and hospitals. Without them, the situation would have been much worse than it turned out to be. Doctors and healthcare professionals were unstinting in their care, dedication and commitment. I want also to mention the Army and the Defence Forces, which were very active behind the scenes and which were very helpful. They are the unsung heroes, in many ways, because of what they have been doing. Perhaps we ought to encourage them and allow the Minister for Defence to talk about all the fantastic work they have done. I am not forgetting about agency nurses. Agency nursing is a very difficult profession because it is uncertain and the pay is not always adequate. They too did fantastic work, as did all the support services in the State and the public generally.

They were all the good things that happened and they make us stronger, not weaker. They make us want to respect and will, hopefully, inspire young people to get involved in the caring careers. In this pandemic, which came on us all throughout the world out of the blue, the response has been fantastic. There are, however, serious issues and Covid has not gone away. I agree with some speakers that the threat is ever-present, and I believe it is growing. Covid is again stalking, regrettably and sadly, our nursing homes. Let us examine those nursing homes and see what they are composed of. There are 585 nursing homes and 31,969 beds. Of those nursing homes, 115 have one or more restricted conditions, meaning they do not meet the full requirements of HIQA. An unbelievable percentage, 34%, of premises are not compliant. Perhaps the most frightening statistic of all is that 195 of those nursing homes are not compliant in fire safety. That is a very serious issue.

All those facts are contained in the HIQA annual report for 2019. That was last year but it was published in August of this year and it is the latest report we have. We do not have many of the other figures that are due to be published by the authority soon. These serious issues in the market must be addressed. Of the investigations that HIQA carried out in respect of dementia, only 49% of the homes were fully compliant. A total of 19% were moderately non-compliant, while about 5% had serious non-compliance. For everyone who lies in a bed in a nursing home tonight, that is a poor return for their €1,000 a week for their care. There should be 100% compliance in all these issues and it is entirely unacceptable that this is the situation.

Many of those who work in nursing homes are poorly paid and have poor conditions of service. Many of them are recent immigrants and have no proper sick pay. They are vulnerable workers, have poor accommodation and many of them have to work in more than one location to make a living. Their status in our society is too low and it is not acceptable. There is a deep flaw at the heart of our long-term care and it is how we treat the people who work there. Nevertheless, nursing home owners are well paid and the top 12 or 13 make hundreds of millions of euro every year. It is interesting that 22 nursing homes changed hands in the past year, and it is people from outside of Ireland coming here to invest in the industry. That raises a big red flag for me. I agree with the view that we cannot allow the privatisation of nursing homes and care of the elderly to continue. We must reverse that, as we are doing with respect to housing, and ensure that the HSE and the State step in. We cannot have the exploitation of people, as is happening in what I accept is a small minority of nursing homes.

Today in the courts, in a case involving Oaklands Nursing Home in Listowel, which had six Covid-related deaths recently, the HSE and HIQA outlined that there were seven inspections this year. The most recent one on the HIQA website, at 7 p.m. today when I looked at it, took place on 18 June. We are now in November. This was when the pandemic had hit and we all knew what had to be done, but what did not happen? There was no person in charge, no social distancing, no clinical oversight and the food and nutrition were not adequate. There was no appropriate and proper medical management. The staff were wearing no surgical masks. There was no management system in place to provide safe, appropriate and constant care, and there was poor and unacceptable infection control. I reiterate that the date of that inspection was 18 June. The draft report was issued to the nursing home on 9 July, with a deadline of 30 July to comply. The chief inspector was not assured by the documentation supplied, but HIQA waited until today to go to court to take over that nursing home and six deaths occurred there. Something is rotten at the heart of this system that allowed that to continue. It is not for me to lay the blame but to explain the facts as I read them. HIQA does a fantastic job and I will not take from anybody working there, but it is entirely unacceptable that this level of abuse of patients was allowed to continue for so long.

I warn those watching the debate that the virus is again stalking our nursing homes. We must act now as a community. I acknowledge the work that Dr. Tony Holohan is doing and I reiterate what NPHET is saying. We are at a turning point now. In fact, the curve has turned upwards, not down. In New York, schools are being closed and people are being told not to travel at all for Thanksgiving, while in the UK, there are tens of thousands of cases every day. We are at a very difficult point and must fully ensure that no effort is spared in helping these people, particularly in nursing homes. One of the problems with the virus is that it has a severely negative impact on residents in nursing homes because meaningful socialisation has stopped.

There is a very significant increase in mental health issues. The incidence of dementia, depression and anxiety among residents has increased exponentially. Loneliness, as we know, is also a problem. Families who have loved ones in homes cannot see, visit or hug them. That is hugely damaging to those relationships because it prevents families from expressing the love and care they have for their loved ones. I accept that the current situation is extremely difficult for everybody but we need to put much more help in place for people in those situations. In terms of media advertising, there should be advertisements for helplines, particularly for families of people in nursing homes. Many of them are old and feeble themselves and they need that support. We must do more for people at this difficult time, when more that 2,010 people have died of Covid, the majority of them in nursing homes. As I said, the virus has not gone away. In fact, it is surging again.

I thank the Minister of State, Deputy Butler, for listening to my concerns whenever I have met her to discuss them. I extend the same thanks to the Minister for Health. There must be an inquiry into Dealgan nursing home. There are two nursing homes where events have given cause for serious concern during this awful pandemic, the latest being in Listowel and the first being the Dealgan home. The latter is the only nursing home where there were practically no staff in place because most were out sick or had left. Awful things happened there and the families need the truth about it. The truth must be found for them and I believe the Minister of State is committed to finding it. What happened is entirely unacceptable. We have talked about it before and we will talk about it again. I urge the Minister of State, if she can, to tell us what she is going to do about it. It is three weeks since we had the meeting about it and the families want an investigation into what happened.

The country has come a long way and we are now at a crossroads. The danger is that the virus is on the rise again. Our nursing home residents are extremely vulnerable in the short, dark, dank days and long nights we are facing into now. I urge absolute vigilance at this time of serious risk for people. In particular, there must be more action and greater commitment from HIQA in respect of nursing homes.

Deputy Michael Collins

I am sharing time with Deputy Mattie McGrath.

As a member of the Special Committee on Covid-19 Response, I take this opportunity to thank the Chairman, Deputy McNamara. He put a huge amount of time and effort into his role and was a very fair Chairman throughout the whole period during which the committee met. I thank the leader of the Rural Independent Group, Deputy Mattie McGrath, for allowing me to be part of the committee. We worked very hard and diligently and the Minister was part of that during the early stages of the Covid crisis.

I do not have time to discuss all the many issues that arose in the course of the committee's discussions. Instead, I will refer to a few specific areas in which the State definitely failed in its response, at the cost of causing great difficulties for many people and, indeed, at the cost of lives lost. Testing was an issue on which we had a great deal of discussion. I made the case that it did not make sense for the Government to be sending swabs to Germany - even to the extent of purchasing a PC-12 aeroplane, at a cost of more than €5 million, to transport them - when laboratories in Ireland were willing to do the testing. A tiny bit of investment would have enabled them to do so. There was one company in Bandon in west Cork that needed only to make small improvements for a tiny investment, but there was no interest in that. It was all about looking elsewhere and what was happening in Germany was fierce dramatic at the time. We also discussed rapid testing at airports and I tried to persuade the then Taoiseach that this was the way to go. When I raised the matter on Leaders' Questions, he refused to consider it, which was the same response I got from some of the airports. Now we are told it is the most important thing we have to put in place.

We talked about nursing homes and community hospitals. There was a lot of pointing of fingers at everybody else when the real culprit was, in fact, the State. In the community hospital in Clonakilty in west Cork, a lot of people died from Covid. That is not down to anything the staff did wrong. They were failed by the State in that the hospital was not brought up to HIQA standards. Year after year, when the deadline came up to improve the standards, successive Ministers chose to extend the deadline. This failure to act cost people their lives. We still have cases today where people are unable to get access to community hospitals because the bed numbers have been reduced.

We need to move on and look at other issues that are being severely affected by the Covid crisis. One of those issues is access to medicinal cannabis. I am disappointed that the Minister for Health is no longer in the Chamber to hear what I am saying about this. I spoke recently to Vera Twomey, who has been a great activist on this issue on behalf of her daughter, Ava. There is talk now of access to the drug being suspended. I ask the Minister of State to look into this issue. There are a number of families who are affected by it. In fairness to the Taoiseach, he has put a lot of effort into dealing with it. I ask that the Minister of State at least return Ms Twomey's calls and try to resolve her difficulties.

The cross-border health directive is another issue I would like to discuss. Unfortunately, I am almost out of time. A lot of people awaiting cataract operations are in danger of going blind. The Minister needs to come into the Dáil and tell us whether that scheme is going to continue.

Deputy Mattie McGrath

I am glad to have an opportunity to contribute to this discussion. I begin by thanking Deputy McNamara for doing, from what I saw of the proceedings, an excellent job as Chairman of the Special Committee on Covid-19 Response. I thank Deputies Michael Collins and O'Donoghue from our group for their diligent attendance at, and contribution to, the committee's work.

The Minister for Health said in his contribution at the start of this debate: "Our numbers have increased in the past week ... but right now we still have the third lowest rate of Covid per 100,000 population anywhere in Europe." Why then is there all this fuss? We have to consider the other health issues people are dealing with, including mental health problems. I am glad the Minister of State with responsibility for mental health is in the Chamber. There is not a mental health bed to be had in Tipperary. People cannot access a long-stay bed anywhere.

We must ask why the Minister did not stay in the Chamber to hear what we have to say. Has he got something against us? He was with us when he was in opposition, challenging the then Taoiseach and the then Minister for Health. Now he is on the other side of the House, poacher become gamekeeper, and he has no interest in what we have to say. He is showing total disrespect for us and for the House.

Why must we have such a disproportionate response to the Covid pandemic? It is a serious issue and a single death is one too many. However, I do not trust the figures and I do not trust the PCR tests, and my concerns in that regard have been proven. The Government will not let any of the scientists or medics with a contrary view within an ass's roar of the discussions. We have a controlled Opposition, a controlled media and a controlled everything else. It is time we let the people of Ireland live. We in this House are fine because we are getting our wages the same as we always did, as are other public servants. What about the unfortunate self-employed people? What about the unfortunate people aged over 66 who are not able to live and do not have a penny? What about the small and medium-sized businesses, as Deputy McNamara and others referred to, that are not getting anything? The lifeblood is being squeezed out of them and they cannot get any bit of solace at all. We need to have balance in our approach instead of this disproportionate impact on people.

Of course we must live with the virus. We are hoping for vaccines but, as other speakers said, I expect we will be waiting. There are games being played by the big pharmaceutical companies, with the talk of being 95% ready or 95.5% ready. It is a big game about who will be first over the line with the magic bullet. That magic bullet will not be what the Government seems to think it can be. The people of Ireland are depressed and downtrodden, with no bit of hope at all coming into Christmas. People are wondering whether shops and other places will be open or closed. Ordinary people want to get out and work. One would think there is no end to the money the Government can throw out for different supports.

The HSE is, and has been, dysfunctional. I am disappointed with Deputy O'Dowd for singling out two particular nursing homes. What about the HSE disasters? Who put the patients with Covid into the nursing homes but the HSE? It was not fit to manage this or any crisis. We see what is happening with the children's hospital at this time. It is an abomination and it is scandalous. I have no faith in the Minister for Health. It is nothing personal but I have no faith in him or the HSE, who are a case of Tweedledum and Tweedledee. The Minister told us in the convention centre that if he was an outsider, he would still be objecting and looking for answers, but he will not give any answers now that he is on the other side of the House. I am fierce disappointed with the way he is treating this House. No matter what debate he is taking, he is flying away from us like snow off a ditch in case we challenge him. It is shameful.

Deputy Joan Collins

I thank the Special Committee on Covid-19 Response for doing this fierce body of work and the recommendations in it. It looks like most of the recommendations will go to the select committees to be overseen and to make sure, where possible, that they are implemented.

I was not a member of the committee. I would have liked to have been, as I was on the Sláintecare committee and I know the amount of work that members get involved in with public representations and the wealth of knowledge that one learns from being a member of such committees, particularly in relation to how our services work.

In approximately two weeks' time, extremely important decisions are expected to be made regarding what level of restrictions are required to hopefully continue to bring the Covid-19 pandemic under greater control. The problem is we seem to be making these crucial decisions in the dark regarding which measures are most effective. After eight to nine months, we seem to know little as to where the cases are occurring most frequently and where the risks of outbreaks are the highest. When one sees community contact, we are effectively saying we do not know where it is.

The pandemic has exposed many failings in our healthcare system and now we are seeing the consequences of the lack of funding, resources and, to put it bluntly, respect for those working on the key question of public health services.

Many Deputies raised the need to track and trace, the need to hunt the virus down and the need to do this and that. Public health specialists have a key role in the track and trace system. They can identify common exposure events and uncover clusters. They link apparently sporadic cases to one another. They can get to the causes of outbreaks and make the risk assessments and advise accordingly. Retrospective case control studies are crucial to the understanding of what works in terms of prevention and control and we should be on top of that now coming out of this second strict restriction.

When the pandemic struck, our public health service had nowhere near the capacity to deal with it. In a recent radio interview, Dr. Marie Casey in the mid-west stated that there are approximately 60 public health specialists, with 40 on the front line at present. Scotland has three times the number of public health specialists and is actively recruiting at present. We are not. That is the madness. That is what she said. They also have bigger teams of staff working with them. Here, we have no teams. There is a major problem with recruitment due to the fact there are no teams. There is no attraction to the specialty. There has been a call overseas. We have not got the response on that. I have seen an article by a public health specialist in Queensland, Australia, who stated that while he would love to come back, it is not attractive to work in the specialty.

These public health specialists have no right to take part in research programmes. They have a single-point salary scale. There is no movement for progression for these specialists. There is a single-point salary scale with no prospect of promotion and despite lip service, consultant contracts have still not been drawn up. The position of the director of the Health Protection Surveillance Centre has been vacant for years. No one is going near it. It was filled for one or two months over the past two or three years. It is just vacant, and that is the key role in public health in this country.

A Crowe Horwath report that was completed in April 2018 was commissioned by the Government. The recommendations contained within the Crowe Horwath Report were considered by the Department in the context of both Dr. Scally's recommendation and ongoing work in relation to Sláintecare. The Department stated that a process of engagement around implementation of these recommendations, including the development of a significantly different operational model for the delivery of public health medicine services, would commence with stakeholders early in 2019. We have a situation where these workers are voting for industrial action because none of this has been implemented. It has not even started. It has not even gone to the Department of Public Expenditure and Reform in relation to funding. This is in the middle of a pandemic and coming out of this restriction and asking how will we deal with this over the next period. The Government has much to answer for in relation to the past eight or nine months.

The inadequacy of the situation leaves us in a situation where some restrictions will be lifted in December in a hit-and-miss scenario with another possible blanket lockdown necessary in January. It is probably too late to correct the situation. As we have said so many times in the Dáil Chamber, lessons need to be learned but we are neither learning nor implementing them. Deputies in this Chamber have stated that people must respond and take responsibility. The Government must take responsibility. The Government must implement what it can implement to the poor people and then explain to them what needs to be done, and the people will support it.

In relation to track and trace, in general it seems we are still way off the HSE target of 800 contract tracers. This led to the system being overwhelmed in October with anything from 10,000 to 15,000 people being asked to track and trace their own contacts. I believe there needs to be many more than 800. I am not an expert but I think that is the case.

Finally, we have had good news of a possible effective vaccine being available early in the new year if it is peer reviewed and accepted. However, a vaccine only works if sufficient numbers avail of it and there is a real question here about how available these vaccines will be internationally, and particularly to poorer countries. Already, 80% of Pfizer and Moderna's output over 2021 has been bought up by the richest countries - the US, Canada, Japan, the UK and the EU - representing only 12% to 14% of the world population. India and South Africa have made a proposal to the World Trade Organization, WTO, to suspend global trade rules on health products until widespread vaccination takes place and we achieve global herd immunity. This would make companies such as Pfizer unable to defend their position to patent these vaccines for 20 years and allow the technology to be copied by other manufacturers. The Government must take a firm stand on this issue supporting countries in the global south to put people's health before the profits of these pharmaceutical companies. We cannot have the global rich taking all these vaccines. I would be first in the queue but we cannot have a case like this where poor countries are being left isolated. We need an international response to this.

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

I thank all the Deputies for their contribution to this debate. Covid-19 has dominated the lives of our people, and, indeed, people around the world, for most of this year and it is fitting and correct that the Oireachtas gives due consideration to the response that continues to be mounted by the State.

The work of the Special Committee on Covid-19 Response is one important area of the role which the Oireachtas has performed on this issue. I acknowledge the work of the committee, the members and the secretariat, and, of course, the Chair, Deputy McNamara, for his efforts. As the House will be aware, I was also a member of this committee prior to being appointed as Minister of State. I have to say I found it to be a very effective committee. Everybody who came in was always well prepared. There was always huge demand for speaking time. There was not a spare minute. At that time, we had to leave the Chamber after two hours had passed. I was happy to chair some of the sessions as well to give the Chairman a break because we were doing three, and sometimes four, sessions every day, such was the intensity of the committee at the time. I compliment Deputy McNamara. The Deputy was impartial when dealing with all the members of the committee, regardless of party and none, and I thank him for that.

As the Minister for Health stated in his opening remarks, we have travelled a long road in relation to Covid-19. It was only about a year ago that we saw the first cases of Covid start to emerge in Wuhan and elsewhere in China, in December and January. None of us could have foreseen last Christmas what this Christmas might be like.

Because there has been a huge amount of conversation tonight on nursing homes, I will focus on that part in the amount of time available. It is important that we realise that a huge amount of work has been done in respect of nursing homes since the pandemic and its many challenges. I wish to remember tonight that during the first spike of the pandemic, we lost 985 of our citizens in nursing homes. Our thoughts and prayers go out to each and every one of their families. When one is sitting down this Christmas and there is an empty chair at the table, that is when it hits home. I know these people were resident in nursing homes but they would have been visited at Christmas time by family members.

To be clear, we are providing a lot of assistance to nursing homes.

Up to €92.5 million has been made available in 2020 to private and voluntary nursing homes under the temporary assistance payments scheme, TAPS, to contribute toward the costs incurred by private nursing homes in acting to suppress and manage Covid-19. A further €42 million has been made available up to June 2021. Obviously nursing homes need more staff; they need more infection prevention and control. They need a lot of supports in place in order to support their residents.

Serial testing of all staff in nursing homes has been ongoing on a fortnightly basis since the end of June. A total of 300,000 tests have taken place and it has proved really effective because if people who are asymptomatic are on the roster for a particular day, they can stay off work if they discover they have the virus to ensure they do not pass it on.

We all know there were huge challenges with PPE provision at the start of the pandemic. Deputy NcNamara will recall we heard about the issues with trying to get PPE in March, April and May. Thankfully that has all been resolved and all nursing homes have an adequate supply. When they have an outbreak there is absolutely no issue with getting PPE to them.

A total of 23 Covid-19 response teams have been set up to provide multidisciplinary and expert advice in the event of an outbreak. I am not going to mention any specific nursing homes, but when a home has difficulty, when their patients go down with Covid or their staff do, these disciplinary teams move in and are there to help and advise and it has made a difference.

As we know, HSE staff have been redeployed to alleviate staff shortages. There is also provision of accommodation for all healthcare workers affected by Covid-19 if they require it.

Much good work has been done. When we are talking of Covid, the most important thing is that we learn. It is very important we learn from what has gone on previously and, as I said, I fully recognise the deep sense of grief and loss felt by families who have suffered a bereavement during the pandemic. To reiterate what the Minister, Deputy Donnelly, said at the start, there are many families looking for answers and we are currently looking at the best way to get them those answers.

An Ceann Comhairle

I join with all of those saluting Deputy NcNamara for the superb job he did leading the committee. He may wish to reply to the debate we have had.

Deputy Michael McNamara

I thank the Ceann Comhairle both for his compliments and for the assistance he gave the committee at various crucial stages. There were inevitably difficulties with accommodating a committee at a difficult time and when advice was novel, as it inevitably is in the context of a novel coronavirus pandemic.

I welcome the fact that both the Minister of State and the Minister have said they are looking at how answers will be given to families. The committee obviously came to the very clear recommendation that a statutory inquiry is the way to do that. If there is another way to do that we were not aware of it. If there is then that is well and good but I think we are all agreed that they need answers and not at some indefinite point in the future. They need and deserve answers.

The committee also had a recommendation around an inquiry into meat plants. Notwithstanding Deputy Eoghan Murphy's comments about the frailties of an inquiry, I am a little bit disappointed by the lack of any sort of movement towards looking at what happened. What happened in meat plants was in some respects different from what happened in the rest of Europe, where there was also a lot of outbreaks in meat plants. We learned that in Ireland workers in meat plants are uniquely vulnerable. They are made so by the work permit system under which they operate; they effectively work in conditions of bonded labour. That is wrong and needs to be addressed. Farmers were also treated very badly by meat plants at the time, although that is not unusual. I should declare that I am a farmer myself. We are used to being treated badly by meat plants but that does not mean it is right. It is wrong and it needs to stop at some point.

The Minister mentioned testing throughout his remarks, and an advancement in testing, and I welcome that. He limited his comments however, to PCR testing. I appreciate that even the Minister for Health does not have an endless amount of time to read everything but there is a new document being considered by EU leaders today. It concerns a European Commission recommendation around rapid antigen testing. I do not know what the outcome of it was; perhaps he will be able to find out from the Taoiseach. PCR testing is the gold standard recommended by the WHO and everybody accepts that. It has frailties however, and many of them. It may be that it is the best type of testing there is, those frailties notwithstanding. Among those frailties is the fact it is very expensive and it takes a lot of time. It seems there is a role for rapid antigen testing, particularly perhaps, in seeking to open up our aviation sector on which we in Ireland are uniquely reliant. I look forward to the Government expanding on that in conjunction with other EU member states.

Various Members referred to the winding up of the committee and it would be remiss of me to not say that the committee did not decide we were sick of it and should wind up - it was wound up by a Dáil motion put down by the Government. That is democracy; it is a great privilege to live in a democracy, one we cannot take for granted, and one must accept the decisions of the majority. I agree with Deputy Patricia Ryan that we cannot talk about a new normal. The basic right to liberty and to live in a democracy are important and cannot be forgotten about. In our response we need to ensure that we do not somehow fail to value what is truly important to us. Deputy Cullinane said he disagreed with me but is it not a fantastic thing that we can disagree in our democracy and we can move on without vilifying and attacking each other? We need to maintain that and it is important to debate our response to this as a State, a nation and a people in the Dáil, and to hold the response to account more in this House.

There was also discussion of proportionality. We cannot lose sight of the fact that 2,000 people have now died with coronavirus in Ireland. We do, however, need to get some more statistics, namely, who died, for how many of the 2,000 people who died was Covid the major cause of death and, even more important, how many of those contracted the virus in hospital after going there with something else. These are important statistics and I do not seek them to minimise Covid-19 or to seek to say it is not important. It is important, but so is so much else. If the mortality rate in Ireland is approximately what it was this time last year, then 3,800 people will have died during the duration of this lockdown. That is 3,800 people who may have died without seeing loved ones. There are people who are not going to get a chance to say goodbye. There are also people who die unexpectedly but how awful to not have seen a parent, sibling or loved one in the last month. We need to reflect on that and maintain perspective. It is important we maintain that proportion and our humanity, that which enables us to think we are made in the image and likeness of a divinity.

I will finish by thanking people without whom the committee could not have run, particularly the clerks in the secretariat for all the work they did to enable the committee to sit, particularly during the summer vacation. I thank the Minister, Deputy Donnelly, and indeed NPHET who came in during the summer vacation to answer questions. Lastly, I thank the witnesses who gave of their time and of their expertise at a time when they were exceptionally busy.

Question put and agreed to.

The Dáil adjourned at 8.58 p.m. until 2 p.m. on Tuesday, 24 November 2020.

Dáil Éireann díospóireacht - Thursday, 19 Nov 2020

Special Committee on Covid-19 Response Final Report: Motion

Dáil Éireann díospóireacht -
Thursday, 19 Nov 2020