Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 16 Nov 2021

Vol. 1014 No. 1

Ceisteanna ó Cheannairí - Leaders' Questions

The need to build capacity in our hospitals has never been more urgent. Decades of bad Government policy meant that our health service was at breaking point before we ever heard of Covid-19. Now we face the most serious health emergency of a lifetime. However, despite what the past 18 months have taught us, there is a real absence of urgency and planning from the Government. We need more beds and staff. We must dramatically improve diagnostic and theatre capacity. Incredibly, however, the Government has waited until the middle of November to come forward with its winter plan for the health service.

As far back as July, Sinn Féin and others said there was no time to wait. We called for preparations for winter to start at that point and urgently. We drafted a plan, sent it to the Minister for Health, Deputy Stephen Donnelly, and we were ignored. The Government's plan does not go far enough. In fact, it is built on the failures of the recent budget. Like the budget, the plan does not provide for one additional acute bed beyond what was already committed, nor has it provided the increase in ICU beds needed to meet this emergency. Front-line staff have been left outside hospitals protesting over unsafe staffing levels, but the plan does nothing to improve recruitment for the health service, where it can take up to six months to recruit a nurse and a year and more to recruit a consultant. How can that be justified? My colleague, Deputy Cullinane, has met with hospital managers in Cork, Sligo, Galway and beyond, all of whom have capital requests lodged for months. They are left to wait. This means that badly-needed 50- to 100-bed expansions are delayed indefinitely. The capital approvals process does not work. It is simply too slow.

Even if we had not been hit by a pandemic, the Government's plan falls far short of what is needed to meet the challenge faced by hospitals even in a normal year. This should have been a plan for real progress and ambition. Instead, it is a plan for our creaking hospitals to stand still. The price for this lack of planning and urgency will be paid by patients left to wait on trolleys in hospital corridors. By the way, there are 409 such patients on trolleys today. It will be paid by children with scoliosis and other conditions crying out for procedures that would change their lives. It will also be paid by front-line healthcare workers, who are denied the resources to do their jobs and are left to work in stress cauldron conditions.

Ní théann plean an gheimhridh sách fada. Is é anois an t-am chun an cúram sláinte a fháil i gceart. Tá níos mó leapacha agus níos mó foirne ag teastáil sa tseirbhís sláinte uainn. Teastaíonn práinn agus seachadadh uainn. We need a big step forward from Government and we need a real change. Does the Taoiseach accept the urgent need to significantly ramp up the number of beds in the system? Will he immediately address the bottlenecks in the capital approvals process so that those hospitals can press ahead with their expansions? Will he act on the call made by the Irish Medical Organisation, IMO to cut the extraordinary time taken to recruit healthcare staff?

Ní aontaím leis an Teachta ó thaobh an plean atá foilsithe ag an Aire, an Teachta Donnelly, mar is léir gur plean cuimsitheach é. Caithfear é a chur i gcomhthéacs an plean a bhí againn anuraidh ina raibh an-chuid áiseanna agus airgid curtha ar fáil do na hospidéil ach go háirithe agus na seirbhísí sláinte go hiomlán. Diaidh ar ndiaidh, tá níos mó leapacha againn anois agus tá i bhfad níos mó daoine ag obair sa tseirbhís ná mar a bhí. Is léir go bhfuil dul chun cinn le feiceáil ach, dar ndóigh, tá dúshlán an-mhór amach romhainn, ní hamháin ó thaobh na paindéime de ach tá an daonra ag dul in airde agus tá brú faoi leith ar na daoine atá ag obair laistigh den tseirbhís.

I thank the Deputy for her question, but to be fair by comparison with previous winter initiative plans - €40 million in 2016, €40 million again in 2017, €10 million in 2018 and €10 million in 2019 - last year's winter initiative plan was €600 million. That went into the base and underpins the efforts we make this year. That €600 million along with additional funding has produced 800 non-ICU acute beds, which is the largest ever. By the end of the year, that will go up to approximately 950, which I would say is the largest increase in hospital beds in decades, and certainly in the history of the HSE. We want to do more on acute beds in 2022. A further 205 beds in 2022 are committed to and funded, and any additionality that can be brought on stream will be brought on stream.

I spoke at a recent Cabinet health subcommittee meeting. I fully understand the issue relating to capital approvals and I have asked for that to be accelerated. I have spoken to the HSE about that. We will work with the HSE in respect of capital approvals to get new elective facilities, in particular, delivered as fast as we can. In Ireland, large infrastructural projects, be they hospitals, road or rail, simply take too long. We have to go through all the planning processes, all the conditions and so on, but it is simply taking too long to get large projects done, and I am determined that major healthcare capital projects will get done much faster.

The winter plan is essentially focusing on a core objective of emergency department avoidance by treating people at home or in the community and by allowing them to return home quickly following hospitalisation. Those initiatives include GP liaison nurses to manage direct referrals from GPs to emergency departments; geriatric community support; enhancement and expansion of frailty intervention therapy teams models; community response teams, involving nursing and therapies in the community; community respiratory admission avoidance teams; expansion of the National Ambulance Service pathfinder initiative; additional home support hours; and COPD outreach teams. We want to get to people before they are admitted to hospital in the first place and then, within the hospital, to have far better flows than was historically the case. That was achieved last year through a record 5 million home care hours that were provided.

The challenge facing us this year is not funding or resources, but rather getting the workers in sufficient numbers in the country to take up posts as home carers. That is a challenge. We have recruited 4,462 whole-time equivalents in 2021.

Last year, it was 6,357 extra whole-time equivalents, so that means approximately 11,000 extra whole-time equivalents recruited in the guts of two years. Again, I have no issue with accelerating the recruitment processes. The funding is there. In fact, more funding was provided, meaning additional people could have been recruited if the people had been there.

The time is up.

As ever with the Taoiseach's Government, it is a case of too little and too late. The middle of November is not the time to produce the winter emergency plan, with the greatest of respect to all involved. That work should have been done in the summer. The facts are that the mistake made at budget time, where not one additional acute inpatient or community bed beyond what had been previously committed to was budgeted for, has been repeated in the winter plan. Resources and money are not everything but if he speaks to anybody working in any hospital across the State, they will give him chapter and verse as to how stretched they are and refer to the fact that resources are lacking. We need more beds, including more acute beds and ICU capacity.

We also need the capital approvals process to be streamlined. The resources held back include, for example, 96 beds for Limerick, 50 beds for Sligo, 50 beds for Cork and I could go on and on. Similarly, on the recruitment process, would the Taoiseach believe me if I told him the average recruitment time for a consultant is 562 days? It is six months for a nurse. Hospital managers across the State know this is ludicrous. This is a bureaucratic nightmare, Orwellian in its proportions.

Rather than the Taoiseach simply expressing interest or concern in this, it is his job to ensure this is sorted and these bottlenecks caused by excessive bureaucracy can be cut.

Time is up, Deputy.

There is a lack of capacity in hospitals.

The Deputy is way over her time. Please, Deputy.

I reiterate to the Taoiseach that the funds and resources must be made available. He has failed in that regard. It is astonishing stuff.

Since I became Taoiseach we have had record recruitment to the health service and record capital funding and beds provided. That is not enough and I am not resting on that. I want to do more. I want to accelerate capital programmes. In some cases, proposals have not come from certain hospital groups.

Is there an example?

I met Cork consultants, who were taken aback when we said funding was available if they wanted to increase bed capacity in the short term. We are there to respond as quickly as possible.

Sorry, who was-----

I made my point and instanced Cork. What tends to happen is working parties are set up and various consultants can have different views as to where particular elective facilities are to be located. They all have preferred options and there is too much analysis, which leads to a degree of paralysis. That is before it ever gets to the Department. That is something I want to cut through and we are going to cut through it to get badly needed facilities done. There will be 1,000 beds provided, more or less, by the end of this year. It is the largest number ever and the Deputy cannot ignore that. That is a fact. The money is there to recruit more than the numbers that have been recruited. I want to accelerate the recruitment process.

If we add this recruitment to what was recruited for the vaccination and testing programmes, the figure is enormous, to be fair to the HSE.

The Taoiseach should be clear. Which hospital was it?

We should give them credit.

I call Deputy Catherine Murphy.

People around the country are deeply concerned today. They are worried about the impact of the virus on their health, jobs, children's education and communities. They wonder if the small measure of normality that had returned in recent weeks is being snatched away and, if so, for how long. They are deeply concerned about the ability of our overburdened healthcare system to cope with the onslaught of cases. They wonder why, given the scale of the crisis in our hospitals, the HSE has yet to deliver the 350 hospital beds that were promised for ICUs.

The people are losing faith in the Government's ability to manage the response to the pandemic. They are concerned about the indecision and delay in the Government's response. Antigen testing has been promised for months but has yet to materialise. Ventilation has never been a priority, despite this being an airborne disease and ventilation being among the best weapons in the fight to suppress its transmission.

The roll-out of boosters has been painfully slow with little clarity on timelines for when the various cohorts will receive it. At the start of the crisis, Mike Ryan of the WHO gave some sage advice. He said, "speed trumps perfection" and "perfection is the enemy of the good when it comes to emergency management". That lesson seems to have been lost. Simple and effective measures, like antigen testing in schools, have not yet been rolled out. The overwhelming evidence that boosters would be required as part of the mitigation strategy has not been acted upon swiftly.

The Taoiseach and the Government have consistently highlighted personal responsibility and have said the onus is on people to limit their contacts and act responsibly, and that is certainly true. However, he has consistently downplayed the State's responsibility to manage the overarching response. Individuals cannot authorise antigen testing in schools, organise subsidies for antigen testing or institute a nationwide booster campaign. Individuals cannot mandate vaccination guidelines for workplaces or air purification systems in schools. Individuals cannot deliver additional hospital beds. Individuals cannot reintroduce the pandemic unemployment payment, PUP, for those who are likely to lose their jobs, even temporarily. All this work must be done by the Government. The Government has been sadly lacking and has taken its eye off the ball.

When will the booster campaign be scaled up? Will the Taoiseach give specific dates as to when each cohort will be dealt with? Why has it taken so long to roll out antigen testing, which is a no-brainer? The Taoiseach has failed to prioritise ventilation. When will he redress that? Will the PUP be reintroduced for people who lose their jobs?

I disagree with the Deputy's analysis of the country and the Government's performance in relation to Covid-19 since the onset of the pandemic. For instance, one key aspect has been the vaccination programme, which has been one of the most successful across the world in terms of speed, efficiency and effectiveness. About 90% of those over 12 years old are now fully vaccinated. That is no mean achievement and it is a tribute to the public, the robust debate within public media and those inside and outside officialdom who have offered opinions.

We reopened the economy substantively from March onwards, which has had a bounceback and has brought thousands of people back to work. That is a positive. We supported companies through the employment wage subsidy scheme, EWSS, the Covid restrictions support scheme, CRSS, the rates relief, and the variety of other supports we provided, including the warehousing of tax for businesses. This meant we kept thousands of businesses viable so that when we did reopen, they could start from a reasonable platform. That is something that should not be underestimated. If you talk to people, they will acknowledge that. The economic platform was very significant. We took a decision to borrow to underpin the economy in the midst of a once in 100 years event, which has borne fruit. That said, there has been a cost to the reopening. When the opportunities for socialisation are created, there will be opportunities for the virus to spread, particularly a transmissible variant of the virus that is the Delta variant. Therefore, there is a balance needed all the time and the Government has taken decisions in that regard.

On the booster programme, the National Immunisation Advisory Committee, NIAC, provides public health advice, which I am sure the Deputy will accept and has accepted from the outset, on the utilisation of vaccines, especially with regard to the booster vaccination. There have been various timelines at which that advice has been given to the HSE on the booster campaign. The booster start date for residents of long-term care facilities aged 65 years and older, of whom there is an estimated cohort size of about 30,000, was 4 October. The end date for cohort eligibility is March 2022, because the five- to six-month interval of the application of that has to be factored in.

The booster programme for that group is expected to be substantially completed by the end of October. Residents of long-term care facilities under the age of 65, of whom there are approximately 18,000, are expected to have received a booster vaccine by early to mid-December. The programme for the cohort comprising healthcare workers aged under 60 years, including those working in long-term care facilities, is expected to be completed by the end of December. There are approximately 305,000 in this cohort. There are approximately 161,000 people in the cohort aged 80 and older. Administration of a booster to this group will be substantially completed by mid-November. Some of these will not be eligible until March 2022. We are looking at the end of November or early December for substantial completion in respect of the cohort aged 70 to 79. We are looking at the end of December for those aged 60 to 69. A booster vaccination campaign for the cohort aged 50 to 59 will now be operationalised. I just got that advice yesterday evening. I also got further advice regarding those who are at a very high risk, including four in seven of the immunocompromised and those with underlying conditions.

There is no doubt the vaccination programme was a real success, but we now know a third stage is required. People in their 70s are asking me when they are likely to even get notified of a date. Has the Government consulted the GPs on their ability to deliver this programme? The GPs are very busy at the moment as there are many things circulating in the community. Do they have the ability to do this? If not, can people be directed to vaccination centres? There is a real problem with people who got the AstraZeneca vaccine, particularly those in their 60s, because there was a 12-week gap between the first dose and the second. This means that some people did not receive their second vaccination until August.

We seem to be moving from wave to wave. The economy has been reopened but some of it has been closed down again. What is going to happen to the people who will be worried about losing their jobs this weekend? The pandemic unemployment payment is being reduced today. People will not be able to get on it again. That simply must be addressed. The likes of NIAC have been very slow to respond to issues, including the issue of healthcare workers. Some 1,800 such workers were out sick or were self-isolating. There needs to be greater speed in giving advice when all the evidence elsewhere shows that a booster programme needs to be delivered quickly.

In fairness, I just outlined the timelines the Deputy asked me for in respect of the booster programme. If you add it all up, including those four in seven and all people aged 50 to 59, there are now between 1.97 million and 2.2 million eligible under the NIAC advice. Those figures come from the HSE. There are timelines to consider with regard to when people got their second doses. That will be a key factor. It is not as simple as considering how the first and second doses, particularly the first, were administered and the original initiation of the primary vaccination programme. GPs, pharmacies and vaccination centres will be used for the booster vaccination programme.

With regard to antigen testing protocols, agreement between the Departments of Health and Education is very close. Again, the biggest issue arising during the presentation yesterday evening and our greatest concern is non-Covid respiratory illness, especially in paediatric medicine. The most dominant issue in healthcare as regards admissions to hospital among children has been respiratory syncytial virus, RSV, and other non-Covid illnesses. I am always surprised there has not as much focus on that in public debate. It is a very significant issue for parents of children.

We are again in a crisis as regards Covid. The Government needs to acknowledge that. Our ICU capacity is in danger of being overrun. There is also the threat of Covid spreading into nursing homes yet again. The Government is once again sleepwalking us into lockdown at Christmas. It is Groundhog Day. What is most surprising is the Government is reported to have been taken aback at the level of Covid-related hospitalisations and the situation we are now in.

Why on earth is the Taoiseach surprised? Look at the decisions his Government made that brought us to this point. After more than a year and a half of a pandemic, it has failed to increase our ICU capacity to the levels that are necessary. We are sitting at little more than half the average for the OECD and, at the rate the Government is going, it will take 13 years to reach the OECD average. After the first Covid wave passed, the private hospital capacity was returned to the for-profit sector, and now it is to be presumed the State will pay over the odds to lease them again instead of taking them permanently into the public system and using them to build a properly funded, quality, one-tier national health service.

Covid-19 is an airborne virus but the Government has repeatedly downplayed the crucial role played by poor ventilation in spreading it. We are 21 months into an airborne pandemic and there are still no legally enforceable, measurable standards for indoor air quality. It is quite incredible when you think about it. The Government refused to introduce anything other than guidance to ensure schools, workplaces and public transport are well ventilated or, where necessary, have HEPA filters, then forced people back into poorly ventilated workplaces and classrooms and onto crowded public transport. Incredibly, after refusing to supply a single HEPA filter to our schools, the Government then abandoned contact tracing and testing in our schools entirely. And so here we are again, utterly predictable and utterly disastrous. To avoid lockdowns it is not enough to rely on the vaccines, crucial though they are. We need a vaccines-plus strategy, based on the principles of prevent, vaccinate and control. We need ventilation, vaccination and vastly increased levels of testing.

At this late stage, will the Government finally take action to avoid the current crisis becoming a calamity? Will it commit to providing antigen tests for free to those who want them, as is done with the National Health Service, NHS, in Britain, to encourage widespread and regular use through the population, and expand PCR testing capacity, which is overwhelmed? Will the Government deal with the crucial issue of ventilation and follow the example of Belgium by saying every workplace needs a CO2 monitor and that CO2 must be kept at safe levels? Finally, will it make our schools as safe as possible for pupils and teachers? Will it reintroduce contact tracing and testing immediately and follow the example of Germany by introducing HEPA filters in all our classrooms?

Our public health advice has been consistent from the get-go that our schools are safe places in respect of the management of Covid-19. A total of 35,000 CO2 monitors have been issued to our schools and they are in use. As I have said, the advice is that if children are symptomatic, in terms of colds or whatever, they should not be sent to school. The biggest issue facing children is RSV, a non-Covid respiratory illness. Those are the facts right now in respect of the challenges that face our healthcare system in regard to paediatrics. It is serious where we are. Given the brief nature of this interchange, I will expand later on the situation that faces us.

The Deputy opposes the extension of the legislation that will enable us to continue with our management of Covid-19. I see an entire inconsistency in his approach, particularly given he was the strongest advocate in the House for zero Covid from the outset and he wanted a zero Covid regime for a long time. He went silent on that when it suited him.

We are doing 200,000 PCR tests a week. We have one of the better PCR systems in Europe and globally in terms of the volume per capita and the level of testing we are doing. We have also expanded antigen testing in different locations. Substantial work is required on the communications of antigen testing. The public health advice, as we know, from the outset has not been enthusiastic about antigen testing. We formed an expert advisory group, which has recommended a series of steps to be taken in respect of antigen testing, but the public health advice is still cautious in respect of it. I support the further roll-out of antigen testing, but I accept a strong communications programme is required on how, when and why the use of antigen testing is important.

The use of antigen testing has been expanded in respect of close contacts and so forth. Tests are being issued and more initiatives will be taken regarding antigen testing, which the Minister will deal with shortly.

In that context, I do not accept the Deputy's criticisms as being valid on testing. In fact, we have a very robust testing system. The issue is that when we open society, socialisation increases and that creates opportunities for a variant as transmissible as Delta. We had, however, to give working people, and people generally, the opportunity to go back to work. By reopening the economy, we have created thousands of jobs. The situation now, however, as we move into the winter and with the seasonality that applies to this virus, is one where we need to take this pending threat very seriously. Collectively, as a society, we need to reduce socialisation and the Government has announced, and will be announcing, steps in respect of specific measures to add to the overall objective of reducing socialisation and contacts and rolling out the booster programme, along with other initiatives.

We are way over time. I call Deputy Paul Murphy.

Someone said to me earlier that Leaders' Questions should be renamed Leaders' obfuscations. I asked three simple questions. I did not get an answer to a single one of them. Instead, I got a repetition of what is just a line that schools are safe places. Is the Taoiseach seriously saying that no transmission of Covid-19 takes place in schools? Is that why he is saying that schools are safe places? That is not what the international evidence suggests. There are children in our hospitals now with Covid-19. That is what the figures demonstrate.

The Taoiseach suggested that it is some kind of revelation that when we reopen that there will be increased socialisation and that then, of course, we will have an increased spread of the virus. Absolutely, but why did the Government then not do what was necessary to make schools, workplaces and public transport safe? That is what my questions relate to. Will the Government introduce free antigen testing? Will the Government introduce HEPA filters into our schools? Will the Government also finally recognise the role that the airborne transmission of Covid-19 plays and introduce legislation to require clean air for everybody?

It is not even necessary for the Government to write new legislation. We did that in the summertime in the form of the Workplace Ventilation (Covid-19) Bill 2021. The Government will not even have to use its time to do that, because we are going to use our time next week to bring this Bill forward to ensure that everybody in a school or a workplace has a right to clean air and that-----

I thank the Deputy. His time is up.

-----if a certain level of carbon dioxide is exceeded, over 900 ppm, then action must be taken. Will the Taoiseach commit to supporting that Bill, even though the Government did not introduce it, to enable people to have safe air and to stop transmission in this way?

Why does Deputy Paul Murphy ignore public health advice and deny it every time he comes in here talking about schools? I did not repeat a line. I gave a line that we have received in respect of consistent public health advice, but he continually ignores it because it suits his propaganda approach to all of this.

What does the Taoiseach mean by that?

The Deputy does not look at this issue from a purely public health perspective. He looks at it from a party or movement advancement perspective. That is my genuine take-away. The Deputy was an advocate for zero Covid for a long time, but now he will not even facilitate the extension of legislation to give capacity for Government to do things, if necessary, in the middle of an emergency. He objects to that and makes a big deal about objecting to that.

Will the Taoiseach answer my questions, please?

He does not answer the questions.

I am answering the Deputy's questions. The Deputy ridicules the idea that public health advice in respect of schools is valid. He has just ridiculed that.

I ask the Taoiseach to answer the questions, thanks.

Regarding another of the Deputy's points, he does not seem to accept at all-----

I ask the Taoiseach to answer the questions, if he does not mind, because there are only 15 seconds left.

I have been in paediatric hospitals. I was in Clonmel hospital two weeks ago-----

There were three questions and he has not answered them.

Deputy Murphy, please. The Taoiseach without interruption.

Not a single question answered.

In the paediatric ward in Clonmel hospital, I was told that the issue was RSV in respect of admissions into that ward and the pressure that the ward was under, and other respiratory illnesses. Turning to workplaces, the Deputy knows that we have worked with the trade union movement and the employer organisations-----

Just the questions, if the Taoiseach would not mind. Please.

----- in respect of the return-to-work safety protocols.

Please, I am trying to get answers here.

Even as we speak, about 50% have returned. Huge efforts have been made in respect of workplaces to make them safe-----

The Taoiseach said he was going to answer the questions and he has not answered any of them.

In respect of ventilation in schools, I have said that 35,000 carbon dioxide monitors were distributed to schools up and down the country to monitor air quality and ensure that it was okay.

Please, we are way over time.

Not a single question answered. The Taoiseach said that he was answering the questions and he did not answer a single question.

I call Deputy Berry.

It is no secret that we are in the midst of another wave of Covid-19.

The peak of that wave is some still distance away. It is also no secret that our hospital system is under severe strain and pressure at the moment. That is being felt by our front-line healthcare professionals, including our doctors, nurses, paramedics, healthcare assistants and everybody else involved. They have been fighting this virus for almost two years now. They are completely exhausted, burned out and flat to the mat. They are used to making life-and-death decisions about their patients but this is the first time that many of them are making life-and-death decisions about themselves. Even showing up for a shift in a hospital is exposing them to significant danger, suffering and distress.

There was a lot of talk over the summer about providing a recognition package to our front-line healthcare workers for the extra stress they are under but that talk has dissipated since. There was, for instance, mention of a small ex gratia payment and additional leave to assist in their recovery. There was even talk of an additional bank holiday to recognise the contribution of essential workers across the country and wider society. The morale of healthcare workers is in their boots and they could do with a lift or a boost. Can the Taoiseach give this House any update on that process? When are we going to get a recognition package for our front-line healthcare workers, something other than just a round of applause?

I thank the Deputy for his question. I acknowledge what he has said and agree with it. We owe an awful lot to the front-line healthcare staff for their management of the pandemic. The most important thing people can do now to help our acute services and those who work in them is to get vaccinated if they have not done so. I urge people, without judgment, to consider getting vaccinated. The good news is that up to 1,500 people are now turning up daily for their first vaccination, which shows the campaigns are beginning to penetrate and people are beginning to respond. That is important. There is evidence that some people have missed their dates for the booster vaccination. I urge people who are eligible for the booster and get a date for its administration to get it in a timely manner.

There have been discussions on the recognition of healthcare workers at the Labour Employer Economic Forum, which involves trade unions, including the Irish Congress of Trade Unions, and IBEC. We are considering the best and most effective way we can recognise workers and their contribution during the pandemic, specifically front-line healthcare workers who have been on the front line and have faced the gravity and the real impact of the coronavirus on people in hospital wards and intensive care units. It has meant enormous trauma for many people working on the front line. I would like to bring that consideration to a conclusion as soon as possible. Some more consideration is being given at Government level in respect of the measures we will take. We accept there is a need to recognise the contribution that has been made.

We received a presentation from the HSE yesterday evening. The Deputy is correct in his analysis about the peak of this wave of the pandemic. The original model suggested infection would peak in the third or fourth week of November. The suggestion now is that the peak will be later, in December. There is uncertainty around all of these predictions and modelling, as there must be. It will never be exactly precise. The impact is being felt by healthcare workers right now. We must do everything we possibly can to alleviate that pressure between now and the end of the year. The measures we have decided to take today will help in that regard but, collectively, we must reduce our socialisation and the amount of time we congregate. We must take up the vaccination when we are offered it. All of that will help to reduce the pressures on our hospital system. The presentation we received from the HSE yesterday evening was quite grim in respect of the challenges ahead and the pressures on the hospital system right now because unlike the first and second waves of the pandemic when we closed everything down, we have not done that on this occasion. There will be pressure to focus on the Covid-19 patients as the various scenarios that have been modelled play out.

I agree with the Taoiseach's views on vaccination and boosters, but my question is on whether we are likely to have a decision this side of Christmas on a recognition package for our front-line professional healthcare workers.

The second group of people I would not like to see ignored or forgotten about comprises the voluntary, unpaid workers who are working in testing and vaccination centres all around the country. The Tánaiste mentioned consideration being given to a small honorarium as a small token of appreciation, but there was also talk of a signed and framed certificate from an tUachtarán and perhaps an invitation to visit Leinster House or Áras an Uachtaráin for the volunteers and their families. I would be grateful to hear the Taoiseach's thoughts on that.

That is a very good suggestion. We thank the Deputy for volunteering for the vaccination programme early on. Others in the House also volunteered in various capacities to help out in their local communities. The voluntary, unpaid workers at the vaccination centres played a very significant role. They were partly responsible for creating the ethos of a community-based response to this one-in-100-year event. We have to keep reminding ourselves that this is a pandemic of a kind that has not been experienced since the early part of last century. There are many uncertainties attached to it. As a country, we must work collectively on it. As an Oireachtas, we must do so too.