Covid-19: Reframing the Challenge, Continuing our Recovery and Reconnecting: Statements

Minister for Health (Deputy Stephen Donnelly)

Printed copies of my speech will be ready shortly. They are on their way over. It is hard to believe that it has been 607 days since the first case of Covid-19 was detected in Ireland. Little did we know what was ahead of us - a pandemic that upended our lives and changed the way we lived, worked and socialised. This disease has shattered lives. It has taken well over 5,000 of our loved ones from us. It has caused great fear, frustration and disruption.

In healthcare, it has taken a very deep toll. Our healthcare workers have made great sacrifices. Many are tired and depleted. Many became sick themselves or provided care to their colleagues. Many more people are waiting for non-Covid healthcare. At the same time, our healthcare workers have been incredible. There has been record investment and funding for new developments and our healthcare workers have turned this investment and funding into record numbers of new beds and staff during the pandemic.

The vaccine roll-out has been a success. More than 7.4 million doses have been administered since the programme began in December last year. Around 90% of the eligible population are now fully vaccinated. Ireland has a vaccination rate that is among the highest in Europe. Our vaccine roll-out has proven what our health service can do when we all work together. There is greater confidence in what our health service can achieve. As I travelled around the country visiting testing centres and vaccine centres in recent months, the pride that healthcare workers have in our health service was clear and palpable. We can build on this positivity as we face into winter and the task of tackling waiting lists.

The pandemic also shone a light on issues that have blighted our health service for far too long, including a dearth of critical care or ICU bed capacity and a poorly resourced public health infrastructure. Before Covid arrived here, we had just 255 critical care beds. We invested €55 million in that this year and will have 321 permanently funded beds by the end of this year, or very early next year. That represents an increase of approximately 25%. We are going to add more beds next year, resulting in a 33% increase in permanent capacity between the start of the pandemic and the end of next year. Are more ICU beds needed? They absolutely are. I have brought a plan to Cabinet outlining further plans to significantly increase capacity.

Our public health teams were significantly under-resourced when this pandemic hit. Public health doctors were not given the recognition they deserved and were the only medical specialists who could not progress to consultant status. This impacted our ability to recruit and retain candidates. This dispute had been going on for decades. The Government resolved it by reaching an agreement with the Irish Medical Organisation. I was delighted to see advertisements for these consultant posts appearing in recent weeks.

Last year, I committed to a significant investment in public health when I announced plans to double the workforce by recruiting an additional 255 permanent staff at an annual cost of over €17 million. In a highly competitive employment market, created by the pandemic, I am very pleased to share that the HSE has filled 196 of these roles to date, increasing staffing levels in our public health system from 254 to more than 450 employees. I know everyone here will welcome that.

Like many countries, we have deployed a wide array of measures to battle Covid-19 over the past 18 months, including masks, social distancing, local restrictions, travel restrictions, testing, contact tracing, guidance on improved ventilation and more. We are still deploying some measures like mask-wearing but lockdowns, which sometimes, unfortunately, involve the cessation of non-urgent healthcare, are not a long-term sustainable solution. Fortunately, safe and effective vaccines were developed in record time. These vaccines are key to turning Covid-19 into an endemic but controlled communicable disease. Only one human disease, smallpox, has been completely eradicated. Others, such as the flu, measles and cholera, slowly became endemic. Since the vaccines are remarkably effective in preventing serious disease and death, they can serve as our conduit for control. Many experts believe that the harm from endemic Covid may ultimately fall somewhere between that of flu and other coronaviruses that cause the common cold but, as we all know, the world is not even close to that point yet.

What is to be done? I want to reiterate the case for everyone to be vaccinated. We are a highly vaccinated country and yet we are seeing that Covid can still create tremendous pressure on our health service. We have 448 people in hospitals with Covid and 88 Covid patients in intensive care. Of course, every one of the beds taken up by those 448 people in hospital with Covid reduces the capacity in our hospital system. As is to be expected, we are increasing our efforts to promote the vaccination of those not yet inoculated. There are approximately 360,000 adults who are eligible but who have not chosen to get vaccinated to date. We are looking at what additional measures can be taken to increase uptake among this group, including pop-up vaccination clinics, which will begin in early November in local election areas where uptake is still low. Ongoing engagement is also taking place with industry and civil society organisations to improve uptake among vulnerable workers and migrant communities.

I appeal to those who have not yet been vaccinated to please step up and get vaccinated. I ask them to do so for themselves and for everybody else. Our waiting lists for planned care, which includes everything from hip operations to scoliosis procedures, are far too long. I am determined to tackle these lists and to bring the same rigour to doing so as we have brought to the vaccine roll-out but we need everyone to play his or her part.

To those who are unvaccinated, the decision not to get vaccinated is helping this virus continue to spread. The most recent figures I have are that more than half of those with Covid in intensive care are unvaccinated. This means ICU beds are not available to sick patients waiting on urgent surgery and we have to cancel operations for children and adults in need of urgent hospital treatment and procedures. I met Nursing Homes Ireland this morning, as I am increasingly concerned about the rising number of outbreaks in nursing homes, as are those living and working in and running our nursing homes. To those who are unvaccinated, I ask them to please think again. I ask them to get the facts, to follow the science and to protect themselves, those closest to them and everyone else in the country who has fought so hard for the gains we have made against this virus.

As we have seen throughout the course of the pandemic, Covid-19 continues to be a volatile and unpredictable opponent. The disease incidence in the country is high and has deteriorated significantly in recent weeks. Taking into account this situation, the Government this week made a decision on the way forward. Our approach continues to be to move forward carefully and steadily with the reopening of our society. Sectors of our society and economy have reopened in recent months and they have stayed open, and we need to ensure this remains the case.

On Tuesday, following public health advice from the National Public Health Emergency Team, NPHET, the Government agreed that the remaining aspects of the hospitality, entertainment and night-time economy could reopen. Given the deteriorating trajectory of the disease, this reopening is taking place accompanied by comprehensive protective measures and the wide and robust use of the digital Covid certificate.

Our booster vaccine campaign will play a vital role in offering continued support to our most vulnerable. The national immunisation advisory committee, NIAC, has now recommended that a booster dose of Pfizer can be offered to everyone aged 60 and above who has completed their primary course of a Covid-19 vaccine. My Department and the HSE are now implementing these recommendations. NIAC will continue to examine new evidence regarding booster doses for other groups. I believe there is a strong case for healthcare workers. We are engaging closely and continuously with NIAC on that, and we will follow the evidence and science and look forward to its ongoing deliberations on this.

I wish to finish with another appeal to the hospitality sector. It is essential, if we are going to continue opening up safely, that the Covid pass is used and enforced. We all know that the majority of operators in the hospitality sector are doing the right thing. However, an unacceptably high number are not. The data we have on enforcement and the survey results from patrons going to pubs and restaurants suggest that about two out of every three pubs and restaurants are doing the right thing and are enforcing the pass but one in every three is not and that has to change. We have to have more compliance. There are things the State can do, and I am sure we will discuss some of that during this debate, but it is imperative that the sector steps up and ensures that those regulations and that compliance are followed.

Deputy Louise O'Reilly

I thank the Ceann Comhairle for the opportunity to speak today on the challenges that we still face in this pandemic. The announcements made by the coalition leaders on Monday regarding the new format of the reopening of our society and economy have some welcome elements but have also caused additional difficulties, especially for businesses and workers. I will focus on a small number of areas.

First, the guidance given with regard to the return to workplaces constitutes what can only be described as mixed messaging, and that is me genuinely being kind. The announcement that a full return to workplaces may not be possible until next spring will mean little to workers who have already returned to full on-site working since September. Many of them can and should work from home but have been requested by their bosses to go into workplaces despite seeing no need for it. While the public health advice is still for people to work from home where possible, the reality for many workers is that they have been summoned back. They want to continue to work from home. Without explicit guidance or a legal right to request remote or home working, the decision on the return to on-site working is solely in the hands of employers and managers. There is a power imbalance in these situations and, as a result, a lot of workers are back in what are effectively full workplaces, even though many can and should be working from home or remotely. It is not good enough for the Government to say that a full return to offices will not be possible until spring without ensuring that workers can continue to work remotely. In the absence of a legal right to request remote working, the Government must give a detailed and written outline of what is expected of workers and employers over the coming months regarding the return to workplaces and remote working. I hope that will be forthcoming immediately.

I also ask the Minister to enlighten us as to why bar counters are still off limits. Mr. Donall O'Keeffe from the Licensed Vintners Association, LVA, and Mr. Padraig Cribben from the Vintners Federation of Ireland, VFI, have queried this in recent days. The measure does not seem to make any sense to the public or those in the pub trade and I hope there is scope for it to be revisited in the interests of common sense. I have said many times that my belief and experience is that when the guidance is clear, easy to understand and logical, people will follow it. Where it is not, that creates doubt and causes problems, not just for patrons in these premises, but for workers as well.

Is it the intention of the Government, in conjunction with Fáilte Ireland, to restate the guidelines that weddings in hotels and guest houses have to be finished by 11.30 p.m.? In the past number of days, many couples have contacted me to seek specific information on this because they have been informed by their wedding venues that the Fáilte Ireland guidance states that weddings have to finish at 11.30 p.m. There is some discussion in the media about the guidelines being different. People want to be able to celebrate and follow the rules, but the rules need to be clear.

Throughout the announcement on Monday, when the Taoiseach, Deputy Micheál Martin, the Tánaiste, Deputy Varadkar, and the Minister, Deputy Eamon Ryan, were at their respective podiums, they repeatedly referenced personal responsibility. The reason I mention this is because it is the public who have displayed the sort of personal responsibility that some, even in this House, have been lacking. They are displaying personal responsibility every day. They have chosen to be vaccinated in huge numbers. They wear their masks. They wash their hands. They have done everything that has been asked of them, yet when a camera is put in front of the Taoiseach or the Tánaiste, they fire back that the public needs to do more.

Maybe the Government and the people in it could and should have done more. Maybe the Taoiseach could have not voted through a recruitment moratorium in the health service last time he was in government. Perhaps he could have been more careful when establishing the HSE. Maybe the Tánaiste could have sanctioned the building of more hospital beds. Maybe he could have tackled the recruitment crisis in our health service when he was Minister for Health or, indeed, when he was Taoiseach. The list goes on.

In the few minutes remaining to me, I want to raise with the Minister the case of Mr. Nadim Hussain, a man who is on hunger strike in a direct provision centre. This young man is scheduled to be deported. I will not get into the rights and wrongs of this case, but I want to say that in the midst of a global pandemic, when our case numbers, while worrying, are low compared with other countries, it is unconscionable that somebody would be deported. I ask the Minister to please raise this case with the Minister for Justice and consider the plight of this man who is on day eight of his hunger strike. As I said, I do not want to get into the specifics of the case but I ask the Minister to please take a look at it.

Working together on solving something requires a high level of humility and self-awareness. I implore the three leaders of the Government to be mindful of this.

Deputy Aengus Ó Snodaigh

This week was meant to be a happy occasion for the entertainment sector, in particular, given the reopening after nearly two years of lockdown when we did not have as much of the vibrant cultural life we had before we all went online. Instead, it is all confusion, contradictory messages and gobbledygook. 100% is not 100% is the message people have got. People can sit and maybe stand, but only stand on a seat or stand next to a seat. People cannot stray or mingle and, God forbid, cannot dance unless they are in a nightclub. While in nightclubs, masks will be required, that is not the case when dancing, drinking or eating.

It is not clear, some wags would say, if it is allowed to wear the face off a partner - or somebody else's partner, maybe. There are a lot of questions. They have been posed since the announcements on Tuesday. If a concert is held in a nightclub, can there be dancing? Nobody sat down and looked at the practicalities of the stupid guidelines that have been mentioned and which are still being written, seemingly.

There is and always has been a chance that the Government might not fully reopen if the Covid numbers were on the wrong trajectory. That is what planning for eventualities is about. While we have been told that all will be revealed and clarified in the latest Covid-19 guidelines, they are like the fourth secret of Fátima. They are still hurriedly being cobbled together as I speak. On Tuesday the overview of public health measures and exemptions from the Department stated that the guidelines would be developed only for nightclubs. What is it to be? What happens to the venues and performers who sold tickets for gigs involving standing room or promised their clientele the chance to dance based on the advance pronouncements Government Ministers made about reopening? What about the nightclubs due to open tomorrow? How will they be able to comply with guidelines which still have not been written, never mind published? We are hearing stories of bars and venues that have hired new staff in preparation for reopening, with events being sold out in advance, now faced with laying off those same staff and not opening at all. Sarah O'Keeffe, a constituent of my colleague, Deputy Ward, summed it up perfectly when she said that a multitude of gig tickets have been sold over recent weeks assuming that they will proceed at 100% capacity and that to impose a requirement for indoor gigs to be fully seated, giving the organisers three days' notice, is financially unviable and logistically impossible. To do this to an industry that has desperately sought to engage with the Department to come up with reasonable solutions and to ensure maximum safety at these events is absolutely reprehensible. The Government has had months to plan for various possibilities and it is inexplicable that it has only one plan and that there was no plan B. What were all the oversight groups and the recovery task force doing during this time? What were the Ministers' Departments doing in this time?

The only clear message musicians and performers are getting from the Government is that their pandemic unemployment payment, PUP, is being cut. Next week a large cohort of musicians and industry workers will receive their last pandemic unemployment payment. They have already seen their payments decrease, despite having no work to go to. We know that this industry will not recover until next summer. Tá ár bhféiniúlacht mar náisiún ag brath air. Tá ár n-earnáil turasóireachta ag brath air. Tá meabhair ár sochaí ag brath ar an tsiamsaíocht - an ceol, an rince, an ragaireacht agus an gliondar. Dá bhrí sin, caithfear cinntiú gur féidir leis na ceoltoirí, na rinceoirí agus na healaíontóirí an fód a sheasamh chun nach gcaillfimid iad de thairbhe neamhairde, dímheasa ná easpa tacaíochta ón Stát. Ba é an Stát a dhún earnáil na siamsaíochta síos sa chéad dul síos agus, dá réir, tá ualach air í a chothú go dtí go mbeidh a gnó go hiomlán oscailte athuair.

I do not believe the Government appreciates clearly the gravity of the crisis in this sector. Musicians and performers are leaving the industry in their droves, and no wonder: as I said, their PUP is being cut. Many promising artists are now thinking of emigration. That would be a shame and a scandal and it would be on the Government.

Deputy Réada Cronin

It would be ridiculous to stand up here and not cite the growing number of new cases and hospital and ICU admissions. Reframing the challenge of Covid-19 is difficult in the context of our current figures. Our children are of particular concern in the context of Covid itself, long Covid and the wider impacts on their physical, mental and emotional health. It is hard to believe that while the Government is committed to retrofitting our schools under the EU energy performance of buildings directive, to include ventilation for health reasons, this plan has not been advanced. Once it was evident that Covid-19 was airborne, safe and warm ventilation in schools should have been acted on with urgency, and I urge the Minister to speak to the Departments of Education and the Environment, Climate and Communications about that and get going on it.

On a wider basis, where vaccine protection is possibly waning and the seasonality of the virus seems to be waxing, we have to make special efforts to encourage and to protect outdoor activities for our children. I believe a special commitment has to be made to this to make sure our children can access outdoor activities as safely as possible because they need them for their health and well-being. They need one another, their friends and their sense of community, and being outdoors is both possible and doable. If we could put half as much thought and talk into looking after our children as we have put into getting the population into licensed premises to consume alcohol, society would be the better for it. Reconnecting is important but it must be a reconnection that is safe and considered in the context of where we are, not where we imagined or hoped we would be. I would like to see a real and firm commitment on the part of the Government to put our children first in schools and to make their lives safer. I believe this can be done because where there is a political will there is a political way.

Finally, on this, the day that partition and the blight it inflicted on our island nation is being commemorated - shamefully, in my opinion, and notably without Uachtarán na hÉireann nó Banríon Shasana - we have to consider the impact partition has had on our Covid experience and outlook and the challenge we faced because of that. Instead of the necessary all-island approach we needed, both sides, North and South, had one hand tied behind their backs. That is no way to proceed to protect our people. Partition is a challenge that must be rectified before another pandemic hits, and we would really want to get on with that.

Deputy Chris Andrews

There is one issue I wish to raise that is affecting sporting communities and that is the continued confusion around the use of clubs' dressing rooms and showers. Last month, from 20 September, dressing rooms were due to be reopened across the board following guidelines from Sport Ireland, yet in late October, with the cold and dark evenings well and truly set in, a number of dressing rooms and changing rooms across the country remain shut and there is a lot of confusion. I have heard reports of different sporting national governing bodies, NGBs, having conflicting policies on changing rooms, despite using the same changing rooms. There is a multi-use facility whereby one code will allow use of the changing rooms and one will not. We cannot have one rule for one sport and a separate rule for another sport. It makes no sense at all, and guidance on this needs to be given. We need clarity and sporting groups need clarity. We cannot continue to have teams changing in car parks in the cold and wet winter months ahead. Strong communication and leadership from Sport Ireland and its affiliated governing bodies could put an end to this.

Another issue of concern to clubs around the country is that of volunteers. We need to have a plan from Sport Ireland for the engagement and re-engagement with sporting volunteers across the country. As everyone out there involved in local sports knows, volunteers are the backbone of youth sports and adult sports and are the lifeline of every club in the country. The past 18 months have been very tough on those volunteering within local clubs. Clubs across my constituency - I am sure this is a national trend - are finding it hard to attract and maintain a network of volunteers due to additional pressures from this pandemic. That needs to be taken into account and we cannot afford to have volunteers drifting off. Sport Ireland needs to be proactive on this.

Deputy Duncan Smith

It is good we have the opportunity to discuss this today, given what was announced earlier this week. This virus has turned the entire world, including our country, inside out and we have seen some unbelievable responses to it that are a credit to the nation and to the State, not least from our health workers at all grades, but also from our retail workers, our delivery drivers and everyone who from day one to this, the 607th day, and beyond has been at every single front line that exists in this country. It is an absolute credit to them.

A lot has been said about the announcement the other day, and I do not necessarily want to focus too much on that.

This is an opportunity to speak about what are now becoming the more systemic issues in this virus, the pandemic and our healthcare system in general.

We are at a stage now where many of our healthcare workers have been fully vaccinated for longer than six months. I will not jump into the science of the efficacy of vaccines and the waning of vaccines because the science is not agreed on it, and I am no scientist. It is prudent that our healthcare workers are included in a third vaccination booster scheme as soon as possible. The hospital cases are going up. The ICU cases are high. Given the resources that are put into ICU, I understand that ICU beds will always have high capacity. They are constant resources. We are not to be distracted either by anything that comes back on that from the HSE or from the Minister, Deputy Donnelly, because a high percentage of people who are in ICU are in there with the virus. That is a reality and therefore, we are on a precipice with ICU capacity.

It is not just a case of making sure we have more beds, we must also make sure that if we have to bring surge capacity into ICU we also have trained ICU staff for those beds. I am new to this brief and I am learning all of the time about the skills set that is needed. It is not just any nurse or any worker in the healthcare system that can be plucked from another section to work at an ICU bed. It is a specialist skill. Do we have those skill sets ready to go should we need them? I am not convinced we do. I am deeply concerned about the trend of losing healthcare workers for myriad reasons. Pay is one reason. Pay versus the high costs of rent, mortgage, living expenses is another. We need a real strategy around this. It affects all grades of healthcare workers. We cannot continue to train thousands of healthcare workers for them to go out to the Emirates to work there for a number of years. That is not a good model for our healthcare system and it is not a good investment of State money into this wonderful human resource we have here. This is the challenge. It will require difficult decisions and difficult conversations. It is the reality and we must start addressing it. It is attractive for many to go to work in a tax-free economy and come back with X amount for a deposit on a house. This is not why we built our universities and training centres with regard to healthcare staff. We want to train people to come and work in our acute hospitals, in our primary care settings and in our community care settings. This is not just about nurses and doctors. We also need physiotherapists, speech and language therapists and the whole gamut. This is where we are at. I am not taking pot shots here. This is the systemic stuff that we need to look at.

I am delighted the Minister referenced those people who are unvaccinated. This is the real elephant in the room. As far as I can see there are two types of unvaccinated persons. We know the majority of people in our hospital beds and acute settings at the moment are unvaccinated. There are people who are genuinely hesitant. We have all dealt with them and we know them. A lot of them are vulnerable people and we need to do something to encourage them and to give them confidence that they need to get this vaccine. There are the others out there, however, who are outside this gate who are preying on those people. There is blood on their hands and they are costing lives. They are ripping apart families with their misinformation and their targeting of vulnerable people with untruths about the vaccination and the vaccination programme. I do not have the answer but we cannot continue like this. We need to find something. I believe we are united across the House, across politics, and across society that we cannot allow such an element in our society to cause this damage with such lies and with such vehemence. Ultimately, some people who are lying in ICU beds now are old or vulnerable people who might be parents listening to their grown-up children spew this misinformation into their ears, and they are dying because of this. We saw the tragic case of Joe McCarron in Letterkenny Hospital as being the most public case, but this is happening elsewhere too. This is an important point.

Covid can twist and turn. We are entering into the winter season. There is a fear about the seasonality aspect. It is not only about this virus as we also have the flu season. We encourage all people to get the flu jab where they can. The reality is, however, that the flu jab still costs money. If a person needs to book a flu jab now, a lot of pharmacies or other places where it can be obtained, are booked out. We called for a free flu vaccine last year and we call for it again this year. It is not going to happen at this stage but we need to encourage people to get the flu vaccine in order to mitigate any bulge in our hospital service over the winter.

We are prepared if this virus turns around. We supported the extension of the framework for restrictions through the winter should that happen. We hope it will not. Encouraging news broke online today with regard to the third booster from Pfizer. It will be interesting to see where that goes. We will all work together. People look to this House and to the Government for a lead on it. Hopefully, with the resources and the right kind of decisions, this lead can continue to beat back this virus.

Deputy Joe Flaherty

I will take this opportunity to acknowledge the vaccination team at Newtownforbes in County Longford. I am aware the Minister visited there a number of months ago and that he was greatly impressed with all that he saw. As of 3 p.m. today the centre has administered 27,600 vaccines, and that number is set to rise further as the centre remains open with its walk-in clinic today until 8 p.m. this evening. They also have two further walk-in clinics planned for next week to capitalise on people having some free time during the midterm week. The centre has also confirmed to me this afternoon that booster vaccines have thus far been administered to 208 people in long-term residential settings, and they have also run a series of very successful immunocompromised clinics. I thank the Minister for ensuring that we had a dedicated clinic in the county, and the terms of the lease on the Clonguish GAA venue have now been extended until next March, which is also reassuring. We have had the naysayers saying that Longford would be overlooked, but the Minister assured me this would not happen on his watch, and I am thankful to the Minister for that.

There has been a remarkable effort of camaraderie and professionalism on show at the Longford centre as the staff there have really put country and community first. I would be remiss if I did not single out in particular the efforts of the manager of the centre, Carmel Braden, who has done tremendous work. The people of Longford rightly take tremendous pride in our vaccination campaign, and we are indebted to the staff at the Newtownforbes centre. It is important to acknowledge that here today. I believe the House is in agreement that we are facing into exceptionally difficult and challenging times this winter with regard to healthcare. This will be compounded further by the omnipresent challenge of Covid. I spoke earlier about our pride locally in the very successful vaccination campaign in Longford. I also commend our GPs and their staff who played a Herculean role. Early on in this battle we would have argued for a role for our local pharmacists in the vaccine roll-out, and once they got the call they were not found wanting. Collectively they have administered an incredible 320,000 doses across 2,000 pharmacies nationwide. The events of this week emphasised that Covid is not going away any time soon. The sustained roll-out of the vaccine boosters is critical if we want to stay ahead of this fast-paced and mutating virus. The winter flu is now upon us, with first cases being reported. It will undoubtedly bring further pressure on our GPs, their staff and hospitals. We need to mobilise every battalion available to us in the battle against Covid. There are several pharmacies in County Longford, by way of example, who are capable of rolling out 200 boosters per week. It would be remiss if we did not involve them in the fight. The vaccine booster campaign gets under way in earnest next week. It would be an oversight if we did not include our network of pharmacies. I believe excluding pharmacies will serve only to slow down the vaccination process and will deprive people, and particularly those whose immunity is challenged and who would clearly benefit from the Covid booster shots. It is also critical that the booster vaccines are made available to front-line workers, including pharmacists and their staff, as a matter of priority and particularly in light of the worrying increase in infection numbers in recent days. I hope the Minister will take this on board in the coming days.

I agree with some speakers that there was certainly a degree of mixed messaging around this week's announcement on the continuation of restrictions, but to a point. I emphasise that two weeks ago we expected we would exit restrictions in their entirety. The reality is that this is a very fast-moving and mutating virus.

You cannot go into a bookshop and ask for a book on how to deal with a Covid pandemic because none has been written yet. A lot of this is happening on the hoof. Decisions are being made in this manner and we have to understand and make allowances for that, but there is a worrying narrative emerging in some sections of our community to the effect that retailers and those in the hospitality sector are being reckless in some way and even profit driven. I can say hand on heart that the vast majority of business owners have behaved impeccably and have led by example throughout the pandemic. I include their staff. I have seen pubs and shops right across County Longford and the midlands generally transformed to ensure public health and that the welfare of their staff and patrons would be put front and centre. This has been an incredibly difficult time for retail and hospitality businesses. In Longford, I have seen at first hand the lengths to which they have gone to reopen and put their public health responsibility front and centre. It is worth noting that, since the outset of the pandemic, which is now 18 months ago, nine pubs in the county have closed. The impacts of Covid will be far-reaching, not only in respect of the health service and our personal health but also in respect of our society and economy generally.

I have yet to attend a premises back at home where I have not been asked to produce my Covid certificate. I saw at first hand where a restaurant missed out on doubtlessly much-needed business when it correctly asked a patron for a Covid certificate. The staff were harangued and abused by the individual, who then walked off and decided to post on social media that he or she had been refused a meal, which was entirely untrue. I received emails from people wondering how they could go about complaining about businesses they perceived to be in breach of Covid regulations, including for not asking for Covid certificates. In those instances, speaking to the businesses should probably be the first port of call. It is important we acknowledge that a great effort has been made by retailers and those in the hospitality sector. It should not go unnoticed. I am aware that public health should come first and inform all our decisions, but in the coming days, particularly as we see nightclubs reopening, we need to prioritise as much as possible what will be the needs and nuances of the hospitality and retail sectors over the coming months. These months will be vital for both sectors.

Deputy Thomas Gould

This is the weekend of the jazz festival in Cork. It is one of the biggest, if not the biggest, weekends of the year for restaurants, hotels, bars and nightclubs. When the businesses were told restrictions would be lifted on 22 October, just in time for the weekend, they were delighted. It presented a good opportunity and it really lifted people's spirits. On Tuesday, however, all this was brought into doubt. Now, at almost 5 p.m. on the Thursday before the jazz weekend, people still do not know what is happening. As we speak, the industry is trying to get clarity from the Government on what is going to happen. It is crazy that businesses are in this position the day before the weekend. There is utter chaos and confusion over what is happening. It is devastating not just for the business community and its staff and suppliers but also for the customers who have booked hotels and tickets for concerts and other events, in addition to those who have made plans and who are looking forward to this weekend. This is not the first time this has happened.

I am all for following the public health advice and have stated that publicly, but nobody should be finding out about new restrictions on Twitter or the day before an event. It is not good enough. The announcement, like many others, was leaked right, left and centre, but leaks are not good enough when dealing with businesses, staff and people's lives. It is just not fair on businesses, workers, suppliers and customers. It must not keep happening like this.

I wish to mention Nadim Hussain, who is currently on hunger strike in the direct provision centre on Kinsale Road in Cork. Maybe the Minister might ask the Minister for Justice, Deputy Humphreys, and her officials to consider Nadim's case. It certainly merits consideration.

Deputy Martin Kenny

We all recognise and understand the great work that has been put in. I pay tribute to everyone in the health services, including those in the vaccination and testing centres, who are still doing their work. They are often forgotten. We have almost become accustomed to the vaccination and testing services being in place but their staff are putting in a huge effort, as are the staff in our hospitals and all the other front-line staff. The immeasurable effort made to fight this virus should not go unrecognised or unmentioned.

Having said that, the position on the proposed opening up this week has resulted in a tinge of disappointment for many. We understand the numbers have gone up, which has had an influence, but the difficulty is that people were given a sense that all restrictions would be removed. Putting that into the public domain left us open to a big problem given the possibility of its not happening. That was the mistake made. I hope the Government will acknowledge it was a mistake to have allowed a sense that all the restrictions would be removed to become the consensus. Everyone thought all the restrictions would be gone in the middle of October. I did not believe that was ever going to happen.

The hospitality sector, which was mentioned already, is under particular pressure because it needs to prepare and to know what restrictions will be in place, how businesses will operate and how they will deal with staff. They have made all their preparations but the reopening was pulled out from under them at the last minute. There is justifiable anger in the sector as to how to deal with that. That said, we all recognise that the virus is something we have no control over unless we do exactly what needs to be done and take the measures seriously.

The vaccination effort that has been made in Ireland has been second to none. There are large numbers of people who have ensured they got the vaccine. We need to consider booster vaccinations for as many sectors as possible and as quickly as possible. I am sure the Government will acknowledge this is a global pandemic and that we need to reach everywhere in the world with vaccines, particularly developing countries, where vaccination levels are very low level.

Those who work from home need more clarity and need to be engaged with more. They have now been told by many of their employers that they need to return to full-time work or go back into the office or an environment that could be quite congested and crowded. There is concern in this regard. It would be useful if we had direct guidance from the NPHET, but eventually from the Government, on the exact position on this. There is some confusion. Some workers are being told they need to go back to work. The workers themselves do not particularly want to and feel they can continue to do their jobs from home quite adequately. They feel they have done a lot of work and made many sacrifices over the pandemic, and they fear returning to the work environment, particularly as they see numbers rising. This is an issue that the Government could deal with as quickly as possible.

Deputy Róisín Shortall

What is happening regarding Covid is very disappointing. It is a genuine setback for individuals, families and the country generally. The starting point at this stage should be determining why we are in the situation we are in and why the numbers are going out of control and trending so high, given that we have had a really successful vaccination programme.

It is important to note the points that were made by NPHET in its letter. It states that, in a pessimistic scenario, there will be 800 to 1,000 in hospital by late November, 150 to 200 of whom will require intensive care. It expects 2,000 new admissions to hospital and more than 300 admissions to intensive care units between now and the end of the year. It states very clearly that since early October, case counts have been following the pessimistic scenario. On the basis of the studies that have been done and NPHET's assessment, we are in the pessimistic scenario. That means a more than twofold increase in the number in hospital with Covid and a doubling of the number in intensive care. All our hospitals are at capacity. The NPHET letter is painting a dire picture for the health service. Questions arise as a result that the Minister needs to answer.

In many ways, this should be a questions and answers session, rather than statements. The first question is why, given that we have one of the highest vaccination rates in Europe, if not the world, and we have had the longest lockdown in Europe, we now have one of the highest rates of the virus. Can the Minister explain that? Can anybody in NPHET or elsewhere explain it? There is supposition in respect of some of it and possible theories being put forward but we do not have anything definite regarding why this is happening. Although we have figures on a geographical basis in terms of local electoral areas, we are not getting any of the kind of qualitative data we used to get regarding how these outbreaks are occurring, where the places of transmission are, why the outbreaks are happening and what are the super-spreader events. Is that information available somewhere? Have the public health doctors gathered that qualitative information? Is it just that we are not hearing it? If we want to respond to this surge, we need to have that kind of information to know what should be done.

Another question that arises is what exactly we are going to do to reverse the trajectory of cases. It is going only one way at the moment, in a very concerning trajectory. What exactly is going to be done to bend that curve, as we used to say last year? How are the figures going to be brought down? I am not hearing anything from the Government in respect of how that will happen. The figures are going up significantly across the board and society is opening up more. What is likely to happen then? What are the projections? Does the Minister accept the projections set out in the letter from NPHET? It points to a pretty dire situation in hospitals. It is all very well for the Taoiseach and others in government to tell us that it is down to individual responsibility and one has to act responsibly. Of course, people have to act responsibly. The vast majority of people are actually doing that and have worked really hard at it, but the Government has a serious responsibility as well.

Let us look at the mitigating measures the Government should be bringing in and using. The whole issue of ventilation was hardly mentioned at all. There was a measly allocation of CO2 monitors to schools, but there was no advice or direction in that regard and no investment in air purification systems. Equally, there has been no advice, direction or requirements in respect of ventilation for workplaces or hospitality. It is significantly remiss of the Government to ignore that because we have known for a long time that the virus is airborne.

I refer to antigen testing. An expert report published today confirms what we were told by Mark Ferguson in his expert report last March. Why has there not been wider usage of antigen testing? Why has the Government not provided advice and direction to people on the use of antigen tests? Why is it not setting any standards in respect of antigen tests?

Obviously, there is also the issue of enforcement. Covid certificates are fine and it is a good idea that they are used, but why are they not being enforced properly? The Minister knows from his own figures that one third of establishments that were checked were not enforcing Covid certificates. What about all the other settings? What about travel? We heard from the CMO that when he was coming home from holidays last week, he was not asked to produce any documentation at Dublin Airport. Other people have had the same experience. Anecdotally, it is being said all over the place.

Ventilation, the wider use of antigen testing and proper enforcement are the responsibilities of the Government. They are not anything that individuals can do. They are the responsibilities of the Government and, to a large extent, the failure to deal with those three key areas are significant contributory factors to the position we are in today.

Deputy Brendan Smith

I agree with the remarks of my colleague, Deputy Flaherty, regarding the outstanding success of the vaccine programme. On other occasions when we spoke here or in the convention centre, Members questioned the roll-out of the programme and some initial delays, but the plan and programme the Minister laid out and stuck with has proven very successful. I compliment him, his senior officials and the personnel in the HSE on the very successful vaccine roll-out programme. I take the opportunity, as Members on all sides of the House have done, to quite rightly pay tribute to all the clinicians involved in administering the programme, as well as the people of various professions within the area of healthcare, including GPs and pharmacists, who administered the vaccine in their own premises. I compliment the volunteers and the retired people who went back at this time of crisis to give additional capacity to the HSE. I spoke to various people in my county and in County Monaghan who had retired and did not think they would work again in the health service but went back because they saw it as an opportunity to contribute once again to helping people who were in a vulnerable position.

I was administered two doses of the vaccine in the centre in Cavan. It was a joy to be there on each occasion and to see the joy on people's faces when they got the vaccine. I recall well that early on in the programme, those aged over 80 or over 70 got a new lease of life when they got even the first dose of the vaccine. It meant a bit of freedom for them. It has been so important. Everybody involved, including the Minister, all the personnel in the Department and the HSE and all those in the vaccination centres, GP practices and pharmacies, deserves great credit on what they have done to date and what they continue to do. We cannot say that often enough.

Initially, there was plenty of criticism. Most of us put that in a constructive way but it turned out for the best. It is to be hoped that there will be a similarly successful roll-out for the booster vaccine. I hope the Minister will be able to push that out as soon as possible because I know many people are anxious, particularly those working in healthcare and delivering services at the coalface, often to vulnerable people, and they want to get the booster jab as soon as possible.

Deputy Kenny mentioned the importance of ensuring the whole world gets the vaccine. The Taoiseach stated recently in the House that we need to have international solidarity on a global vaccine supply. That is very important. Those of us who spoke on this issue this day last year did not think we would have such a successful roll-out. It shows what can be achieved when the global community gets together and governments throughout the world put resources into dealing with a pandemic or any particular disease.

The Joint Committee on the Implementation of the Good Friday Agreement spent several hours today speaking to the people who are developing an all-island cancer research centre. They appreciate the support of the Minister and that of the Northern Ireland Minister of Health, Mr. Robin Swann. They explained to the committee what has been done on an all-Ireland basis since the Good Friday Agreement and the first memorandum of understanding in the early 1990s. They told us that it is now not just an all-Ireland project, it is a transatlantic one, in collaboration with major centres of excellence in research in the United States, as well as linking up with colleagues in Europe. That shows what can be done when research is done on a collaborative basis and people do not work in silos but, rather, work together, striving for the common good.

I listened to the Minister being interviewed on "RTÉ News: One O'Clock" on Tuesday. The one thing that struck me - Deputy Shortall referred to it as well - was when he quoted the figure that one in three establishments was not implementing the regulations in respect of the Covid certificate. Like all others present, I have been doing very little socialising for the past 15 or 16 months, but in any hostelry I visited in my own county and my constituency, I was asked to produce my Covid certificate and it was checked. It was not just a case of showing the certificate on my phone; it was checked properly. It is most disappointing that in towns with 30 establishments, ten of them are not implementing the law of the land. That is just not acceptable, especially in the context of the 20 establishments that are doing it well and properly. There can be no easing up in that regard. The Health and Safety Authority, HSA, the HSE and whatever other statutory agencies are involved must be firm in ensuring that the regulations that are in place for the benefit of everybody are adhered to.

If one operator is enforcing the regulations strictly, then all should, because it is for our benefit. People are happier to be asked for their Covid certificates when they go into a premises. Deputy Shortall referred to Dr. Tony Holohan coming through the airport and not being asked for the relevant paperwork. I have heard similar anecdotal stories, although I have not been to an airport. If employees of the State are not implementing the law, it does not set a good example to people in the private sector in respect of implementing the regulations. If people going through airports are required to show details of where they are coming from or going to, or are required to show their Covid certificate, there is no excuse for not showing it. I sincerely hope that people will act responsibly. The overwhelming majority of people are happier if they are asked for their travel documents or their Covid certificate. The overwhelming majority of people in business and going about their daily lives, for example, going out to socialise for a night or whatever it may be, want to be comfortable and know that they are in a place that is safe and hopefully free from the virus.

I understand why the Government took a cautious approach on Tuesday. It was the right approach to take. Unfortunately, the figures changed for the worse relatively recently. It was sobering to hear Dr. Holohan say on the radio this morning that there are 86 patients in ICU, with hospital admissions increasing and pressure mounting on the hospital system. We are going into winter so, hopefully, that pressure will not exacerbate problems with the system. We all know that the personnel working in the healthcare system, whether it is in the community, residential homes or hospitals, have been under enormous pressure over the past 17 months.

Within our own parliamentary party, we discussed the whole area of mental health and how the pandemic has placed additional pressures on people. I know that our colleague, the Minister of State, Deputy Butler, has worked extremely hard to put in place additional resources to improve the delivery of services. I believe there is funding in the budget this year for reconfiguring and enhancing supports in response to the challenges posed by Covid, and further improvements in developments in child and youth mental health will continue. That is much needed. The Minister of State outlined that a proportion of the additional funding will allow for the enhancement of child and youth mental health services. That is all welcome and necessary. Both the Minister and the Minister of State have outlined the different initiatives that have been taken in support of the work of NGOs, including the provision of information lines, text lines and yourmentalhealth.ie, and all of the additional supports that are necessary for young people who are going through difficult times.

Unfortunately, in my own county, a young man lost his life very recently. His parents and siblings spoke very well on the local radio about how their family member was subject to consistent and different forms of bullying and how they were anxious for the statutory agencies and Departments to take a new approach to the whole area of the crime of bullying, and at least put in place some confidential lines to ensure that there is a cross-government and a cross-agency approach so that this area can be addressed. We know of the bullying that is happening on social media, unfortunately. It is a blight on society. Many young people are being bullied constantly. As least when we were at school, there was a fight in the school yard over football, hurling or whatever, and we went home and it was over. You did not get a lot of sympathy at home if you complained about somebody pushing you and kicking you in the shins. It did not matter. When you got out of the school yard, whatever messing was going on finished. Unfortunately, now, in far too many instances, the bullying is continuing online with detrimental consequences. I think of that fine young 18-year-old, Eden Heaslip, who lost his life following consistent bullying.

I hope that the Minister's Department will play an active part, along with other Departments, in ensuring that there is a cross-government and cross-agency approach to try to tackle the whole area of bullying, particularly of young people. It is bringing additional pressure on mental health services. Obviously, if we can prevent some of the misbehaviour and misdeeds that are happening, it will improve many people's quality of life and it will also save lives. I know that there is no simple answer, but I would hope that the Minister's Department could be central, along with the Departments of Justice and Children, Equality, Disability, Integration and Youth, to a whole-of-government approach taken to ensure that the requests and suggestions of families, who have gone through so much in their lived experience of the awful loss of a young person and do not want to see it happen to others, could be taken on board in the hope that it will help avoid such loss of life or suffering to individuals. It is an area that we need to address as a matter of urgency. Person-to-person bullying is happening, but online bullying is happening to a much greater extent. It cannot be tolerated any more. The social media companies must be taken on in a big way. The Government has promised the establishment of a media commission. I sincerely hope that that commission will have the powers and the resources to tackle head-on the misbehaviour of the international media companies in what they allow to happen online.

Deputy Paul Donnelly

In moving forward to some sort of normality when all of this is done, we need to ensure that those in our communities, the communities we represent, and those most at risk, are not forgotten as we recover and reconnect. The people I am talking about are the thousands who worked through the pandemic and volunteered in the community. Throughout the pandemic and when we were in strict lockdown, I was part of an incredible organisation, both within the GAA and outside of it, through Fingal County Council, that delivered meals on wheels and picked up people's medication. So much incredible work was done right throughout the pandemic. Each and every one of those actions that was taken was a real gift to the community. As I know people really want to believe that we are coming out the pandemic, I want to use this time to thank each and every one of those who volunteered and, indeed, who continue to volunteer. I regularly check my emails from Fingal Volunteer Centre through Fingal County Council, and the amount of work that is still ongoing is phenomenal.

As we move forward with the easing of restrictions, those operating many of those services that local people relied upon, such as crèches, dance classes, sports clubs, aftershool and community cafés and community centres, need clarity and a sense of where we are going with this. They need to know what they can do and what they cannot do. Unfortunately, every time there is an imposition or an easing of restrictions, there is a lack of clarity for a period of a number of days following the announcement. People look at the restrictions and struggle to understand where their group, organisation or crèche fits into it, and what is required of them. For example, those running a community centre might ask whether they can have indoor gatherings, how many are permitted and what activities can be run. The reason they are apprehensive, struggling and annoyed is that much of their funding relies on people using the services. It is really important that we get clarity on the issue over the next while and that we ensure that those operating the community centres and facilities get clarity in that respect.

Deputy Pat Buckley

I listened to the Minister's opening comments earlier. I am not here to bash anybody.

I thank all the front-line workers. We could spend 20 minutes naming all of the jobs.

I am worried about clarity and the short notice. We have the jazz festival in Cork this weekend. I have been speaking to many business owners who were planning for additional hours. It is hitting that sector again. I want to flag this. This debate is about reframing the challenge, continuing our recovery and reconnecting. Reconnecting is getting back to where we were. I have listened to many of the contributors to the debate and mental health has been mentioned. With regard to reframing the challenge and continuing our recovery, I have to bring up a particular issue again. The Minister will be black and blue from listening to me. In the middle of a pandemic, when mental health issues are off the Richter scale, we are closing the only mental health facility in my town in east Cork. I know the Minister has reports from the HSE but I have told him before and I will tell him again it is misinformation. The people are suffering. If we lose this service in east Cork, it will never come back. If we are trying to move forward, how is it prudent to close a centre that never had a Covid case or a suicide? It has long-term care, short-term care, a respite service and a mental health day service. All of a sudden, whoever calls the shots decided this is the right thing to do. It is absolutely ludicrous and I appeal to the Minister. If I could sit down with him for ten minutes and go through this with him, I would give him the truth on it.

In the short time I have left I will say that we are not going in the right direction. I appeal to everybody to adhere to a common sense approach. Please listen to the people outside but please listen to us in here when we raise genuine concerns. It is not about bashing the Government all of the time. I worry when something is working right and it has been a complement to society and the community that somebody in another power or entity decides to shut it down or fix something that is not broken. I thank the Minister for his patience.

Deputy Mick Barry

I will start by making a point on hospitality and the situation we will have tomorrow. In the past 24 to 48 hours, we have heard from the hotel industry, the restaurateurs and the publicans. The group we have not heard from very much in the media, and I challenge the media on this, is the workers in the hospitality industry. In some ways this is not surprising. Those workers are generally not organised. They are in non-union workplaces. Many of them are in anti-union workplaces. Some of them will be going back to work with different feelings and emotions.

Someone sent a text to a radio debate I was at last night looking forward to being able to pull a pint again and hearing the beat of the music. That is completely understandable. There will also be concerns about health and safety. This is not surprising when we see the way some publicans in particular have acted in recent weeks. The idea of checking Covid certificates at the door whereby people flash their phone and in they go has not been exceptional. A Covid blitz is being organised over the weekend. This is good. I encourage workers to have conversations among themselves and discuss what steps they might be in a position to take to defend their own health and safety if their employers are negligent in this regard. Workers can make a difference on this.

While I am on the subject of workers, I welcome the comments of the deputy chief medical officer, Dr. Ronan Glynn, on working at home where possible over the winter period. Many workers will welcome this statement. The feedback from employers is more mixed. Some employers are fine with it and will go with it. Others do not like it but will go along with it reluctantly. There are others again, and not one or two, who will stand against it and push back against it. Again, I encourage workers to discuss it among themselves, organise among themselves and push back where it happens. There are unions that people can join. My office is available if workers need help or advice in this regard.

We have almost 100 people in ICU. We have almost 500 people with Covid in our hospitals. Clearly a surge is taking place. Even if we had a very strong health service it would come under pressure from that surge but not to the same degree as our health service is coming under pressure. This is not a comment on our health service workers who have been magnificent. It is a comment on successive Fianna Fáil and Fine Gael Governments which have left our hospitals in a position that they should not be in, with a lack of beds, including ICU beds. There is still need for action on this front.

I want to make some points on people who are unvaccinated. To be clear, I am pro-vaccination. The benefits of vaccination can be seen by the situation in the hospitals and ICUs. The percentage of people there who are vaccinated is far less of a percentage of that cohort than the percentage who are unvaccinated. I appeal to people who are unvaccinated to get vaccinated or at least to have conversations about it, in particular with medical professionals.

I have listened carefully to radio debates over the past 24 hours. I participated in one last night. I want to voice a note of concern. I do not want to see a situation where Government spokespersons, however subtly, try to divert the anger, confusion and questions that are there from the Government and on to the shoulders of people who are unvaccinated. The media should watch this carefully and call it out where it happens. It is not in society's interest to create a pariah group. The Government should not attempt to go down that road.

Covid passes were to last until October. They are now being extended for the winter. Covid will be with us for a number of years. The WHO has said this recently. Is the Government aiming to make these a semi-permanent feature of Irish life? There would be serious civil liberty implications if that were the case. I want to put a marker down on this.

On the issue of a Covid bonus, I would say the Government kicked it to touch in the budget. It has been very quiet on the matter this week. Workers will not accept crumbs from the table with one day of a bank holiday. There needs to be a real Covid bonus for public sector and private sector workers. This includes the low paid who helped get us through the pandemic on wages we would hardly be able to pay rent on. The minimum wage should be increased to €15 an hour.

The question has come up as to whether we should have boosters in Irish society when people have not been vaccinated in Africa, Asia and Latin America. Why is there a scarcity of vaccines? The industrial capacity is there to provide vaccines for everyone in the world. It is because we have production for profit and not production for need. We need a waiver on the patents from the World Trade Organization. We also need public ownership of the pharmaceutical industry and production for need. This can only be done on the basis of a socialist plan of production internationally. This is what is needed.

It is positive that antigen tests are coming more into the picture now. Why does the Government have a stockpile of only 2 million? It has been obvious for a long time that they would play a role at a certain point. There should be tens of millions of these tests. We need tens of millions of them. They should be freely available. Urgent steps need to be taken to resolve this issue now.

Deputy Kieran O'Donnell

The number of people on trolleys in University Hospital Limerick is still very high but has decreased to 27. It is not the top Trolley Watch figure today, which is welcome news. There are 40 confirmed Covid cases in the hospital. They are putting pressure on isolation beds. Nine of these patients are in ICU. It is said that almost six in ten people ending up in hospital are unvaccinated or not fully vaccinated.

It is said that 52% are fully unvaccinated, 5% are partially vaccinated and 2% of cases are unknowns. We have to get a campaign going to persuade people to continue to be vaccinated. I welcome the booster programme that is coming on stream and I hope it will spread to all the age cohorts. It is of great importance.

I will spend my time discussing the just published interim report of the rapid testing expert advisory group, chaired by Professor Mary Horgan. The Minister will be aware that I am the Chairman of the Committee on Transport and Communications, which has been pushing for antigen testing since December last. We produced a report seeking rapid antigen testing for aviation. We held various public hearings with all of the interested parties, including the Chief Medical Officer, Dr. Tony Holohan, various aviation experts and the Minister for Transport. We very much welcomed the announcement establishing a rapid testing expert advisory group four months ago.

I welcome that there has been a programme on rapid antigen testing but I am somewhat underwhelmed by advisory group report. I accept that it is an interim report but I would have liked to have seen more progress around the terms of reference, including that it "Support Government departments". There has been some engagement with Departments, specifically the Department of Tourism, Culture, Arts, Gaeltacht, Sport and Media and the Department of Enterprise, Trade and Employment, but there appears to be no engagement with the Department of Transport. That is very disappointing.

The terms of reference include that the advisory group support Government Departments "in the design and assessment of pilots". There have been some pilots. It was to provide "guidance to Government departments on the use of rapid tests." The report appears to be based on developing a risk assessment model to assist in supporting the use of rapid antigen testing. There is no timeframe for having that particular framework in place. I welcome a risk-based model, as I always do, but the purpose of rapid antigen testing is to assist PCR testing. It is not a stand-alone test. It is used for screening in the tourism sector, nightclubs and so on to contribute to reducing infection rates.

Rapid antigen testing detects people when they are at their most infectious. PCR testing detects people across a much wider range, whether they are infectious or not. PCR is the benchmark but rapid antigen testing has a role. We need to see the final report and we need a timeframe for putting in place the risk assessment model. The report is looking at a model to be based on the background risk of SARS-CoV-2 within the population participating in an activity; the risk of SARS-CoV-2 transmission associated with the activity or setting; and the most appropriate testing approach to best mitigate the risk. We all know that PCR is the gold standard. I would like to see more pilot programmes and more engagement between advisory the group, which has been up and running for four months, and the Department of Transport, as well as other Departments. It should set out a programme.

Members of the public have started to use rapid antigen testing. The chair-designate of the Dublin Airport Authority appeared before the Joint Committee on Transport and Communications yesterday. He uses rapid antigen testing for his own purposes, as do the staff where he works. My worry is that people will escalate their use of rapid antigen testing. I would like that to be done in a co-ordinated and structured way. The basic model is in place but I would just like to see more urgency in implementing it. This is a welcome first step and I commend the Minister on that. However, I would like to know when the risk assessment model will be in place.

The conclusions of the report do not give dates in respect of when rapid antigen testing will be introduced. We have no concrete dates as to when it will become a formal part of the toolkit for detecting Covid-19. Rapid antigen testing has a place in nightclubs, restaurants and schools. It is complementary. My worry with this report is that it appears to compare antigen testing with PCR testing. They are not comparable tests. PCR is the gold standard and is very successful but we cannot use PCR tests to screen people because it costs too much and takes too long.

I will present an example to the Minister. If someone is flying in having taken a PCR test, the result will be available in 24 hours. Given that the virus escalates so quickly, someone could take a PCR test 48 hours before a flight and by the time that person gets on the aeroplane, he or she may be heavily infected with Covid-19. The rapid antigen test would detect that. I see rapid antigen testing as stand-alone.

The terms of reference of the advisory group, which I greatly welcomed, refer to supporting Departments seeking to deploy rapid tests in their respective sectors, supporting them in the design and assessment of pilots for their respective stakeholders and supporting them in developing standard operating procedures. These are all very welcome tasks. The group was also to maintain a list of currently validated tests for guidance.

The EU is beginning to do that. It was also to monitor rapid tests in development and those emerging on to the market.

I wanted the Minister, in addition to PCR testing, which is the gold standard, to bring in antigen testing along to assist in the detection of the virus. This is a low-cost model. PCR is very good in detecting at any range but I wanted to use rapid antigen testing to assist. If these tests are not 100% accurate, that is fine, but if they detect one person who is highly infectious, particularly in settings like nightclubs or live venues where we have seen pilot testing, they will be of great benefit.

I ask the Minister to ensure there is engagement with all Departments, including the Department of Transport. I would like to see the risk assessment model being expedited. The report states:

To address the first component, [This is about the population] … HIQA and University College Dublin have developed an algorithm which can provide a time-updated estimate of the risk of someone who is ... positive attending an activity/setting.

The expert advisory group is looking at the type of risk and setting a person is going in to. In many cases, for example, in live venues or nightclubs, PCR testing will be impractical. Rapid antigen testing has a key role to play in these settings because it can be done just before people enter and highly infectious people can be detected. This is nothing new. The Joint Committee on Transport and Communications has been front and centre on this from day one. We see that the biggest mistake is that people compare PCR with antigen testing, which are two totally different tests. One complements the other or, to put it another way, the PCR test is effectively the engine and main driver. It is the mother bee and the antigen test is basically the ground worker, the bees working away assisting the queen bee. They should not be viewed as like for like.

The report notes that a rapid review evidence synthesis being conducted by researchers at SPOR will examine the evidence for each of the other two components. That needs to be expedited. I fully agree on the risk-based model but I am worried that we are putting PCR testing up against antigen testing. PCR testing will win every time on the overall spectrum.

Antigen is there to assist PCR. I would like that to be front and centre in the final report that will be provided by Professor Horgan and her colleagues. I would also like to know when the report will be published and the risk-based model put in place. We need to get practical. PCR is the Mercedes and antigen is the Mondeo, but the latter complements the former, not vice versa.

Deputy Donnchadh Ó Laoghaire

Like Deputy Gould, I briefly raise the case of Mr. Nadim Hussain, who is on hunger strike and ask that the Minister for Justice give it her attention and see whether she can assist.

School leaders and boards of management feel isolated. They can hardly get hold of the HSE and they feel completely abandoned by the Department of Education. The changes in respect of self-isolation were expected. Making children who were asymptomatic and had received negative tests self-isolate was completely disruptive and did not make sense. It came as a surprise, however, both to me and to school leaders, that contact tracing and risk assessment would be removed completely. School leaders, students and parents now feel they have been left in the dark.

I have written to NPHET officials on this, as I have done throughout the pandemic. Briefings with party health spokespersons have been facilitated, yet education has been a fairly core issue and we have never had a briefing from NPHET. I do not know why that is. I have heard nothing in response to my latest request. I wanted to ask them about these changes and what they will mean on the ground in schools. There are still little details that need to be worked out and schools are trying to figure out exactly what the changes mean. Parents, students and school staff have questions and we need the Minister for Health, Dr. Tony Holohan and the Minister for Education to be front and centre in answering them.

I am hearing from schools they have been told they are not allowed to tell parents if there is Covid in their child's class, yet that is exactly what is done in the case of chicken pox and a number of other illnesses. This is wrong. Parents deserve to know, particularly families who have vulnerable children or adults at home. They deserve the information in order that they can take a decision that suits their family and their health risks. It helps no one to pretend there is no Covid in schools. It does not help teachers, parents or students to be kept in the dark in regard to a public health issue within the school community.

The Minister stated, at the time of these changes being announced, that they would be kept under review. The Government, throughout this pandemic, has been keen to find a middle ground. Will the Minister and his colleague, the Minister, Deputy Foley, revert to NPHET and try to find a middle ground? Will they explore with NPHET how they can ensure schools will get the support they need to retain access to well-resourced public health teams, risk assessment and contact tracing while preventing schools from being disrupted, without requiring the unnecessary exclusion of healthy children, as was the case previously? That did not make sense. Education continuing without disruption is of the highest priority to me. Knowledge is power and there is a lack of knowledge out there at the moment. Sinn Féin and I will be bound by any public health advice but knowledge and data are the key here. We are in something of a vacuum and the Minister should engage to explore the options at this stage with NPHET and the Minister, Deputy Foley. I urge her also to end the substitution crisis, which is having an impact on the issue, by extending panels to the entire country and ensuring banked hours are returned.

In recent days, there have been changes to the access restrictions in maternity hospitals and hospitals in general, although not all the issues have been resolved. There seems to be a strange, arbitrary distinction, which the Minister identified, regarding established labour. That is completely wrong-headed and needs to be resolved. Nevertheless, I commend the campaigners on the progress that has been made. They have been relentless and the protest made a significant difference. I am glad the Minister, the HSE and the hospitals listened, although there are issues that have yet to be resolved.

Finally, we have spoken a great deal about ICU beds and my party is very critical of the fact that no additional ICU beds have been added beyond what was already announced. That is a matter of serious regret. It could cause us great challenges and I want it to be addressed. I am very concerned about step-down beds, too, because they are all part of the same jigsaw. In Cork, we are down 20 or 30 community step-down beds since before Covid. The new beds that were supposed to have been built at St. Finbarr's Hospital have not come to pass and I believe they have not even been started. We urgently need modular step-down beds because they will mean beds can be freed up in the hospital. There are so many patients there who have nowhere to go because there are no community step-down beds. If we can resolve that, it will free up an awful lot of beds and capacity. I am very worried about the danger of huge trolley counts at Cork University Hospital, CUH, this winter. Step-down beds in the community and modular units are the key to resolving that.

Deputy Peadar Tóibín

The Government made some seriously important decisions this week regarding Covid and restrictions and, true to form, it did not provide any space for a debate. There has been a democracy deficit in this country since Covid emerged. The elected representatives of the people have been sidestepped in respect of most of the important decisions that have been made. It is only because I called for a debate during the Order of Business on Tuesday that we are having one and it is being held at a time when most Deputies have gone home, which is a disgrace.

The Government stated in September that NPHET would be wound up in the middle of October but that is now completely off the agenda. Paul Reid stated in August that once we had hit 80% vaccination rates, we could fully reopen. That milestone has come and gone and been ignored. Ireland is now the most vaccinated nation in Ireland, with a 92% adult vaccination rate. Ours is the longest and most severely restricted country in Europe. It has cost more here than in almost any other country in Europe; in fact, per capita, it has cost twice the European average to deal with Covid in this State. Still, we have the seventh highest incidence of Covid in the European Union. The Government's policy is failing radically when it comes to Covid.

The truth is we are in a very dangerous place now. The Government simply does not know what is happening. It has been blindsided by what is happening in society. I listened to Professor Luke O'Neill on the radio this week admit they do not know what is happening. Evidence is rapidly accumulating that suggests Covid is spreading between people who have been vaccinated. Nobody could have foreseen or second-guessed that and I do not suggest the Government was out of place in that regard. Dr. Cillian De Gascun has stated that while vaccination reduces the risk of Delta infection, fully vaccinated individuals have viral loads similar to those of the unvaccinated and can efficiently transmit infection. Vaccinated people are catching and transmitting Covid and ending up in hospital and ICU and, tragically, some are losing their lives.

Do not get me wrong: vaccines significantly reduce mortality and morbidity. They are a significant tool in dealing with Covid, but transmission among vaccinated people is happening in this country at a rate far higher than anybody expected and that creates very significant problems for the Government. The first problem is that the Government has put all its eggs in the vaccine basket and is allergic to antigen tests, which is causing massive damage to our country. The Government's opposition to the proper use of antigen tests is, in my view, criminal. It is shocking.

Under the Government's law, a person who has been vaccinated but has Covid is allowed into a pub or restaurant and allowed to spread the illness to other vaccinated people. By contrast, a person who has not been vaccinated but has received a negative antigen test and is Covid free is banned from the hospitality sector. Despite that being phenomenally discriminating, segregating and so on, the policy simply is not working.

I agree with what a previous speaker said. There are hundreds of thousands of people in this country whose civil liberties have been taken away. There is a two-tier citizenship and they are being othered for something that is not having the desired effect. In television and radio studios for the past year, Deputies and Ministers have stated that they are completely in favour of antigen testing, that they are looking into it and that it will be rolled out soon, yet here we are, 12 months later, and there is practically no difference in what is happening.

It is not being rolled out. There is a chasm between the language the Government is using and the actions it is implementing. It is a prime example of government capture - Ministers saying what they think people want to hear, but not implementing it because the Civil Service tells them not to.

NPHET is in a small minority of national public health organisations in the European Union in its opposition to antigen testing. Antigen testing is widespread throughout Europe as a means to stop Covid spreading in hospitality. It saves lives, it allows businesses to function and it is non-discriminatory. Take Denmark as a comparison. Denmark has a lower vaccination rate than Ireland has. It has had no hospitality restrictions since September. It had a vaccine plus antigen pass when it opened hospitality fully in May. That has been dropped since September. It has a Covid incidence rate that is one third of this State's rate. It is absolutely damning. The difference has been that Denmark is antigen testing radically. Even in the plans the Government promoted this week, antigen testing is still largely aspirational. The Government states that the HSE should implement a programme of Covid-19 antigen testing, but this only applies to people who are identified as being fully vaccinated close contacts. That is a small number of people. The Government is posting it out to these people. It reminds me of the iodine tablets issued by a former Fianna Fáil Minister, also from Wicklow, a number of years ago.

The Government's plan states that the rapid testing expert advisory group has been requested to provide a view as to the potential utility of voluntary self-testing. It also talks about requesting the rapid testing expert advisory group to examine the potential role and feasibility of rapid testing. We are talking about views and feasibility 12 months after the rest of Europe successfully engaged in rapid antigen testing, using it as one of the tools to mitigate against Covid. For me, this is the equivalent of the Donegal Catch fisherman saying "they're keeping my idea on file. In a filing cabinet." It is the most frustrating thing I have seen. I have listened to the Minister's colleague Deputies and the frustration in their voices about this. It is an absolute disgrace that the tests are not being rolled out. It is costing lives, costing health, costing the economy and costing civil liberties in the State.

I wish to speak briefly about capacity. Capacity in the health service has hardly shifted. The Government and the HSE are seeking to close the ICU and emergency beds in my local hospital in Navan, despite them being on the front line in the battle against Covid. I admit there has been a stay of execution in the past week, but it is still the priority of the Government. The Minister mentioned unvaccinated people being the cause of waiting lists in his speech. I hope I am not misinterpreting what he said. The Government and the partners in government own the waiting lists in this country.

I also refer to the immunity cliff that is happening in the State. We are calling for the Government to quickly allow booster shots to be made available in nursing homes throughout the State. They should be given to both the staff and residents of the nursing homes. The idea that it is only for people over 65 years old while there could be people there who are just under that age does not make sense. We must ensure that the nursing home sector is not the epicentre of the next wave.

Finally, I fear that if the Government does not implement widespread antigen testing it will be looking at the other tool that it knows well, which is deepening restrictions. That would be a disaster for this country.

Deputy Colm Burke

I thank the Minister and all the Deputies for their contributions to this debate. It is important to discuss the various challenges that exist. While 92.4% of people over 18 years of age have been fully vaccinated, unfortunately, in this case vaccination does not give immunity. Earlier, my colleague outlined how one can be fully vaccinated but still be a carrier of and contract Covid-19. That is the challenge we have with Covid-19.

We are not far from going into a third year of dealing with this issue. It started in March 2020 and it is now over 20 months in which staff have been on the front line dealing with large numbers of admissions, particularly to the intensive care units. It is important to acknowledge their commitment, dedication and hard work over the last 20 months and the way they have dealt with the pandemic. It is important to acknowledge their contribution. As we confront the new challenges over the past number of weeks, they still have to deal with very difficult situations.

As there is still a large group of people not vaccinated, it is important to convey a message to encourage them to take the option of vaccination. I understand from the HSE that over 1,000 people per day are being vaccinated. Can we get that number up to 2,000 or 3,000 per day over the next two to three weeks to help improve the number of people who are vaccinated? One concern I have relates to obstetrics-gynaecology. A medical consultant recently advised on social media that she had seen ten patients in a clinic, nine of whom had not taken the vaccine. A special effort is required in respect of that cohort, women who are pregnant or who want to get pregnant, to convey that the vaccine should not in any way cause any type of restriction or damage. It is important to get the message out to that cohort to ensure that if a woman is coming into clinics regularly over the six or seven month period, she will not put anyone else coming into those clinics at risk, and to ensure the woman can feel that she is not putting the baby she is carrying at risk either. It is important to get that message out.

The challenge now is that, according to yesterday's figures, the number of people in ICU is 86, with 14 admitted over the 24-hour period up to yesterday, and the number of people in hospital is 464, with 54 admitted in the preceding 24-hour period. It is a huge number in a very short period of time. According to the figures for the last seven days, over 155,000 people were tested and 8.9% got a positive result. That shows the virus is continuing to spread and the number of people contracting it continues to increase. We all need to convey the message about being more careful, wearing masks, keeping one's distance and all the other precautions that must be taken.

With regard to the hospitality sector, the figures we have seen relating to HSE inspections are not welcome news. Two thirds compliance is not good enough. That means one third are not fully compliant. Where one third of the people in the hospitality sector are not compliant, it means they are now contributing to us possibly facing into another closure. They are the net losers by not complying fully with the regulations at this stage. That is disappointing.

They are also putting themselves, their employees and the people who are attending their restaurant or bar at risk. People should not frequent premises where they see no checks are in place. If we want to deal with this pandemic, we need to ensure that the regulations are complied with insomuch as they can be.

It is interesting that we have now decided that people over 60 should get the booster vaccine. I welcome that more than 123,000 people aged over 80 have already received that booster. We need to continue to work on the cohort of people who have not received a first vaccination, let alone two.

The difficulty with antigen testing is that it is not foolproof. A very good explanation was given recently about the difference between antigen testing and PCR testing. Someone could get a negative result on an antigen test today and be positive on an antigen test in three days' time, whereas a PCR test today will show up as positive because the degree of infection is at a lower scale initially and it increases as the days go on. That is difficulty with antigen testing. It would be welcome to use it, but it does not provide a comprehensive result. That is the difficulty that any establishment would have in using antigen testing.

While much work has been done, this is a new challenge and we see something new every day. Four, six or eight weeks ago, we did not expect to be in the position we are today. Unfortunately, we now have those numbers of patients in ICU beds and in hospitals. We need to see the numbers contracting the virus level off and then start to reduce again. I do not believe we have reached the maximum level of people contracting the virus and that is the difficulty we will face over the next two to three weeks.

It is important to ensure that all those who work in the healthcare sector get full support and that where needed, additional resources are provided. I agree that we also need to ensure we have an adequate number of step-down beds in the coming months. We have much catching up to do in all areas of healthcare, in ensuring that people who are on waiting lists for elective surgery can be dealt with in a timely manner. I thank the Minister for the work he is doing.

I join my colleagues who have raised the issue of Nadim Hussain in the direct provision centre on the Kinsale Road, Cork. It is a very serious issue. While I know it cuts across a number of Departments, something needs to be done on that issue and I ask the Minister to take it on board.

Deputy Michael Collins

I thank the medical staff who have been at the forefront and worked tirelessly throughout the pandemic in community hospitals and general hospitals. I commend them on their bravery despite the difficulties they have experienced. While these people are professionals, what they have seen must have been terribly traumatic for them. Often, they were away from their families and it must have been difficult. We can only say, "Thanks", but sometimes thanks is just not enough.

The pandemic has exposed what is wrong in our hospitals and our nursing homes. Many of the community hospitals need to be up to a standard and those standards were set many years ago. I know that because I am chairman of the Friends of Schull Hospital. I commend the former Minister, James Reilly, who, during his term in office, provided the funding to Schull Community Hospital to allow it to reach the required HIQA standards. It is probably the top community hospital in Ireland.

Unfortunately, Clonakilty hospital did not get those funds with devastating consequences for many families during this pandemic. It also had devastating consequences for many of the staff in that hospital, through no fault of their own, because the hospital simply did not have the funding to achieve the standards required. Since the onset of the pandemic, it has yet to receive any funding to rectify this situation. The approach appears to be to shut down beds rather than allowing beds to remain open in a safe manner. The standards were very clear. Ten or 12 years ago we felt that Schull Community Hospital was not up to that standard. We were very worried about how it would be brought up to that and how we would get the funding for it. We fought bravely and thanks to James Reilly and others, we were lucky enough to get the funding and the hospital was brought up to a tremendous standard.

Unfortunately, any hospital or nursing home that was not brought up to that standard was found out very quickly. Not only has the HSE failed, but the Government has failed to give the funding for Clonakilty Community Hospital. If the Minister is not able to answer me today, he might be able to come back to me and tell me if the funding has now been provided to bring that hospital up to the required standard so that if there is a continuation of this pandemic or another pandemic the patients in that hospital will be given the respect they deserve. It serves a large community in Clonakilty, Timoleague, Barryroe, Courtmacsherry, Ballinascarty down into Bandon and back from Rosscarbery into Skibbereen. It covers a large terrain. Many people have used the step-down beds in that fabulous community hospital. However, it is does not meet the standards and the same is true for other nursing homes. It came at a very high cost to people's lives.

Last week I spoke to a lady who badly wanted to visit her mother in Bantry General Hospital. When there are additional Covid cases, the hospital is required to be closed to visitors. I understand the need for that; there is no disrespect to the hospital. However, there needs to be some mechanism for the families to communicate with their loved ones in the hospital. There is nothing worse than to be parted from a loved one, such as a mother or father. Sometimes they may have dementia and the concern is they may think they are being abandoned. It was a great relief when a lovely member of staff helped her to communicate with her mother even though it was only for ten minutes. Surely even if it is not a medical professional, somebody can provide a person with a phone or a tablet, go to the patient and talk to the loved one at home for those ten minutes a week. It is a small thing to ask but it is very important for people who cannot visit a loved one in hospital for a long time.

Having 1 million people on a waiting list is an extra scourge on people who need hip, knee and other surgical procedures. I think we should consider opening hospitals 24-7. We need to find a way to alleviate this because if the pandemic ends, those 1 million people will become 1.1 million or 1.2 million. Where will it stop?

I must now to discuss the services that were lost and are being lost. Earlier I raised with the Minister, Deputy Eamon Ryan, the issue of the SouthDoc service in Castletownbere. I appreciate that the Minister, Deputy Stephen Donnelly, communicates back to me but someone is giving him false information because he has told me that it has been resolved. The professionals in Castletownbere have told me there was no out-of-hours SouthDoc service last night and there will be no out-of-hours SouthDoc service in Castletownbere over the weekend. If that happened in Cork city or Dublin, there would be a national outcry. It is frightening that the people from Ardgroom, Lauragh, Glengarriff, Adrigole, Allihies and Eyeries have no out-of-hours service.

It is not fair. They got a solution and a gentleman came but he had no vehicle. The only way he could go to a house was to hitch-hike in the middle of the night. That does not make sense at all and there is no sense of reality.

I know CoAction is outside the Minister's brief but it deals with people with intellectual disabilities and it is closing one of its homes in Castletownbere in the next three to four weeks. Three people with intellectual disabilities are losing their home after the past 30 or 40 years in that community. Some of them are 50 or 60 years of age. Will the Minister speak to his Minister of State, Deputy Rabbitte, who communicated with me to say she would try to resolve the position but I have heard nothing since? It is not good enough in a pandemic that these people may be taken 120 km or 130 km away to a different home. These people must be respected.

Deputy Catherine Connolly

I will start on a positive note and thank the Minister for coming back to me about compliance. He said he would do it and he did. The level of compliance is worrying. I have six minutes so I will make a few points but I wanted to start by thanking the Minister.

From the beginning I asked for a human rights approach on this topic. I thank Deputy Tóibín for asking for this to go on the Clár Oibre. I have asked repeatedly in a proactive manner that the Government would come back to us in order that we can engage on this process. I will make my comments, as I always do, in the knowledge and recognition that we have had 5,369 deaths, with 88 confirmed cases in ICU and 448 cases in hospitals. I make my remarks firmly in the recognition that we are dealing with a very serious crisis with Covid-19.

From day one, however, I have been most unhappy with the way the Government, including the previous Government, has dealt with this matter. In the beginning I gave my full support to the draconian legislation on the strict understanding it would be a partnership and the Government would come back to us in an open, honest and accountable way. I have watched with dismay how we speak about opening up nightclubs and what appears to be a "Cinderella" dance licence where it is safe to dance after midnight but it is not safe to open respite services in Galway. We are into the second year of the pandemic with no respite services because they are not safe but, theoretically, I could go dancing in a nightclub if I had the energy. I presume that could happen after midnight tonight.

The Irish Council for Civil Liberties, ICCL, has clarified matters in a press release. It is becoming extremely difficult to raise any questions in this country about civil rights or alternative views in dealing with the pandemic. The Irish Council for Civil Liberties qualified that it is a pro-vaccine organisation and went on to note it supported the vaccine programme roll-out. It states, however:

At the same time, we respect everyone’s right to bodily integrity and privacy in relation to their health. We believe vaccination, and all medical treatment, should be a choice.

I believe that as well and that vaccination should be voluntary. The strong message should be to encourage and not demonise but, unfortunately, the Minister's speech continues that narrative. The Taoiseach did this as well and it is an unacceptable narrative. The Irish Council for Civil Liberties argues this could be counterproductive but I believe it is counterproductive. The Government legislation on vaccines has created an infrastructure aimed at segregating and risk-scoring individuals on their health basis and the Irish Council for Civil Liberties warned in July that this set a dangerous precedent. I fully agree with it.

We are 18 months into the pandemic and there is no evidence of any human rights impact assessment by the Government of Covid-related legislation, despite repeated calls from me, the Irish Council for Civil Liberties and others. As I said, I have constantly called for a proper debate, reasoned and rational, on this topic so we can inspire confidence.

Like the cross-party committee on Covid-19 response, I have asked for an urgent investigation into the deaths in nursing homes. I note with horror that those numbers are increasing again. I feel a little sympathy for the Minister because I have read the eight-page letter from NPHET, which has three or four pages of appendices. I note what it states and it is of extreme concern. It states "disease incidence across the country is high and increasing" and "in summary, the epidemiological situation in Ireland indicates a worsening disease profile with the future trajectory very uncertain".

The letter indicates five criteria that are essential before we move to opening in a full manner and yet NPHET goes on to agree with the Minister that we should be opening up. Of the five criteria, we have achieved one, which is that "at least two weeks having passed from the attainment of at least 90% vaccination". The Minister has told us that is now 92%. The letter goes on to speak about hospital and critical care occupancy and we utterly fall down on that. We also fall down on public health capacities. Of course, NPHET also speaks about the absence of a new variant of concern and how everything becomes unpredictable if that occurs. We have control over hospital and critical care occupancy and public health capacity but we have failed utterly on both of those, although I recognise the Minister's efforts in increasing capacity.

This immediately brings to mind the question of private hospitals in Galway. Galway city has two closed wards and the head of the Saolta University Health Care Group, Mr. Tony Canavan, was on the radio recently telling us those two wards had been closed because of Covid-19. This hospital was in crisis continuously before Covid-19 and it is much worse now. The staff are at breaking point and my heart goes out to them. We have two private hospitals, however. We have spoken about everything we learned about taking over private hospitals and using them but they have not been mentioned anywhere. It is extraordinary. There are two hospitals, one of which was seriously under capacity when Covid-19 started. I would not say it did well out of Covid-19, and that is a bad way to put it. It was used, theoretically, but remained underutilised. Will the Minister tell us about that?

Perhaps the Minister might also tell us about the absence of respite services in Galway. If we have 92% of the eligible population vaccinated, where are the respite services? I see I am benefiting from a stopped clock.

Acting Chairman (Deputy Aengus Ó Snodaigh)

It has been stopped for a while.

Deputy Catherine Connolly

I will send letters I have to the Minister and the Ministers of State. They are from 21 October and 24 September. I do not expect them do deal with them during my speech. They show what we are dealing with.

In dealing with two agencies in Galway, the Health Service Executive states that the waiting list for children in respite services is 34 weeks, for enhanced services it is 14 weeks and for adult services it is 45 weeks. These are the low figures. We asked the service to break down the agency from zero to three months up to four years. At the end of that we have 89 adults waiting more than four years. Something may be wrong with the reply but I am only reading what I have relating to respite services. I can pick from the range. Eight adults are waiting two to three years. Six are waiting for 12 to 18 months. There are also data on children.

Getting that information alone has been a marathon and it was with the help of the Department that we got it. It is truly shocking that people were waiting so long prior to Covid-19 and during the pandemic for the most basic services. I have seen this in Galway because I am on the ground all the time. It is amazing what people are dealing with when it comes to care. They are saving the State a fortune and they love the people with them, who are very vulnerable. They have absolutely no respite.

After seeing this I witness a discussion on "Cinderella" licences and whether people can dance after midnight. This demonstrates a split in our population, which is totally unacceptable. We saw this happening in the beginning, gently and insidiously, when people over 70 were told they had to stay in their houses. Months later it was argued that was not really said but we encouraged people to stay in their houses. We are doing the exact same thing again and ignoring that the five criteria set out in that very long letter from NPHET have been ignored one way or another.

It seems we should have learned and I must keep asking why we are not learning? Why are we not learning that we cannot put all our eggs in one basket? NPHET has even said that in the letter because it raises the possibility there could be another variant and existing vaccinations may not deal with the current variant. Nevertheless, somebody is writing speeches for the Minister and other Deputies to demonise those who make their decision in the full knowledge of what is best for them while complying with all the rules. I have no time for somebody who does not comply with the rules, such as wearing a mask or endangering people.

Ultimately, it is a decision for the person. We are, therefore, persisting in this decisive manner and ignoring what is really happening. We have ignored the absence of a human rights assessment of any legislation passed. We are debating today without any regulations before us, unless I am wrong and they have been published. I am speaking in a vacuum.

Very little information has been provided on ventilation. Over the past few years I have stayed in hotels where the window did not open because building regulations allowed that, although not in the hotel I am currently staying in. We have allowed a system to develop whereby ventilation has not been built in as a necessity.

We have refused to consider antigen testing and have failed utterly from the beginning in regard to testing and tracing. Now we will demonise and isolate people and turn one against the other, when it is totally unnecessary.

How does the Minister stand over the confusion and contradictions? Nightclubs are set to reopen, but respite care is still closed. We are all in this together and yet we are going to divide and conquer. A negative Covid test is sufficient for unvaccinated people to travel to Ireland, but is not sufficient for indoor dining. The issue of CO2 monitoring was raised by other Deputies.

I could go on given that I have been given the benefit of extra time, but I will not. It is extremely difficult for me to go out and to inspire confidence with the confusing and contradictory messages we are getting and their divisive nature.

Minister for Health (Deputy Stephen Donnelly)

I thank the Deputies for contributing to this important debate this evening. I welcome the opportunity to hear from colleagues as to what is and is not working, and where more needs to be done.

I will begin with the excellent contribution from Deputy Connolly. Some of the points she raised have also be raised by other Deputies this evening. Deputy Connolly referred to people who have chosen not to be vaccinated. She quite rightly said that this is voluntary and people must have a choice, which is true. However, many of us are familiar with the phrase that "with freedom comes responsibility". We must bear that in mind when we say people have the freedom, which they do, not to be vaccinated. The issue is not about whether they chose to be vaccinated. It is not about whether they chose to protect themselves. If they chose to leave themselves at risk of serious illness or death, that is their choice. I do not think it is the right choice, but it is their choice to make. As the Minister for Health, I have to deal with the implications of that choice as do those working in the healthcare system. I am not making any value judgments; I am providing the facts.

Let us consider adults, that is, those aged 18 years and over. Approximately 6% of them are not vaccinated in any way. Some 94% of the adult population are either fully or partially vaccinated. That provides a huge amount of protection against hospitalisation and, in particular, admission to an intensive care unit, ICU. We considered all ICU attendances over several months - from April to October - and we found that 70%, seven in every ten, of Covid patients in ICU were not fully vaccinated. At present, there are 88 people - 87 adults and one child - in intensive care with Covid. A massively disproportionate number of those are unvaccinated. They have chosen not to be vaccinated. We know there is a very small number of people who cannot be vaccinated for medical reasons, and we are not referring to them.

We need our ICU capacity to treat sick children and adults. An awful lot more of that ICU capacity is used for Covid for the 6% of people who chose not to be vaccinated. Is that their choice? Of course, it is. Are they free not to be vaccinated? Of course, they are. However, as the Minister for Health, I must point out that there are serious implications for the rest of society because of their choices. If we do the maths, approximately 60 ICU beds could be freed up right now and used for life-changing operations for adults and children. That is the reality of the situation. It is incumbent upon me, as the Minister for Health, to state the facts and to say to the 6% of adults, while fully respecting their bodily autonomy, that this is not just about them. It is about the people they know, their friends and family and our healthcare system. Scarce and incredibly important healthcare resources are having to be deployed because of the choices they make. That is the position and why I must make that argument as the Minister for Health. If people chose not to be vaccinated, let them make that choice knowing all the facts and the implications their choices have on wider society and our healthcare system.

There has been much good debate on many other issues, which I will try to touch on. On antigen testing, I agree with Deputies that this has a role to play. It has already been deployed. Right now, we are doing serial testing with antigen tests in a large number of nursing homes throughout the country, including my county. They are being used in hospital settings, higher education, childcare and workplaces, and individuals are using them. However, I want to go further than this and I think most Members, probably every Member, agree that we should. To that end, I set up the rapid testing expert group to help with implementation. I wish to acknowledge the work done by Professor Mary Horgan and others in that group, who have worked incredibly hard. Members will be aware I published the group's report today. It is a very good report. Our strategy was that if antigen tests were needed at scale and disease rates rose again, we would be ready. That need has arisen and we are ready. That is partly down to the work the group has been doing with the HSE.

As colleagues will be aware, asymptomatic close contacts will now be sent rapid tests in the post so they can test themselves. The group has put together comprehensive material, which will be shared online, for individuals, employers and organisations who want to use rapid testing. It will include training materials, videos, testing protocols, check lists, and details of the types and makes of rapid tests that are deemed to be good and where people can get them, etc. There will be a lot of information available in that regard. We are also developing a risk assessment tool anyone can use. Depending on their age, where they live and the type of activity they will participate in, people can determine whether a rapid test would be a good thing for them to use in that case. I hope colleagues will be encouraged by the progress made there.

Deputy Shortall asked whether the data on outbreaks was being published anymore. It is published by the Health Protection Surveillance Centre every Wednesday. Deputy Buckley referred to a mental health situation in his constituency. If the Deputy sends me and the Minister of State a note on that, we will be happy to look into it. Similarly, Deputy Connolly has quite rightly continued to raise the issue of respite in her constituency.

I commit to following up with the Minister of State, Deputy Rabbitte. One of us will get back to the Deputy on that issue because, when it comes to healthcare provision and these essential respite services, anything that can be opened safely, must be opened.

Deputy Andrews asked some questions on volunteering and situations in which different organisations had made different decisions on the use of certain facilities in some sports clubs. I will revert to the Minister, Deputy Catherine Martin, and ask that Deputy Andrews be engaged with on that issue.

The issue of schools was raised, which is very understandable. I will make a few points on this. First, as I said to the Deputy as he was leaving, if the education spokespeople ask to meet with the public health experts, I am very happy to facilitate such a meeting. We need to provide all the expertise we can to Members of the House so that they can do their job. I am very happy to do that, if people would like me to.

The solution to making schools as safe as possible is for us to drive down the number of cases in the community. We are finding that children are picking up Covid more in the community than in the schools. That is down to the great work being done by the schools and by the students while in school. They deserve great credit for that. Some Deputies asked about contact tracing and why the isolation of asymptomatic contacts was stopped. This was done for various reasons. Very few of these tests were picking up positive contacts but the ten days of isolation was causing a lot of disruption for the children themselves.

I hope I have got to most of the questions that were raised. I again thank colleagues for their time and for their contributions this evening.

Dáil Éireann díospóireacht - Thursday, 21 Oct 2021

Covid-19: Reframing the Challenge, Continuing our Recovery and Reconnecting: Statements

Dáil Éireann díospóireacht -
Thursday, 21 Oct 2021