Saincheisteanna Tráthúla - Topical Issue Debate

Cuanta agus Céanna

Baineann an t-ábhar seo le ché ar Inis Oírr. Chuir mé síos an t-ábhar seo an tseachtain seo caite agus chuir an Ceann Comhairle é ar liosta cúltaca. Sin an fáth go bhfuil sé ag teacht aníos inniu. Fáiltím roimh an deis labhairt faoin togra seo mar tá a lán cainte taobh thiar de gan aon bheart.

Bhí cruinniú dearfach inné. Bhí na hionadaithe ann ar Zoom ón oileán agus bhí cuid de na Teachtaí Dála agus an Seanadóir Kyne i láthair. Is dearfach an rud é sin. Cuid den fhadhb, áfach, ná go bhfuil dhá Roinn i gceist. Is maith an rud é go bhfuil an tAire Stáit anseo agus go bhfuil an díospóireacht seo ar siúl trí Ghaeilge ach baineann an t-ábhar seo leis an Roinn Forbartha Tuaithe agus Pobail freisin agus leis an Aire Forbartha Tuaithe agus Pobail, an Teachta Humphreys.

Dúirt sí go raibh sí thar a bheith dearfach. Cuirim fáilte roimhe sin ach roimh an tAire seo, bhí Airí eile ann a bhí dearfach freisin ach fós tá fadhbanna ollmhóra leis an gcé, go háirithe ó thaobh cúrsaí sláinte agus sábháilteachta. Chomh maith leis sin, tá fadhbanna maidir le dul chun cinn san oileán mar is gné lárnach den saol í an ché ó thaobh fostaíochta, ó thaobh na n-iascairí agus ó thaobh na ndaoine iad féin.

Bhí mé ag breathnú siar ar fhreagraí parlaiminte agus chuir an Teachta Ó Cuív a lán ceisteanna faoin ábhar seo. Tá an freagra ceannann céanna á thabhairt anois ar feadh ar a laghad dhá bhliain, go háirithe ó 2019 ar aghaidh. Bhí an Rialtas ag caint faoi chás gnó in 2019 agus táimid fós ag caint faoi chás gnó in 2021. An t-aon dul chun cinn atá feicthe agamsa ná go bhfuil sprioc ama sé seachtaine i gceist anois, chun deis a thabhairt do cibé Roinn atá i mbun na hoibre sin measúnú a dhéanamh ar an gcás gnó. Tá súil agam go mbeidh an Rialtas sásta leis an gcás gnó. Ansin tá tréimhse de shé mhí i gceist chun an próiseas tairisceana a chur chun cinn. Sin an áit a bhfuilimid faoi láthair.

Bhí cur i láthair iontach againn inné ón toscaireacht ó Inis Oírr agus is fiú breathnú air. Níl an t-am agam anois ach ba mhaith liom an tréimhse ama a lua. Tá sé seo ag dul ar aghaidh ó 2003 go dtí anois agus tá geallúintí agus geallúintí á dhéanamh. An rud a sheas amach ná go ndearna an toscaireacht tagairt don ché i Dúlainn. Laistigh de thrí mhí bhí deireadh leis an obair ar an gcé i Dúlainn agus tá muintir Inis Oírr ag fanacht ó 2003 le geallúintí éagsúla. Ag an bpointe seo, an bhfuil freagra ag an Aire Stáit faoin tréimhse ama? An gcloífidh an Roinn leis an sprioc ama de shé seachtaine don chás gnó agus an sprioc ama don phróiseas tairisceana? An dtabharfaidh an tAire Stáit sprioc ama maidir le tús na hoibre agus deireadh na hoibre? Tá gá práinneach leis an obair sin.

Tá sé mar chuspóir lárnach ag an Roinn Forbartha Tuaithe agus Pobail go ndéanfaí caomhnú ar bhonn inmharthana ar phobail na n-oileán amach ó chósta na tíre. Mar chuid den chuspóir sin, tá sé riachtanach go mbeadh rochtain shábháilte ag na hoileánaigh agus ag cúirteoirí chuig na hoileáin. Chuige sin, aithníodh le tamall gur theastaigh go ndéanfaidh forbairt ar ché Inis Oírr, agus tá tagairt shonrach déanta don togra seo sa phlean forbartha náisiúnta. Tionóladh cruinniú idir an tAire Forbartha Tuaithe agus Pobail, an Teachta Heather Humphreys, toscaireacht ó Inis Oírr agus baill an Oireachtais inné chun an cás a phlé. Tuigim gur fhreastail an Teachta Connolly ar an gcruinniú fíorúil sin freisin.

Aontaíonn gach duine go bhfuil gá le forbairt shuntasach a dhéanamh ar ché Inis Oírr ar mhaithe le sábháilteacht na ndaoine atá ag baint úsáid as an gcéibh, idir oileánaigh agus chuairteoirí. Tuigim gur aithníodh é seo chomh fada siar le 2007, nuair a forbraíodh cur chuige a chuimsigh síneadh ar an gcé agus tonnchosc chun aghaidh a thabhairt ar na tonnta ag dul thar an gcé. Ar chúiseanna éagsúla, lena n-áirítear tionchar na géarchéime airgeadais ar chaiteachas phoiblí, níor cuireadh an fhorbairt seo i gcríoch faoi mar a bhí beartaithe.

É sin ráite, tá dul chun cinn déanta le cúpla bliain anuas agus is gearr go mbeidh Comhairle Contae na Gaillimhe ag dul i mbun tairisceana chun cé nua a dhearadh agus a thógáil. I dtreo dheireadh 2018, chuaigh Comhairle Contae na Gaillimhe i mbun oibre ar chás gnó nua, chun meastachán nuashonraithe ar chostais a áireamh agus chun riachtanais an chóid chaiteachas phoiblí a chomhlíonadh. D’oibrigh oifigigh na Roinne agus Comhairle Chontae na Gaillimhe as lámha a chéile chun an cás gnó a thabhairt chun críche agus tuigim go bhfuil an fhaisnéis uile a theastaíonn chun tacú leis an gcás gnó seo faighte anois ag an Roinn Forbartha Tuaithe agus Pobail ón Aoine seo caite, an 5 Feabhra. Tá an cás gnó á scrúdú ag an Roinn anois agus tuigim go bhféadfadh sé timpeall sé seachtaine a thógáil chun an próiseas a chríochnú.

Ach an cás gnó a bheith faofa ag an Roinn, is féidir le Comhairle Contae na Gaillimhe tairiscintí dearadh agus tógála a lorg d’fhorbairt na cé. Meastar go dtógfaidh an próiseas tairisceana dá leithéid seo de thogra thart ar naoi mí. Is tionscadal suntasach é forbairt na cé ar Inis Oírr agus déanfar an maoiniú don obair seo a sholáthar thar roinnt blianta, de réir an chláir tógála. Tuigim go bhfuil cás láidir déanta ag an Aire, an Teachta Humphreys, leis an Aire Caiteachais Phoiblí agus Athchóirithe chun maoiniú a chur in áirithe don ché seo mar chuid den athbhreithniú ar an bplean forbartha náisiúnta. Idir an dá linn, tá maoiniú breise ar fáil i mbliana ag an Roinn Forbartha Tuaithe agus Pobail do mhion-oibreacha ar na hoileáin. Molaim go láidir do Chomhairle Contae na Gaillimhe iarratas a dhéanamh ar an maoiniú seo le haghaidh aon oibreacha eatramhacha a d’fhéadfaí a dhéanamh chun go mbeadh an ché níos sábháilte d’úsáideoirí.

Is féidir breathnú ar aon fhreagra go dtí seo agus bheadh sé mar an gcéanna. Deir an freagra ó Dheireadh Fómhair 2019: “Agus an cás gnó a bheith faofa, is í an céad céim eile sa phróiseas ná tairiscintí a lorg don obair.” Sin in 2019. Is féidir dul siar agus dul siar ach ní hé sin atá ag teastáil uaim. De réir mar a thuigim, tá cúrsaí pleanála réitithe agus bhí an t-airgead curtha ar fáil. Rinneadh praiseach den rud seo ach ag an bpointe seo teastaíonn aitheantas, ar a laghad, go bhfuil gá práinneach leis an obair agus nach bhfuil sé sábháilte ar leibhéal bunúsach ar an gcéibh sin.

D’admhaigh an fear a bhí ag tabhairt an chúlra dúinn inné go raibh sé san uisce faoi dhó é féin. Bhí timpiste ann maidir le bád agus tá tuarascáil scríofa faoi sin ach níl aon tuarascálacha faoi na daoine a cuireadh isteach san uisce de bharr na dtonnta a thagann trasna ar an gcéibh. Táimid bréan de gheallúintí. Táim ag iarraidh oibriú in éindí leis an Aire Stáit agus na Teachtaí eile. Tá sé tuillte ag muintir Inis Oírr go gcomhlíontar na geallúintí anois, go leagtar síos spriocanna ama agus go gcomhlíontar iad. Sin an rud atá ag teastáil. Táimid ag fanacht do pholasaí do na hoileáin agus ar a lán rudaí eile. Ag an bpointe seo, is féidir le muintir Inis Oírr fanacht cúpla mí ach sin amháin má tá an tréimhse ama ann agus má chloímid leis.

Gabhaim buíochas leis an Teachta as an ábhar seo a ardú tráthnóna inniu. Tá gach rud atá ráite aici nótáilte agam agus ardófar na pointí seo le hoifigigh na Roinne. Tuigim go bhfuil an cheist seo an-tábhachtach do mhuintir Inis Oírr. Tuigim an imní agus an frustrachas atá ar mhuintir Inis Oírr freisin faoi staid na cé. Cé go bhfuil moill leis an togra, tá sé tábhachtach go ndéantar gach iarracht anois an tionscadal a bhrú chun cinn agus tairiscintí a lorg le rochtain shábháilte a chinntiú d’oileánaigh agus d’úsáideoirí na céibhe. Mar a mhínigh an tAire ag an gcruinniú inné, is tosaíocht di é forbairt ché Inis Oírr, agus tá i gceist aici go dtabharfaí tosaíocht di sa phlean forbartha náisiúnta athbhreithnithe i mbliana.

Agus an togra seo á chur i gcríoch, molaim do Chomhairle Contae na Gaillimhe gach rud gur féidir leis a dhéanamh chun aghaidh a thabhairt ar shaincheisteanna sláinte agus sábháilteachta, lena n-áirítear trí fhorbairt a dhéanamh ar an bhféidearthacht go ndéanfaí mion-oibreacha nó fodhlíthe a d’fhéadfadh tacú le pobal Inis Oírr. Cé go bhfuil sé riachtanach tabhairt faoi phróiseas chuimsitheach agus críochnúil tairisceana do dhearadh agus do thógáil na céibhe, tá mé muiníneach go ndéanfar dul chun cinn suntasach maidir leis an togra seo le linn 2021, go háirithe leis an dea-thoil a léirigh na páirtithe uile a bhí i láthair ag an gcruinniú leis an Aire inné. Iarrfaidh mé ar an Aire teacht ar ais ag an Teachta go díreach maidir leis na pointí eile a luaigh sí inniu.

Paediatric Services

I am extremely worried about developments at the paediatric diabetes clinic at Mullingar hospital, where services and appointments have ceased as a result of a farcical recruitment issue. There are 130 children attending this service, with 41 on insulin pumps.

Based on those numbers and international standards, there should be two clinical nurse specialists, CNS, attached to this service. A former CNS was due to retire in May 2019 but remained working on a part-time basis until November 2019 to ensure the service could continue. Unfortunately, it is now almost 20 months since the service has had specialist diabetic nursing support for clinics and for the necessary follow-up support services. Parents are deeply perplexed. Great credit is due to Professor Michael O'Grady who heads up the service and in recent days took the time to issue parents with a four-page document setting out the comprehensive background that has led to the suspension of services.

The case for a replacement CNS was first rejected at national director level in 2019 but, thankfully, following the intervention of Professor O'Grady, that decision was subsequently reversed. As we all know, there is a shortage of nurses qualified to work in the role of CNS in paediatric services. Professor O'Grady again intervened and asked that a background in paediatric nursing be removed from the job specification to broaden the pool of potential applications. Unfortunately, that request and advice was ignored. Not surprisingly, when the post was advertised in December 2019 there were no applicants. So began a new recruitment process which, within the HSE, typically takes six months. Once again, the prohibitive requirement that applicants have a background in paediatric nursing was retained despite the HSE knowing it would restrict the level of applications. Around this time, and in conjunction with the recruitment campaign, Professor O'Grady presented a business case for a second CNS for the service in line with the aforementioned international staffing requirements. That case was duly approved by local management but was subsequently rejected up the line.

Last September, the service was forced to scale back the number of services offered in Mullingar and to close access for new patients, who are now being sent to Dublin for treatment. The service was also forced to suspend the initiation of insulin pump therapy for new users following the departure of one of Professor O'Grady's consultant colleagues. As things stand, a replacement CNS has been approved but, unfortunately, for personal reasons, this person is not in a position to take up this position until 2022 and the service in Mullingar is paused. Children are being referred to Dublin where the service is already at capacity in the three hospitals. Those hospitals will be overwhelmed with an additional 130 patients.

Professor O'Grady has fought valiantly for more than a year to save this service. It is regrettable that the future of such an important service for our region is the subject of a debate here this evening.

I thank the Deputy for raising this issue and for setting out clearly the history in this situation, which gives me the opportunity to provide an update to the House in regard to the concerns relating to the paediatric diabetes service at the Midland Regional Hospital, Mullingar.

The HSE has advised that the Midland Regional Hospital, Mullingar, has a comprehensive diabetes and endocrinology service. This is an integral part of the overall services provided by the hospital and is supported by a multi-disciplinary team of doctors, nurse specialists, dieticians and administrative staff. The services include a rapid access diabetes service, a general diabetes clinic, a young adult clinic, a diabetes in pregnancy clinic, a diabetes foot clinic and a community e-consultation service.

We know that diabetes affects people from all walks of life, from the very old to the very young and that the number of people with all types of diabetes is predicted to increase rapidly in the coming years. Internationally, type I diabetes is increasing in all age groups. In Ireland, this is especially true in the 10 to 15 year old age group. In regard to paediatric diabetes services generally, the HSE has developed a model of care for paediatrics and neonatology in Ireland, which includes a chapter on the provision of diabetes services. This model of care highlights that high-quality diabetes care is complex and requires intensive consultant-delivered care. It also recognises that diabetes care should be provided by a multi-disciplinary team that includes clinical nurse specialists, dietetics, social work and clinical psychology.

The HSE has advised that, as highlighted by the Deputy, 130 children and adolescents attend the paediatric diabetes service at the Midland Regional Hospital, Mullingar, which consists of a clinical nurse specialist and specialist dieticians. The Deputy might wish to note that the hospital has also recently secured approval for 19-hours per week senior dietetic support. The HSE has further advised that the paediatric diabetes service was suspended temporarily last week pending the successful recruitment of a paediatric diabetes nurse, that prescriptions are still being offered through the service and that if a patient is sick, he or she can be seen through the hospital's emergency department.

The Deputy outlined that the paediatric diabetes nurse position was first advertised in December 2019. However, for a number of reasons the position was not filled on foot of this process. The position was again advertised in autumn 2020. I am advised that interviews for that position were completed recently and that an offer has been made to a successful candidate. It is, therefore, expected that the new paediatric diabetes nurse will take up employment shortly.

I welcome the response, but I take issue with parts of it, specifically that the current service consists of a clinical nurse specialist. That is not true. I appreciate that a position has been offered but the reality is the person cannot take up that position until 2022. In effect, there is no clinical nurse specialist attached to this service.

I refer to Professor O'Grady's recommendation and business case for a second clinical nurse specialist for this service in line with international norms. I acknowledge that parents and children can access services through the emergency department, if necessary, but in the context of Covid-19 we are trying to discourage that. It is critical that we get this service back up and running. It is a vital service for the region. To be honest, the response issued from the HSE through the Minister of State is not good enough for the parents and young children.

I would be remiss if I did not acknowledge Professor O'Grady who, along with his family, moved here from Australia eight years ago, settling in Mullingar town, and pioneered and developed this state-of-the-art leading paediatric diabetes service in this country, of which the hospital in Mullingar is incredibly proud. He has spoken passionately about this service. He is exasperated and the parents are crestfallen. They have spoken about the demise of the service and have communicated this in emails. To be honest, they are angry and distraught. It would seem that the only bodies that can save this service are the HSE and the office of the Department of Health. I plead with the Minister of State to take back to the HSE the message that the people of four counties, including Longford, Westmeath, Offaly and Meath, are dependent on this service and that its response via the Minister of State this evening is not good enough for the parents and children concerned.

I thank the Deputy for the constructive manner in which he has approached this matter. I take on board his acknowledgement of Professor O'Grady and all of the work he has done over the past eight years to develop this service, which is very important.

The Government is committed to further developing and strengthening diabetes services throughout the country, for both children and adults, given the prospective increases in the number of people that will be affected by this chronic health condition in the years ahead. I reiterate that it is expected that the new paediatric diabetes nurse will take up employment shortly. The HSE has not mentioned this will happen in 2022 but, coming from the particular area, I am sure the Deputy has a lot more knowledge on this issue than I do.

I understand the widespread concern that the current suspension of the paediatric diabetes service in Regional Hospital Mullingar has caused. As I said, the HSE has advised that an offer has been made to a successful candidate and the recruitment process for this post will be finalised as quickly as is possible. I am confident that the paediatric diabetes service will recommence operation when this post is filled. I will bring the Deputy's concerns to the attention of the HSE.

Covid-19 Pandemic

There are 170 people in Irish intensive care units at this time. Fortunately, that number is reducing by the day but, right now, 170 people are critically ill with Covid-19 in Ireland. That is 170 people whose families are crippled with fear. I ask the House to imagine for just a second if we could change that. I ask colleagues to consider that we could introduce a simple and cheap intervention that could decrease the number of people fighting for their life in ICUs. I ask the Government to imagine what might happen if it were brave enough to take a bold decision instead of waiting for additional evidence that may come too late. What if, by taking that decisive action, we saved hundreds of lives across Ireland?

That is what I am asking of the Minister for Health. I am asking him to be brave enough to make a decision that could change the trajectory of this pandemic and potentially save hundreds of lives. I am asking him to provide free vitamin D supplements to people who present at Covid test centres and free activated vitamin D to people on admission to hospital. I am asking that he advise our general population to start purchasing and taking these affordable, readily available supplements as part of our response to the pandemic.

All the decisions we have made during this pandemic have been rooted in science and this would be no different. The positive effects of vitamin D are widely known. Studies in the UK, France and, in particular, Spain show a direct correlation between high levels of vitamin D and enhanced immunocompetence against Covid-19. In Spain, 50 out of 76 patients admitted to hospital with Covid-19 received activated vitamin D. All of them were discharged without complications. Of the 26 patients in the study who did not receive vitamin D, half of them ended up critically ill in ICU and, sadly, two of them passed away. In Connolly Hospital in Blanchardstown, our medics have seen at first hand that patients with low levels of vitamin D are more likely to require admission to ICU and three times more likely to require a ventilator. The evidence exists and the studies are being done. There is no risk in advising our general population to take vitamin D at high dosage. The Food Safety Authority of Ireland and European studies have confirmed that.

Despite this evidence, here we are, with a Government approach that is at a do-nothing level of caution. If we continue on this path, it may be too late for the people in ICU. That is not me being dramatic. That is me paraphrasing The Lancet medical journal, which published an article last month warning us that additional evidence on the correlation of Covid-19 and vitamin D may come too late. What is taking the Minister so long to act on the evidence that exists? We already know that half of all Irish people have insufficient levels of vitamin D. We already know from the Irish Longitudinal Study on Ageing, TILDA, that the populations for whom Covid-19 is most deadly, including older people, have an 80% vitamin D deficiency. These are the cohorts that account for 50% of our fatalities. It is not just older people. A staggering 94% of black, Asian and ethnic minority people here in Dublin have vitamin D levels below the threshold for enhanced immunocompetence.

What is stopping the Minister from recommending that people start taking vitamin D to help protect themselves from ending up on a ventilator? I have tabled tens of parliamentary questions on this issue and asked for meetings between the Minister and the Covit-D Consortium, which specialises in this research. That group of experts was not even consulted by HIQA ahead of its recommendations to the National Public Health Emergency Team, NPHET. There is negligible risk in this strategy and potentially a massive gain. I am asking the Minister to include recommendations around vitamin D supplementation in the living with Covid plan. That simple act could save lives.

I invite the brave Minister of State from Waterford, Deputy Butler, to address Deputy Higgins's questions.

I thank Deputy Higgins for raising this important matter. Vitamin D is essential for bone and muscle health and to support the normal functioning of the immune system. Vitamin D can be found in a variety of foods, including in fortified cereal and dairy products, and humans can also absorb it from the sun. I take this opportunity to highlight the importance of a balanced diet that not only supports overall health but can also help to increase vitamin D intake. This is particularly important for vulnerable populations. I ask that nursing homes and all service providers continue to ensure suitable food offerings and outdoor activities are provided, as appropriate, to further maximise vitamin D intake.

Department of Health guidelines on vitamin D, which were updated in November 2020, advise adults aged 65 and older to take a daily vitamin D supplement of 15 micrograms to support bone and muscle health. In the context of Covid-19, it is currently advised that those who are self-isolating or are unable to go outside, including adults and children over the age of one, should consider taking a daily supplement containing 15 micrograms of vitamin D to ensure a healthy vitamin D status.

The role of vitamin D supplementation in the prevention or treatment of Covid-19 has not been definitively established. NPHET considered an evidence synthesis paper on the role of vitamin D in the prevention and treatment of the virus on 28 January 2021. The paper examined available research evidence up to January 2021, including recent rapid reviews, randomised controlled trial evidence, observational studies and laboratory studies. A recently updated rapid review conducted by the National Institute for Health and Care Excellence in the UK concluded that there is currently a lack of evidence linking vitamin D and the incidence and severity of Covid-19. The report advised increasing awareness of existing recommendations relating to vitamin D supplementation. Results from a randomised control trial reported reduced admission to ICU and reduced mortality in patients with Covid-19 receiving standard care plus vitamin D compared with standard care alone. However, this trial was noted to have significant methodological limitations, including low participant numbers and a serious risk of bias. Collectively, other evidence provides conflicting reports of an association between vitamin D supplementation and a reduced risk of poorer outcomes from Covid-19 infection.

NPHET agreed that, at present, there is insufficient high-quality evidence with respect to vitamin D in the prevention and treatment of Covid-19. NPHET also agreed that efforts should be made to increase awareness of existing guidance. Adults spending increased time indoors, those who are housebound or in long-term residential care and people with dark skin pigmentation are recommended to take a daily vitamin D supplement. NPHET's recommendations for the use of vitamin D are being incorporated into wider messaging and, additionally, are being communicated across the health service, including in nursing homes and social care settings as necessary. The Department of Health has recently written to the HSE and Nursing Homes Ireland to encourage implementation of guidance on vitamin D supplementation in nursing homes. In the coming weeks, a presentation will also be delivered to GPs through the Irish College of General Practitioners on the importance of vitamin D and it is expected that this will reach upwards of 3,000 GPs.

NPHET will continue to monitor ongoing developments and research in this area, particularly randomised control trials, and will review guidance accordingly. The Government will continue to look to NPHET to provide recommendations with regard to vitamin D supplementation and Covid-19. The Government remains united in its resolve to tackle the spread of the virus.

I thank the Minister of State for her reply. However, all she has done is reiterate what we already know. I do not mean to be disrespectful to her when I say that I am frustrated that the Minister, Deputy Stephen Donnelly, is not here to participate in the debate. He seems to be avoiding this issue entirely. He is giving me evasive replies to parliamentary questions and promising updates on my meeting requests which never arrive. His role is not to sit back and blindly do what he is told to do by cautious, anonymous public servants. His role is to question, probe and, above all else, act. He is not a passenger in the car; he is the person driving the car for us during a pandemic. He is choosing our course and our speed of acceleration.

I believe, as do the scientists and academics I am working with, that we cannot afford to wait any longer for action on vitamin D. We are not alone. People like Professor Luke O'Neill are flying this flag too. The Minister must make vitamin D supplementation part of the Government's new plan for living with Covid. We can look across the water for inspiration in this regard. Finland, with a higher population than us, has buried 3,000 fewer people than we have during this pandemic. For almost two decades, Finland has been fortifying its food with vitamin D.

Apart from the remote island of Iceland, the people of Finland have the lowest death rate from Covid-19 in Europe, and because of vitamin D they had a head start when it came to Covid-19.

Let us look closer to home. Right now in England - the Minister of State referenced the report - a four-month supply of vitamin D supplements is being given to those who are medically vulnerable. Those responsible have not said this new measure is a direct response to Covid-19. I imagine this is why they have not advised to go with a higher dosage, which is what the covit-D consortium are recommending. Is that because they do not have evidence to categorically and definitively say so? Instead of waiting for additional evidence that may come too late, they are acting on what they already know. As we know, in a pandemic speed trumps perfection.

It would be remiss of me not to say that the Minister for Health, Deputy Donnelly, was here this afternoon speaking on the Covid-19 vaccines question-and-answer session. I believe the Minister had another appointment.

I thank Deputy Higgins for raising this important matter. An evidence synthesis paper on vitamin D and Covid-19 prepared for national public health emergency team was discussed at its meeting on 28 January 2021. The paper examined available research evidence up to that date, including recent rapid reviews, randomised controlled trial evidence, observational studies and laboratory studies. NPHET agreed that at present there is insufficient high-quality evidence with respect to vitamin D in the prevention and treatment of Covid-19. NPHET agreed however that efforts should be made to increase awareness of existing guidance on vitamin D.

As I have said, a number of groups should take a daily vitamin D supplement, including adults spending increased time indoors, those who are housebound, those in long-term residential care and those with dark skin pigmentation. Measures are now being taken to communicate these recommendations for the use of vitamin D. Communication has been already issued to nursing homes and a presentation will be made to GPs. I encourage everyone to note the guidance from the Department of Health advising adults aged 65 years and older to take a daily vitamin D supplement of 15 µg to support bone and muscle health.

While the role of vitamin D supplementation in the prevention or treatment of Covid-19 has not been definitively established, I wish to assure the Deputy that NPHET will continue to monitor ongoing developments and research, especially randomised control trials, in this area and will review guidance accordingly. The Government will continue to look to NPHET to provide recommendations with regard to vitamin D and Covid-19.

Once again, I thank Deputy Higgins for her interest in this subject. I will certainly pass on her thoughts to the Minister, Deputy Donnelly.

National Broadband Plan

I thank the Minister of State, Deputy Butler, for taking this Topical Issue matter. On some level she got the cards no one would want. It is straightforward like that.

I accept that the Minister is busy. However, I believe this is a particular issue and I have said to an official in the Minister's office that I expect the Minister to come back to me on this matter.

There are several issues we need dealt with at Government level. We all welcome the initial roll-out of the national broadband plan. We see it in the light of rural electrification by the ESB and the Minister has spoken of it as such.

The remote working scheme has been talked up by the Tánaiste. He also said that supports are available and an attempt by Government has been made to look at every means from the point of view of accelerating this process. That is absolutely necessary. However, I believe we might need an operational point person for when there are issues relating to National Broadband Ireland that need to be dealt with, whether at Civil Service, local authority, cross-departmental or governmental level.

I had a meeting with representatives of National Broadband Ireland earlier in the week. In fairness, the chief executive officer and the deployment officer, among several others, were at it and I thank them for that. It is straightforward. I do not need to go through the ins and outs. I was given an update in respect of Louth. I could talk about areas of Louth that do not have deployment. I could talk about the difficulties that people have with remote working and home tutoring of children who are unable to be at school at this point. However, I will leave that all behind.

We know this is a plan to be rolled out to 544,000 premises. That number has increased. More people now live in the intervention areas. It was deemed that other areas needed to be included in the intervention area because their broadband connectivity was not good enough.

I will shift through to several of the problems. National Broadband Ireland, like everyone else, was impacted by Covid-19. The organisation is slightly behind but those responsible still intend to keep as close as possible to the timelines.

One issue needs to be brought up. Obviously, when NBI is operating in deployment areas tree trimming is an issue. I know it is an issue for the Irish Farmers Association and others. This could be a problem for the roll-out. We need a moratorium, or perhaps under the Act there is a means for a major infrastructure project like this to be accommodated. It needs to be dealt with as quickly as possible.

Section 254 guidelines are being rolled out in respect of poles and planning. I have been told by National Broadband Ireland that this is good. Those involved expect this to be rolled out across all local authorities. Sometimes the problem is the means by which they look for permits. They will try to deal with everything. If NBI needs to put in 50 poles, maybe 30 fit the guidelines and then the operators have to deal with the others. Problems occur during operations. One of the difficulties is the fact that they have to put in fresh planning. If that planning is with Transport Infrastructure Ireland, it could take four to eight weeks. If it is with the local authority, it could be anywhere from two days to eight weeks. That is not good enough and it is holding them up.

There is also a problem with skillsets. We need to talk with the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris. There is talk of taking in teams from abroad. There are difficulties around ensuring that safe passes can be sped up. I will deal with the other matters presently.

My thanks to Deputy Ó Murchú for raising this issue. As the Deputy rightly said, I am taking this for the Minister for the Environment, Climate and Communications, Deputy Ryan, this afternoon.

The national broadband plan contract was signed with National Broadband Ireland in November 2019 to roll out a high-speed and future-proof broadband network within the intervention area. The area covers 1.1 million people living and working in more than 544,000 premises, including almost 100,000 businesses and farms as well as 695 schools. Despite the challenges presented by the Covid-19 pandemic in 2020, National Broadband Ireland has made steady progress on initial works. I am advised by National Broadband Ireland that, as of 11 February this year, more than 174,000 premises across 26 counties have been surveyed. This is ahead of schedule.

The next step is for National Broadband Ireland to develop a network design to deliver the new fibre-to-the-home network to these premises. Substantial design work is under way. The first fibre-to-the-home connections are in Carrigaline, County Cork and Cavan. This project will be subject to technical testing and validation prior to a wider release to the area. Since 25 January, retailers have been able to resell the service. Householders in these areas will be able to order high-speed broadband provided via the NBI network. The next areas in which connections will be available are Galway and Limerick. Further details on specific areas are available through the NBI website.

NBI provides the facility for the person responsible for any premises within the intervention area to register interest in being provided with deployment updates. Individuals who register with this facility will receive regular updates on progress by NBI on delivering the network and specific updates related to their premises when works are due to commence.

Broadband connection points are a key element of the national broadband plan to provide high-speed broadband in every county in advance of the roll-out of the fibre-to-the-home network. As of 11 February 2021, some 268 broadband connection point sites have been installed by NBI. The high-speed broadband service will be switched on in these locations through service provider contracts managed by the Department of Rural and Community Development for publicly available sites and by the Department of Education for schools.

An acceleration of the schools aspect of the project was announced in December. It will see 679 primary schools connected to high-speed broadband by 2022, well ahead of the original target delivery timeframe of 2026.

While substantial progress has been made to date, the Covid-19 pandemic has had an impact on the delivery of the fibre network, resulting in delays to delivery of aspects of the programme of a number of months. The extent of this impact is currently being assessed and NBI has committed to putting in place measures to mitigate the impact insofar as is possible. The Covid-19 pandemic has also highlighted the importance of good, reliable broadband to ensure that citizens across Ireland can avail of remote working, education and other essential online facilities. This is reflected in the commitments in the programme for Government, where delivery of the National Broadband Plan will be a key enabler of many of the policies envisaged, particularly around increased levels of remote working.

The programme for Government commits to seek to accelerate the roll-out of the National Broadband Plan. In this regard, the Department of the Environment, Climate and Communications Networks continues to engage with NBI to explore the feasibility of accelerating aspects of this roll-out, in particular to establish the possibility of bringing forward premises currently scheduled for years 6 and 7 of the current plan to an earlier date. NBI has now established a dedicated team to investigate acceleration of the roll-out from its current contracted schedule of seven years. Exploring the potential to accelerate the network roll-out is being undertaken in parallel with the measures required to mitigate delays arising as a result of Covid-19, which must be the priority at this juncture.

I will detail some of the issues that have been brought up and perhaps we could get them dealt with. NBI is going to use the infrastructure of Eir and the ESB. It believes at this stage that Eir and the ESB probably need to up their capacity to be able to follow on from NBI but the relationship with Eir and ESB, NBI tell me, is actually very good at the minute. However, we are talking about survey, design and build and we are hoping that, as I think the Tánaiste said, this could be reduced from seven years to four or five, possibly.

The Safepass issue for contractor teams that need to come in must be dealt with. That is the reason some of them are not being brought in. We also need to look at the fact that if we need to bring in people from abroad it means we might be lacking skillsets here.

On tree-trimming, obviously the Minister of State herself has said that Covid has held up operations. There must be a moratorium because if this is necessary the tree-trimming required for dealing with this absolutely necessary infrastructure just needs to happen. Sometimes planning permits are required and we may need a new system, as it was put to me that the one we have is a stop-start system. If one suddenly needs to put in a new planning application because a problem has appeared with a particular pole then one must start the planning process again. With Transport Infrastructure Ireland, TII, that can take upwards of four to eight weeks, as I said. Even with the local authority, in a perfect situation it can be done in two days but again it can take from six to eight weeks. NBI have these guidelines that is trying to operate across the board to reduce this but we need to put in place a system that will steamline this and will operationalise it. This is probably not the forum to deal with this but if the Minister could come back to me on it, we could find a solution to streamline this. It is just too important, we need delivery and at the end of the day the Minister has responsibility.

I have listened to the points the Deputy has raised, especially on tree-trimming, Safepass issues and the others. As we all know, the pandemic has highlighted the importance of good, reliable broadband to ensure citizens across Ireland can avail of remote working. Every parent in Ireland who has home-schooled knows the importance of good broadband. We have all taken Zoom meetings at home and we have dropped off those calls every so often. Everyone realises the importance of remote working, educating and other online facilities.

It is reflected in the commitments in the programme for Government where delivery of the National Broadband Plan will be a key enabler of many of the policies envisaged, particularly around increased levels of remote working. The NBP will ensure citizens throughout the entire country have access to high-speed broadband services and that nobody is left without that vital service. Despite the impact of the pandemic, NBI continues to make steady progress on its deployment activities. As I have mentioned, more than174,000 premises across 26 counties have now been surveyed. Not unlike other large construction projects, Covid-19, as the Deputy has said, has had an impact on the delivery programme and has resulted in delays to aspects of the project. The delays NBI have had to mitigate include, among other things, mobilisation of key contractors with restrictions on operations, supply chain and logistic delays, nationally and internationally. The recruitment of key personnel, as NBI and its contractors scale up, includes challenges associated with onboarding and training people. Inevitably, like many other organisations NBI and contractor staff are at risk of contracting Covid-19 themselves or may have to restrict their movements as a result of being a close contact.

As I already mentioned, the Government has committed to seek to accelerate the roll-out of the National Broadband Plan. This includes the possibility of bringing forward premises which are currently in year six or seven to year five and exploring the potential to accelerate the network roll-out. Of the 2.4 million premises across Ireland, 77% now have access to high-speed broadband of more than 30 Mbps through commercial operators. NBI will address the remaining premises through the National Broadband Plan.

I thank Deputy Ó Murchú. I will pass on his comments to the Minister.

The Dáil adjourned at 5.17 p.m. until 10 a.m. on Wednesday, 17 February 2021.