Covid-19 Health Related Issues: Update

I welcome the Minister for Health, Deputy Stephen Donnelly, to the meeting. He will provide us with an update on a number of issues, including capacity, and the situation regarding the pay of student nurses. The Minister is joined by the Ministers of State, Deputies Butler, Feighan and Rabbitte. They are all very welcome.

I thank the committee for inviting me today. I am joined by my three ministerial colleagues, namely, Deputy Butler, Minister of State with responsibility for mental health and older people; Deputy Rabbitte, Minister of State with responsibility for disability; and Deputy Feighan, Minister of State with responsibility for public health, well-being and the national drugs strategy.

I thought it would be useful to use my opening comments to address the impact that Covid-19 has on the delivery of healthcare and our plans to deal with this. The first wave of Covid-19 led to an unprecedented interruption to normal healthcare activity, both in community and acute settings. While many vital services were maintained or restructured to respond more appropriately to Covid-19 related risks, other services were suspended or delivered on a reduced basis. In the acute settings, many health services were suspended on the advice of NPHET. The provision of other health services, particularly in community settings, was also affected.

Many steps have been taken within the HSE, over the past number of months, to restore services. Over the summer of 2020, the HSE prioritised, among other things, communications to advise and encourage the public to seek necessary healthcare and to attend appointments. Many critical services continued through all stages of the pandemic, including cancer services. Urgent and time-sensitive treatments are being prioritised, based on clinical considerations. Innovative use of technology also benefited outpatient appointments in 2020 and between March and December 2020, more than 557,000 patients attended a virtual outpatient appointment.

Notwithstanding the significant resumption efforts, the overall effect of this was that less non-Covid healthcare was delivered last year than in previous years. Waiting lists for care in the country have been too long for many years and this has been exacerbated by Covid. Our waiting lists have increased over the past year. There are more than 622,000 people waiting for an outpatient appointment. There are 81,000 people waiting on our active inpatient or day-case lists - almost 22% more than this time last year.

To tackle these waiting lists we are providing an unprecedented level of investment. The total budget for 2021 represents an increase of around 20% on the 2020 allocation. While €1.67 billion of this is for Covid-related care and supports, including our vaccination programme, there is significant additional funding for new measures. This money will be used: to address the known capacity deficits by funding more beds and employing more staff; to replace, insofar as possible, the lost capacity and activity due to Covid-19 with the necessity to operate at reduced levels for clinical and public health reasons; to ensure people can stay at home for as long as possible and be treated as close to home as possible, in line with Sláintecare. For example, we are providing funding for several million additional hours of home support. The money will also be used to help alleviate waiting lists with an ambitious access to care fund.

The HSE National Service Plan 2021 sets out how the funding will be used. There is an access to care fund, which, together with funding allocated to the National Treatment Purchase Fund, NTPF, comes to €340 million.

As I mentioned previously, some services have yet again been reduced or suspended out of necessity to assist in preventing the spread of the virus during the third surge. Given this, it is the intention of the HSE to keep the planned levels of activity, performance and reform as set out in the national service plan under close review and the chair of the HSE board has committed to updating me formally in April 2021 in this regard.

I would like to conclude by acknowledging that we cannot predict with certainty the future trajectory of this disease. We must continue to ensure that our response is agile and flexible. Most importantly, we must ensure the public feel safe using our health and social care services, and that everything that can be done, is being done, to maximise the availability and quality of those services.

I welcome the officials from the Department of Health, namely, Mr. Greg Dempsey, deputy secretary general, and Ms Margaret Campbell, principal officer. I call on Deputy Colm Burke.

I thank the Minister for his presentation. I wish to go through the challenges that are currently facing the health service. Many staff are very tired and drained because of the challenges they have had to face over the past 12 months.

The information I am getting back from a number of them is that we may very well have far more people leaving the health service over the coming 12 months because of the pressures put on them. Has an assessment been conducted of how to deal with this and give more support to staff? On a number of previous occasions I raised the issue of planning for retirements so we would know at any time how many people are to retire over a 12 to 18 month time period so we can plan for recruitment. This does not appear to be happening in the HSE. Will the Minister clarify what has been put in place to deal with this issue?

I want to ask about the €240 million care fund. My understanding is that people are being referred for assessment and then referred back to the HSE or hospital where they were initially on the waiting list without a procedure being carried out. People want to be referred for assessment and for full care procedures to be followed through without having to be referred back. Is there a proposal to revise this process? As a result, we are making no inroads on waiting lists, especially when we are referring people to the NTPF.

I thank the Deputy. On the first issue, I wholeheartedly agree. Many of the HSE staff are exhausted. Before Covid arrived, they were run off their feet and over the past year they have been asked to step up again and again. They deserve huge credit for what they have done but we all agree simply thanking people for their work is not enough. We have to look very seriously at how fatigued people are and whether they are close to burn out. If what the Deputy is saying is true, and people have had such an experience at least in some parts of the system that they are thinking about retiring, changing career or moving to a health service in a different country, it is something we need to look at very seriously.

The good news is the pressure has eased. Today the number of Covid cases in hospitals has reduced below 500, which is very welcome. The figures the chief clinical officer has given are very encouraging with regard to the impact the vaccine is having. It is not just the vaccine, as it reflects lower community transmission also, but, from memory, the chief clinical officer was citing figures that suggested an approximate 95% reduction in Covid infection rates for hospital staff, which is very encouraging.

There is no question but that we need to work closely with the HSE, management, the representative bodies and, most importantly, the staff themselves to make sure they have the supports in place that they need. My view is we need to do something for them and I believe that in the fullness of time we will. We need a Government decision on this and Government agreement on what it is. Certainly the HSE, the Department and the Government are taking very seriously the issue the Deputy has raised, which is that staff are exhausted.

To go back to the topic we are discussing today, when we successfully manage the resumption of services we will look at ever greater waiting lists and greater pressure. With respect to planning for retirement, I might ask for a note to be provided to the Deputy on this.

With regard to the access to care fund, the plan is absolutely as he proposed. It is for referral and treatment. The plan is not that people get a referral and are then designated for treatment but the supports stop there; the plan is that people will see the clinician or clinicians they need to see and are treated.

On the issue of the challenges that staff have faced over the past 12 months, is it proposed that a process will be put in place to assess how they can be assisted? I have not heard of anything new being done in the HSE over the past 12 months. I know there were administration challenges in the same way as there are challenges with regard to front-line staff. Surely we should be putting in place a process to consult staff so we can see what needs to be done to increase the level of supports for staff. Is this being planned?

That is exactly right. We do need a process. What I can tell the Deputy is that the HSE is engaged on an ongoing basis at a comprehensive level with the various cohorts. There are mechanisms in the HSE and there is a lot of engagement across the service. What we are speaking about now is something on top of this to look at addressing the very serious burden and very serious exhaustion that so many of our staff are carrying. The Deputy is right that we need to address it as a specific piece of work.

I raised this issue previously when the HSE came before the committee and I am still not happy with the reply. A comprehensive survey of people who are leaving, in other words analysing and finding out the various reasons they are leaving, is not done. My understanding is that in some places surveys are being done and in others they are not. Can we not set up a comprehensive survey so we can learn from it, whereby when people are leaving they fill out a survey? Obviously it would be anonymous. It would then be available to see what changes need to be brought about to assist management in dealing with the number of staff leaving. Over the past 12 months, quite a number of staff have left but over the next 12 months it will be an even bigger challenge.

That is exactly right. I have seen data and the committee in the previous Dáil saw data on various cohorts and why they might be leaving the profession or the country. Certainly some of what the Deputy has proposed is being done but at a HSE-wide level. It is an excellent idea. In fact, we could perhaps go further. Something we want to keep an eye to is that as many of our graduates as possible stay in the country and work in the public health system. A systematic survey, essentially exit interviews, is what the Deputy is speaking about. To understand the same for our graduates would also be very useful.

Non-consultant hospital doctors from outside the European Union appear to have a particular difficulty at present because no structures are in place for them. There is also a lack of support in place for them. We have more than 6,000 non-consultant hospital doctors working in the healthcare system. A large number of these are not Irish and a large proportion are not European. Are the Department and HSE, together with the training bodies, looking to review how we can set up a better structure for their training because there is a benefit for us in Ireland? Many of them will leave and go off to other countries. This is something we need to look at.

I wholeheartedly agree and, in fact, I met a group of foreign doctors who are non-consultant hospital doctors. They have two very reasonable asks. One is on their visas. They need to update their visas regularly. From memory it is every six months but please do not hold me to that. It may be different for different countries. I am engaging with the Minister for Justice, Deputy McEntee, on this.

The second issue is one the Deputy, I and other members discussed at the committee in the previous Dáil.

It involved the situation where some foreign NCHDs do not have access to the consultant track and, therefore, do not have access to some of the ongoing continuing professional development that is needed. I have met a group of them about that and it is something we are working on with the Department. It is something I would like to see sorted out for two reasons. One is because, ideally, we want them to stay here and, therefore, we want them to be able to train up to be consultants. We want them all to be the best clinicians they can be and right now, they do not have that opportunity. Even if they do want to go back to their country of origin, there is an ethical responsibility on, and an opportunity for, Ireland to train them up as consultants as well as possible. It is something we are working on.

I wish to raise a point of order. We wrote to the Minister a number of times and the matter was raised twice in private session that we would ask him to set out his position regarding pay and allowances for student nurses and midwives in his opening statement. The matter was not addressed in his opening statement. It would be very unfair if time for members was eaten into by the Minister setting out his position. Can I ask that without using up any of our time, he use a minute or two to set out his position? He was specifically asked by the clerk of the committee, and I checked this again before the meeting started, to set it out but it was not addressed in his opening statement. There was universal cross-party support for the Minister acting on this and on a Dáil motion that was unopposed that called on him to revert to the March agreement. Will the Minister address in his own time what he should have addressed in his opening statement and set out the position regarding pay and allowances for student nurses and midwives?

I will have to defer to the Chairman on that. I do not have any extra time. I was asked to cover a very wide gamut of issues, including capacity within the system, the impact of Covid on waiting lists and many other issues. I had five minutes as an opener, which is about 600 words. We have two hours now so my understanding is that any members who wish to ask any relevant questions can but, obviously, I do not have any time myself so I will defer to the Chairman on the Deputy's point of order.

I think all the members who are lining up for questions would be interested in hearing the Minister address that issue in a few minutes. We will then deal with Deputy Cullinane's questions. Does the Minister have a note on the updated position relating to student nurses and midwives or does he want to address it later? The committee is interested in hearing his answers. The matter has been discussed privately by the members and we wrote to the Minister and Department about it. If the Minister has a note on the updated position regarding pay for student nurses and midwives, it would be helpful. I will certainly put a couple of minutes aside for him if he wishes to address it now.

That is entirely up to the Chairman. As members will be aware, I commissioned an independent review by Professor Tom Collins to look at the allowances payable to student nurses and midwives while on clinical placement in the context of Covid. There are two different reviews. One is the review by Professor Collins, which is specifically in the context of Covid, while we are starting a second one that I would like to see finished and implemented for the September academic year. This second review looks more broadly and structurally at the clinical placements themselves. What we agreed to was an independent review. Professor Collins provided that. He was under a lot of time pressure. I was keen to see that any recommendations if they were to be accepted by all sides could be implemented from 1 January so in fairness to Professor Collins, he did huge work right through Christmas. He came back with a series of recommendations, which will be available to the committee. The report on that has been published. I accepted all of the recommendations on that.

His specific recommendation on pay was that there would be a pandemic placement grant of €100 per week supernumerary so it would be a non-taxable amount of €100 per week. This would be from January. He also gave me the option to backdate that to the start of the academic year in September should I deem it appropriate. I did that and I have accepted those recommendations. I would very much like to be able to pay it but, obviously, we would be paying it as an agreed settlement. The discussion is ongoing with the representative bodies to see whether or not they want to accept that. It is fair to say that their reaction to it, which they stated publicly so I am not giving away any secrets here, was that they were disinclined initially to accept the proposal from Professor Collins. There is an ongoing conversation with the Department at the moment. I would very much like to get to an agreed position as quickly as possible.

I thank the Chairman for his indulgence, which I appreciate. It was important for the Minister to set out his position on this issue. Staying with this issue, can I put one point to the Minister. When Phil Ní Sheaghdha from the INMO was before this committee a number of weeks ago, she said:

We are on the record and have said from the outset that when we have 6,000 staff out sick and we have an unpaid workforce of 1,500, what do people think they are doing? I do not accept, nor do they, that they are standing in a supervisory capacity and not engaged in the business of work. Of course they are working and they are not getting paid.

She said that when the Minister was asked at a meeting on 8 February with the same union whether he was going to revert to the March agreement, his answer was "No". Is the Minister's answer still "No"? Is it the case that he will not revert to the March agreement?

Can the Deputy explain what he means by "reverting to the March agreement"?

The March agreement was that those first, second and third years would be offered temporary contracts and those fourth-year interns would be paid the healthcare equivalent rate.

To be clear, what happened last March was that the clinical placements were stopped and the students had to make up that time later in the year. The clinical placements were stopped and the supervising senior nurses were then deployed into the healthcare system. About one in three students who were on placement where the placements were paused came back as healthcare assistants and were employed as healthcare assistants. What is important is that under the EU directive, that time cannot count towards their clinical placement and degree. My understanding is that a lot of work was done to make up that time. To some extent, what happened last March did happen so the HSE did request that the clinical placements for the first, second and third years be paused and I accepted that request. They were paused for a short number of weeks. We wanted to pause them for as short a period of time as possible. It was at the time when the need for qualified nurses was at its greatest so they were redeployed accordingly. As per March, some hospitals did engage with students and brought them back as healthcare assistants. Essentially, with regard to last March, to some extent, although it will not be perfectly comparable, what happened again was that the clinical placements were paused and some students came back as healthcare assistants and were paid as healthcare assistants. I know the Department, the HSE and the higher education authorities are now working to find opportunities for those students to make up that clinical placement time.

In my view, the reason the offer of €100 per week was declined by the healthcare trade unions was because it was seen as a slap in the face by most student nurses and midwives.

I ask the Minister to revisit this issue, engage with the healthcare trade unions and put in place a fair settlement. There is universal political support for dealing with this once and for all. I hear what the Minister is saying about the second review that will look at the long-term implications. There are many more questions I need to ask. I will get to the next question but I would ask the Minister to engage urgently with the healthcare trade unions involved and resolve this issue once and for all.

Quickly, if the Deputy does not mind, the answer to his last question is "Yes".

I will ask the Minister about testing and tracing, which is important as well. Unless we keep on top of the virus and unless we can keep the numbers down low, that will present more challenges for our healthcare system. The best we can do is to make sure that the overall strategy is correct in terms of the public health strategy and all of the tools that we have at our disposal are working. Why, according to the latest figures that I have got, was there a target for 2,000 swabbers and contact tracers to be employed yet only 1,577 are currently employed? Why is the HSE not even meeting its own targets for staffing and for capacity when we know that testing and tracing will become very important again as the numbers become lower? Can the Minister explain why he has set a target of 2,000 swabbers and contact tracers yet, despite all the sacrifices that people have made by abiding by public health restrictions, the State has not met it?

The HSE is coming in next week and probably will address this issue.

Is the Minister responding?

The Minister is, but he is on mute. We cannot hear the Minister.

Can the Chairman hear me now?

Sorry. I thank the Deputy for that question. I will get Deputy Cullinane a detailed response as to the gap between the target and the full-time staff. The Deputy will forgive me, as I do not have the detail. It is not one of the topics that the committee asked us to discuss today and I do not have those exact figures in front of me. I understand the HSE is coming in next week and will have those details for the committee.

The testing and tracing system that has been put in place by the HSE has done extremely well and compares favourably by international standards. It is for another day. I note some of the highly critical remarks that the Deputy has made publicly about the HSE's testing and tracing system and I would respectfully suggest that they do not stand up. The Deputy's remarks are at odds with the facts. The HSE has not got it all right. It would not claim to have got it all right but under the circumstances, it has done a very good job. With respect, some of the criticism has been very unfair.

In good news, again, on testing and tracing, we have had a very significant increase in genome sequencing of positive tests. In fact, the numbers have gone from 1% of positive tests being genome sequenced to now 15%. We will be looking to increase that further within the realm of all of these new variants. That is why it is so important.

I would be delighted to come back to the committee in the near future and have a detailed conversation about rapid testing. It is something we discussed previously. I appointed an expert group to do a short piece of work on it. It is chaired by Professor Mark Ferguson, who is the Government's chief scientific adviser and the head of Science Foundation Ireland. They will be reporting back to me soon on that.

In terms of the regular testing and tracing, or polymerase chain reaction, PCR, testing, in response to Deputy Cullinane, the NPHET advice has been changing; for example, we are now going back to testing close contacts, and there is more NPHET advice coming on further improvements to the testing and tracing system.

I will put one last question, if I may. We had all of the healthcare unions before us a number of weeks ago. There was much understandable frustration where they were representing their members who felt - in my view, rightly so - overworked, exhausted and at burnout. I want to relay to the Minister one remark that was made by the representative of the Irish Hospital Consultants Association: "There is no doubt that we are facing a tsunami of missed or late care. Unlike the Covid crisis, we know exactly the scale of this." The representative further stated: "There is no doubt the public health system as structured does not have the capacity, either in terms of personnel or in terms of infrastructure and beds, to deal in a timely fashion with the tsunami." The Minister himself referenced all of the cancelled care and all of the care that is on hold. We all accept that is the case.

We also heard that there are hundreds of thousands of hospital appointments that did not happen this year to date, and possibly will not for the rest of this year - they certainly did not happen last year - that will add to the problems as well. Can the Minister set out what additional capacity will be put in place because we cannot expect those on the front line, who are exhausted and at breaking point, to continue to provide the service that we need and to try to deal with all the levels of catch-up care that will need to be done without sufficient additional capacity?

A hospital manager at University Hospital Waterford in my constituency told me the hospital made an application for a rapid build 72-bed modular unit with single isolation rooms, which is what the healthcare unions are telling us they need, and it has not received the funding. It was not approved in the capital plan. Hospitals are making the applications for funding to ensure that they have the capacity to deal with these issues and it is not being provided. What additional capacity will be put in place to deal with this tsunami of missed care that is coming at us, and can the Minister outline when all of that care that has paused will be resumed? If the Minister does not have the answers to hand, can he send on a detailed note on timeframes as to when that care would be recommenced?

I do not know how much time I have left. Can the Chair guide me?

The Minister might give us a written reply on some of those questions. He has approximately one minute, if that is okay.

I thank the Chairman and Deputy Cullinane. Between us all, we could not overstate the challenge in terms of the waiting lists, the unmet care and the missed care. The challenges we face are very significant. We are responding in various ways but, obviously, within a very challenging Covid context.

The first place to look is the national service plan, which is now up online. We have broken the additional funding into a few different areas. On increasing capacity, for example, we are looking at an additional 1,146 inpatient beds, increasing the critical care beds - up to 321 is the plan for the end of the year - 135 sub-acute beds and 1,250 community beds, including 600 new rehabilitation beds, and the very significant staffing that has to go with all of that. There are big capacity increases as well in community care, social care, mental health, disability, wellness, etc. I am probably out of time but I am happy to send the committee a detailed note and engage further with the committee.

Could I end this response by asking something of the committee in return? The scale of the challenge we face, in terms of the waiting lists we already had coupled with everything that has happened with Covid, is completely unprecedented and nobody has all the right answers. I would very much value the committee's view. I do not know if the committee will hold sessions or, indeed, has held sessions on this. If the committee has views, that it would like to sit down on, do a report on, etc., that the Government, the Department or the HSE should be taking on board, I ask it to let us know because the task ahead is bigger than any one entity and the more people we have trying to solve it, the better.

We will respond positively to the Minister's remarks in that regard. Our hands have been tied given the amount of time that we have had to meet. We will try to address that at some stage. I call Deputy Lahart.

I welcome the Minister and thank him for giving his time to the committee. I pay tribute also to the Ministers of State, Deputies Rabbitte and Butler, who have been available at any hour of the day or night over the last six or seven months to answer myriad questions, and to the Minister of State, Deputy Feighan, who is also very obliging.

I want to pay tribute to the Minister's temperament during what he has described as – I know it is a cliché – the tsunami of issues and events, the ups and the downs, that face him as Minister. I want to acknowledge the courteous and mild-mannered way he has dealt with everything. I also welcome the opportunity we get in the committee to tease things out in a little more detail with him, and not in the combative way that is so typical of the Dáil Chamber, even in the Convention Centre.

I want to echo the comments made in regard to the student nurses. I made those points in a parliamentary party meeting and the Minister is familiar with them. I welcome the comments the Minister has made here so I do not need a response from him. However, I ask him to always bear in mind that this cohort of student nurses, as I know he knows, never envisaged what they would be thrown into. Without them, the health system, particularly in regard to Covid, while it would not have collapsed, would certainly have had its foundations seriously shaken. I ask the Minister to take into account the uniqueness of the circumstances they have faced and how they have risen to the challenge. The Minister does not need to come back on that.

I also thank the Minister's officials and the HSE. These are unprecedented times and this is an invisible virus, although we often lose sight of that in the midst of our own anger, frustration, anxiety, despair and distress. When we do not have an outlet at which to direct those feelings, obviously, they get directed at the person who politically carries the can, and that is just part of the job description, I guess.

I want to ask about the national immunisation advisory committee, NIAC, review. A different cohort of people contact politicians every day and we are told, for example, that we dealt with the kidney transplant people and those on dialysis as a result of public representations, which was welcome. However, each week is going to see new cohorts of people and these have started to come into our inboxes in the last few days, suggesting that different categories need to be prioritised. Is the recent NIAC review the end of that process? Is it the objective that abundant supply, beginning to arrive from early April, will begin to handle all of the other groups?

I thank the Deputy for his kind words. Is it the end of the NIAC review? Absolutely not. NIAC is reviewing on a weekly basis and on a daily basis. We are learning new things all the time, new studies are being published and new decisions are being made. For example, Professor Butler, who is the chair of NIAC, was referencing with me at a session recently a new study from NHS Scotland. From memory, she said it showed the performance of AstraZeneca and the MRNA vaccines was quite similar, and more similar than in the clinical trials, so that is relevant. The data coming out of Israel are highly relevant in terms of reductions in hospitalisations in different age groups, and various reports have been published out of the UK as well. NIAC is constantly looking at that. For example, it considers what age groups are appropriate for the AstraZeneca vaccine. France made a decision either today or yesterday around increasing the age groups for AstraZeneca. New evidence is being looked at in terms of the timing for Pfizer or the MRNA vaccines, for example. At a medical or scientific level, NIAC is conducting what we call a rolling review.

That is welcome.

As to prioritisation, what it has concluded recently, which we published, was, if one likes, a clinical prioritisation, looking at those with underlying conditions and age cohorts, and it did some very detailed work in terms of prioritising according to vulnerability. What it is now looking at is the next and very large grouping, which is key workers, for example, family carers. Many people have been advocating on behalf of family carers and I have a lot of sympathy for them, particularly family carers of children, who I believe are caught between two stools at the moment. One of the things NIAC is now looking at is key workers, including, for example, the role they play in supporting healthcare or the vaccination programme itself, or other essential activities, such as education, caring and so forth.

Excuse me, I am tight on time. If I understand the Minister correctly, it is organic, flexible and evolving. It is not the end of the review and as more supply comes, that allows for increasing flexibility.

Yes, that is a much more succinct answer.

I want to ask about Cabinet discussions with regard to essential workers coming in from overseas. I am happy with a written answer on this. I have no doubt this issue exists and that it is legitimate. Could the Minister give some of the categories of essential workers who must travel in and out of Ireland on a daily, weekly or monthly basis - some kind of categories or a brief overview of that? We have never got them. We know about the fruit pickers, and that is one, but what other kinds of people are coming into the country on the basis that the country cannot function without their presence here?

The Deputy is looking for a written reply on that.

Unless the Minister can give some indication, I am happy to take the written reply.

I will get the Deputy a written reply.

With regard to the over-85s, on which Professor MacCraith answered on Saturday, we are all inundated with representations that they have not got their GP appointments yet, and some who have got them have had them postponed because of issues with supply. Am I correct in stating that this issue has begun to be resolved from yesterday forward?

That is correct. The latest briefing I have from the HSE is that a large majority of those aged 85 and older will have received their first vaccination by the end of this week. There will be some who are housebound for whom individual solutions are being put in place. Some who are housebound have already been vaccinated and in some cases, I understand, GPs will be calling to houses and the National Ambulance Service will be involved, and there may be more solutions as well. What I am told this morning is that the large majority of those aged 85 and older will have received their first dose by the end of Sunday.

A number of very well-meaning and generous community organisations in different constituencies offered their facilities where GPs had to buddy up, and they were refused and were a little bewildered by that. The GPs seemed to think the facilities would suffice. Has the Minister any intelligence on that?

It was an operational decision taken, I believe, between the HSE and the Irish Medical Organisation, IMO, that, at least for now, the vaccinations should be done in a clinical setting.

I will move on to a different area, and the Minister is going to love me for asking this question. He inherited the issue, as I think the committee acknowledges. Is it time that some sort of mediative process was introduced into the national children's hospital debate? It is dragging on. It is going on in the background and there is a kind of slinging going on from both sides. It seems to me it requires a good, strong, experienced political-business head to bring these two parties in and basically get them to deliver what we all want to see delivered. I want to emphasise the Minister inherited this but it is he who is going to have to deal with it. What is his view on that?

It is a big question, and one that has occupied us all. There is a lot of work going on. The development board, I believe, very successfully resisted a lot of claims from the contractor. I do not have the numbers with me but, as I understand it, the amounts awarded by the appeals mechanism or mediation mechanism as part of the contract are very small relative to the awards being made.

In fairness to both sides, things were further complicated by Covid. The site was shut down and it was then slow to get back up. I was not satisfied with the speed with which it started up again, but it did start back up. Unfortunately, because of Covid there will be delays as there are to all major construction projects. There is a mediation process, although "mediation" might not be the right legal word. There is an independent mechanism in place which the hospital development board and the contractor use for these claims. They can always escalate a matter to the courts if they need to. We should certainly not rule out the idea Deputy Lahart has tabled, should it be needed.

I thank the Minister.

I have a number of questions, which I will run through one by one, the first of which is on the vaccine programme. The fortnightly sessions in the Dáil on the vaccine programme have not been terribly satisfactory because it is hard to get answers in that forum. I asked the Minister some time ago if he would commit to providing figures on the actual delivery of vaccines into this country. The Minister did this once in the briefings but we have not had anything since. It appears from the figures that I have been able to put together that there is a substantial gap between the number of vaccines delivered to Ireland, across the three vaccines, and the number actually administered. This is how it appears to me. I hope that it is not accurate but we simply do not know. For this reason, I ask the Minister to give a commitment to provide the daily figures for the vaccines that have been administered and the vaccines that are actually delivered and in this country. Will the Minister commit to doing that please?

I will certainly ask the task force to look at that. I do not know whether we could produce the delivery figures daily. The Deputy and others asked for the figures for daily doses administered, which we are providing in the data hub and on the app. I believe all members of the committee and all Members of the Oireachtas are getting a daily briefing. I can certainly take up the Deputy's request. On the core of her question on whether there is a big gap, as of now, we have received 520,000 vaccines and by the end of the week, the forecast is that we will have administered approximately 500,000. We can take from those figures that the amount being kept is very small indeed. We are expecting an additional amount of vaccines from AstraZeneca this week. It has not arrived yet.

Those figures do not tally with the figures in the table that has been put out and the table that was used in the plan for living with Covid. That is why we need up-to-date accurate figures. The figures do not tally as of now and it is important that we have accuracy.

Previous speakers referred to our meeting a few weeks ago with the Irish Nurses and Midwives Organisation, the Irish Medical Organisation and the Irish Hospital Consultants Association. All three organisations spoke of the crisis in recruitment and retention. That crisis existed before Covid ever appeared and the pressures of Covid have hugely exacerbated it. There are already a lot of data. The Health Research Board has done a review of the reasons hospital doctors leave. The Medical Council did a review. The framework for safe nurse staffing also sets out a number of reasons. Why does the service plan not contain a major recruitment and retention strategy that is funded? Will the Minister commit to producing such a strategy given the urgency of the situation?

The short answer is "Yes". Many important elements have been agreed for this year, one of which is the very important framework for safe staffing for nurses, as referenced by Deputy Shortall. There were huge benefits on the pilot sites where it was done. I have told the HSE that the Government wants staffing and the increase in nursing levels to be done in line with the safe staffing framework. Based on the pilot projects, this will have a big effect.

Another element, one for which the Deputy deserves great credit, is the Sláintecare contract, which we are moving ahead with. As the Deputy and I have discussed in the committee previously, this will be the only game in town. It will be a public-only contract and will be for all new hires. My hope is that many existing consultants will also move across. I believe the Deputy and I share that understanding.

We have talked about the NCHDs and significant work is required to treat our NCHDs better. The IHCA and IMO have told me that some of the issues are contractual and some will be solved simply by hiring enough people. One of the problems is that when there are not enough consultants, and we do not have enough of them, they are, on an individual basis, simply under too much pressure.

Speaking of Sláintecare, a critical element of the plan is ensuring that services are provided at the lowest level of care, particularly for chronic illness, which is to be taken out of the hospitals and brought back to primary care level and nurse-led care. This is critical for chronic illness generally but also for the whole issue of nurse and midwife-led care right across all care settings. When can we expect to see some real progress in that area?

Are we talking specifically about community-based care, social care and staffing across community-based care?

I am talking about community-based care that would be nurse-led care for chronic illness management, which takes up about 70% of healthcare activity. There is a commitment in Sláintecare to move that out of hospitals and into nurse-led care within primary care. When will we see action in that area?

In fairness to the HSE there has been action. Some of that would have been taken under the previous Government. The chronic disease management agreement with the GPs was put in place by the previous Government. It was activated through this year and further ramped up in the winter plan. It is also being further ramped up in the national service plan.

When will we see some of that chronic illness care being nurse led, given that nurses in the main are best qualified to lead the management of chronic illness?

I will ask a member of the Sláintecare team to get back to the Deputy with a detailed note on that. Various programmes and pilots are being rolled out and looked at this year.

I am sure the Minister will accept that it is time to move beyond pilot schemes. We need to start implementing Sláintecare in a serious way. I must say that the service plan this year is disappointing in that respect.

My next question is on public health doctors and the pertinent need to have proper retrospective tracing. When will we see a resolution of the public health doctors' issue?

On the Deputy's previous comment, we will have to agree to disagree. I know from the Sláintecare team and some of the testimony the team gave to the committee that its view is that this budget is very much a Sláintecare budget. They are very excited by Sláintecare and spoke very highly of it. Obviously, the Deputy and I just have different views on that, which is fine.

I want the consultant contract for public health doctors to be put in place as quickly as possible.

The IMO and the Department are meeting next week on exactly that.

My final question relates to vitamin D. Last week, a group of experts and varying different disciplines of doctors appeared before the committee. They made a compelling case for the recommendation of a minimum level of vitamin D supplementation. Will the Minister give that some serious consideration? It seems that it has been put on the back boiler by NPHET. There is, however, compelling evidence from other countries, particularly Finland. We need all the help we can get in terms of our ability to respond to the threat of Covid-19. Can the Minister please address that issue?

I asked NPHET to come back with a formal view on it for exactly the reasons laid out by the Deputy. NPHET has published a paper on it, which I will ask the Department to send on to the committee.

My non-medical synopsis of the paper is that it was very positive about vitamin D generally in boosting the immune system. I may be wrong on this, but, from memory, I believe its conclusion was that there was not evidence specifically linking it to a higher resistance to Covid-19. I will ask for the paper to be sent to committee members, however.

Briefly, studies have been done on vitamin D in this country related to bone and muscle health, which is obviously a completely different area. Anybody at the committee who listened to the evidence presented by that group of experts last week cannot but believe we need to make clear recommendations on that to the public in respect of Covid-19. I ask the Minister to please brief us on that issue.

I must move on the next questioner. I call Deputy Hourigan.

I thank the Chairman. I wish the Minister and the Ministers of State, who are in the room with him, a good afternoon. I want to ask the Minister about the requirements HSE staff are being asked to meet to volunteer for the vaccination teams.

I have been contacted by an employee of Crumlin hospital who has responded to a call for people to join the vaccination team in Citywest, which is being run by the Dublin Midland Hospital Group. Like many of her colleagues, she feels she could spare some time for vaccination in addition to her existing work, which is incredible considering the pressure staff are under.

Despite being employed by the HSE, working on the front line and being registered with the appropriate medical body, she is being asked by the HSE to do the following: No. 1, supply proof of police clearance for any country resided in for more than a period of six months; No. 2, start a Garda vetting process; No. 3, provide name and contact details of three references; No. 4, provide a notarised copy of two forms of photographic proof of identification; No. 5, provide a notarised statutory declaration; No. 6, provide a verification of service by her current and previous employers; No. 7, fill out an employee set-up form, pension deduction form and section 51 form of the public services pension; No. 8, complete an occupational health assessment; No. 9, provide a copy of registration and qualifications; and No. 10, supply a work permit, if required.

I realise how important it is to get this right and ensure staff are appropriately qualified. This seems unnecessarily bureaucratic, however. Perhaps we are flush with qualified vaccination staff but my fear is that the vaccine roll-out may be slowed down by a lack of qualified staff. Does the Minister believe those requirements are onerous and may act as a barrier to the recruitment of volunteer vaccination staff? Does he feel that we can rationalise that process in any way?

That does not sound right to me at all. I will raise it directly with the HSE. We need as many vaccinators as possible. The last time I looked at the figures, I believe approximately 7,700 vaccinators had been trained. The number is probably higher now. I received the report some time ago. However, it includes GPs, pharmacists and the vaccination teams we have in place. I would like dentists brought on board as well. People are suggesting optometrists and others and exactly the type of volunteers the Deputy mentioned. It must be appropriate and we need to put in place whatever safeguards are required. Certainly, however, what the Deputy has read out, if it is about an existing clinician within the HSE, certainly sounds a little over the top.

It sounds onerous. Can we agree in principle if a person is registered by a relevant medical body, that is proof of a qualification?

If the Deputy does not mind, I prefer not to make definitive statements on the process right now. There may be reasons particular things must be followed. I will certainly ask the HSE to take a look at that, however. It sounds like a lot.

I want to follow up on the previous session we had. One of the questions I asked related to the use of GPs as the primary referral into the vaccination programme. I highlighted the fact that many people in Ireland do not have a relationship with, or access to, a GP. We all know we are relatively short on GPs in this country. That is particularly relevant in communities where people are experiencing lower incomes. Those who have chronic conditions, however, might have a closer relationship with a nurse practitioner in an outpatient clinic or with their own consultants. I believe there was a discussion that, perhaps, the referral system would be broadened to include or allow for referrals from consultants or nurse practitioners in outpatient clinics. Is there any update on that?

If anyone in any of the cohorts being done now or that will be done next, which are the high-risk, very high-risk and underlying condition categories, has any worry about not being contacted by a GP, they or a family member can make a telephone call to 185 024 1850. As the Deputy quite rightly said, not everyone has a GP and not everyone is on a list. I know in my constituency in Wicklow, for example, it was impossible for a long time to even get on a list for a GP, such was the shortage of supply.

I see no issue why consultants could not refer. I know at the moment, based on NIAC's latest clinical advice on the very high-risk category, the HSE is working with the consultant body to identify its patients who would meet the various criteria and, therefore, it may well be that the consultants have a role to play with that cohort.

Ultimately, when we move to bigger population levels, people will be able to essentially sign up online themselves through a portal. Not yet, however, but when we get to the wider general population cohorts.

I thank the Minister for his statement. I have a number of questions, the first of which is with regard to vaccines offered to countries outside the EU. For example, there was a report in the Business Post recently regarding Russia offering the Sputnik V vaccine to Ireland. There is also a vaccine from China, and one from Cuba, which is off-patent.

To date, have the Irish Government and HSE been offered vaccines that were sourced outside the European Union?

I thank the Deputy. We are following the process as part of the EU. Our regulator is the European Medicines Agency, EMA. I can tell the Deputy from an update I received yesterday that the EMA is looking at some of these other vaccines, which are not the ones we have all been talking about. That is happening. We actually have quite a lot ourselves, however. For example, the three of which we are all aware, because they are now actively being deployed, are Pfizer, Moderna and AstraZeneca. We are also quite aware of Janssen or Johnson & Johnson. Hopefully, that will be coming soon. It has a very high effectiveness and is a single dose. I hope the EMA will make a decision on that very soon.

We have also signed up to three further vaccines, which are CureVac, Valneva and Novavax and, therefore, in our own advance purchase agreements, we now have seven vaccines. I believe that comes to approximately 18.5 million doses, and because Janssen is a single dose and the others are double dose, this will vaccinate a little more than 10 million people.

Yes, the European Medicines Agency, EMA, is looking more broadly as well at other potential vaccines.

My second question is on vaccination inequality and the call, particularly by the World Health Organization, for a people's vaccine. This week, there is a crucial vote on the suspension of patents and intellectual property rights and if that happens it will give the less developed countries access to vaccines. I hope that anybody on the health committee would agree with giving as many people as possible access to vaccines. If the suspension happens then it could free up pharmaceutical companies, particularly in the European Union, to make these vaccines and make them available to as many people as possible. That is important because the fewer people who are vaccinated then the more chance there is of variants and so forth. I am talking about a hypothetical situation and I hope that Ireland votes in favour of the suspension. If it happens would the Minister, as a member of Government, direct the pharmaceutical industry, which is quite wide in this country, to immediately ramp up production of a vaccine that is off patent?

I would agree with the Deputy on the objective. This has to be a global vaccination programme. The reality right now is that the developed or richer world is buying up the global stock, and there is no question about that. Even if some of the stock was available for some other parts of the world very serious supports will need to be put in place in terms of healthcare supports, logistics, supply chains and a lot of other things. Yesterday, there was a meeting of EU health ministers. On behalf of Ireland, one of the calls that I added to that was that Europe would be the leader in terms of global justice on vaccinations and that was for two reasons. The first is ethical as I think we have a moral obligation to help and, second, is enlightened self-interest. There is no point in us vaccinating ourselves or Europe or America vaccinating itself if large swathes of the world are unvaccinated. That simply does not work as a strategy. For those two reasons we probably share the same end goal.

In terms of whether suspending intellectual and patent rights is the right way to go, what would have to be borne in mind is what happens the next time. Undoubtedly, there are enough vaccines out there right now that if IP was suspended across the world generic producers all over the world could produce a huge amount of vaccine very quickly. That is my sense of what would happen but here is the other question that we would have to think through. What happens when there is a mutation that requires very serious investment in an updated vaccine or vaccines, or if an entirely new disease hits us in one year's or three years' time? We would have to be very clear that if we suspend it at this time, the very same companies that we have relied on to produce all of these vaccines would not just say the next time that they would not do because the previous time we suspended their IP. That consideration would have to be given very serious thought.

I am sure that the Minister will agree that vast amounts of public money have gone into pharmaceutical companies and it took up to about $8 billion to create these vaccines. The private sector did not create them themselves even though they will profit hugely from them. Public moneys have gone into vaccines so they should benefit the public.

Last Thursday, we informally spoke about the HSE service plan and the funding for the medical cannabis access programme. I ask the Minister to comment on that. What funding is available? When could the programme commence? I hope that it is this year so people can for the first time get medical cannabis under prescription.

I acknowledge the Deputy's ongoing work on this matter. As he will be well aware, there are two avenues to access these particular treatments. One is the ministerial licence scheme, which been active to date. Since 2016, when the scheme was brought in, 144 licences have been approved for 55 separate patients.

What the Deputy and I have focused on is the medicinal cannabis access programme, MCAP. It was based on a 2017 Health Products Regulatory Authority, HPRA, scientific review. The programme was put in place but never funded so it could not be used and I am activating that this year. My Department has estimated that several million euro will be required but we do not know the exact figure yet. Covid has complicated things a bit because of exports from Holland. What the HSE and the Department have done, for which they deserve great credit, is to have deliveries made direct to patients' homes. What I think we both want to see is for MCAP to be put in place as quickly as possible, and it is funded for this year, so that deliveries are made to local pharmacies for the patients, which will be a gamechanger. I have no doubt that I, the Deputy and others will debate some of the other products from the Netherlands that, to date, had not been considered for inclusion; Bedrocan is one that we will all be familiar with and I think we need to look at that. What I am told is that the Dutch authorities do not permit their commercial export at this time but that is something we should continue to engage on.

I welcome the Minister for Health, the Ministers of State and the officials. In political life one is never thanked for what is done or is positive but one will always be blamed for mistakes or be questioned about them.

I have questions on the vaccine roll-out. Every dose that is administered is a positive. I know that there is a great vaccination plan that will be rolled out over the next number of weeks and months, including up to 1 million doses in April that will be administered. People over 85 and, indeed, over 70 in hospitals who await vaccination - and I am sure there are cases all over the country but I hope that it is a small number - were told following inquiries to hospital management that they must wait, that supplies are not available and that vaccination has to be done in the community. When will people over 85 and, indeed, over 70 in hospitals be vaccinated?

The community GP roll-out is going well but I understand that some GP practices have not yet received vaccine supplies. That might be a small number but I do not know. Certainly, I have been made aware of cases. As a result, their list of patients over 85 and over 70 are not getting calls but I know that neighbouring doctors are currently vaccinating patients in their 60s.

I know that at least two offshore islands - Inis Meáin of the Aran Islands and Inisbofin - have received no vaccines for people who over 75 or 85. I have advocated that we vaccinate all of the cohorts on the islands because it would be easy to vaccinate these small populations quickly.

In terms of the nursing home and healthcare sector, I wish to inquire about healthcare assistant staff. I know that the occupation list for employment is being reviewed at the moment by the Department of Enterprise, Trade and Employment. Has the Minister and the Department liaised or engaged about this matter? The role is notoriously difficult to fill and requires the right candidate with a suitable skill set and caring disposition. As we know, such people might not always be available even though there is a high number of people on the live register at the moment.

Finally, I wish to refer to nurses who have left the profession for childcare purposes, etc. and have not returned to the workplace in the past five or ten years. What engagement would the Minister or the Department advocate to get some of these nurses back into front-line services? I know it is not always easy to do such work and these nurses as they get older may not be able to perform nursing duties. If these people are available but require some retraining or upskilling, can that be considered?

To the Senator's initial point, it is the good news versus the challenges we face. The good news is the forecast that by the end of this week we will have administered more than 500,000 vaccine doses. Great credit goes to our vaccination teams across the country, as well as to the GPs, the practice nurses, the Defence Forces and so on. There have been so many people involved and it has been a huge effort. Has it gone flawlessly? No, of course not, neither here nor in any other country that I can see. However, it has gone very well and I am told that, by the end of this week, the large majority of 85s and over will have received their first dose. It is worth acknowledging the efforts across the country. People are working seven days a week.

To the Senator's question on the islands, the Air Corps has been directly involved in delivering vaccines to several islands. I will check in with the HSE on exactly what the plan is for the islands he referenced. It is wonderful to see. It has been a real all-Ireland approach.

With regard to GP practices, I am aware of the situation as well. GPs have been in contact with many Deputies and Senators to say they have not got the vaccine yet. The majority of the GP practices were scheduled for this week so most of that will be addressed this week. I have no doubt, given the scale of the programme, there may still be a number who say they did not get it in certain locations. The HSE is working hard to that end. It holds regular WebEx sessions for the entire general practice community, with thousands of GPs getting involved. Part of the frustration some of the GPs have had is, if we look at it another way, due to the fantastic demand. One thing that has stood out for Ireland is the very high acceptance rate and demand for these vaccines, much higher than some other countries. It is fantastic to see.

On the 85s and over in hospital, logistically I see no reason. Perhaps there is a reason the HSE has identified. I wonder if there are clinical reasons for them to say they prefer the patients to be discharged in the community. I will check in with the HSE and revert to the Senator on that.

On nurses who have taken a leave of absence, a career break or who have simply left, it will be part of the considerations for this year because we have ambitious targets in terms of nursing and other clinical grades across the system. One of my hopes is that, as we scale up and hit the safe staffing levels, some of the awful pressure nurses and midwives have been under will be relieved. If the pilots are anything to go by in terms of safe staffing, they made a huge difference to the clinicians, nurses and midwives involved. Absenteeism and sickness fell while job satisfaction went way up. That might be one of the ways. We need a public health system that people enjoy working in and that supports our staff. I have spoken with the Minister of State, Deputy Butler, about healthcare assistants in nursing homes and she will revert to the Senator with a detailed written reply on that, if that is okay.

I thank the Minister. On the over 85s, I checked in with one hospital which told me it is not getting vaccine supplies. They are all in the vaccination centres or in GP clinics, so they do not have supplies in the hospitals and cannot administer, which seems strange to me. One individual I was working on behalf of has been in hospital for 22 days. Her son has been on to me and has said she is aged 89. He wants her vaccinated and the hospital tells me it does not have vaccinations and that it has to be out in the community.

Regarding long-term residential care homes, anybody over 65 would have been vaccinated in such settings. A patient in an acute hospital setting would be vaccinated in the community because he or she might be not there for the second vaccine. I was told that is the reasoning. A patient might be there for 12,14 or 16 days but they are not vaccinated in the hospital setting. That person would be vaccinated in the community. If a new entrant goes into a nursing home who has not been vaccinated, we will not go back into the nursing homes on a weekly or two-weekly basis. We cannot do that. They would have to receive the vaccine through their GP. That is my understanding regarding acute hospitals.

I thank the Minister of State but that is not satisfactory. Surely a small number of individuals can be vaccinated in the hospital and have their local GP follow up. Their families will look after that and ensure that in X number of days, they are brought to the GP. They need the first vaccine. If they are willing to take it, of that age and in a hospital setting, it gives peace of mind to family. That policy should be looked at again if possible.

We can look at it but my understanding is that is the way it operates at the moment.

I will jump to my favourite topic of student nurses. What else would I talk about? The reason given for our inability to pay student nurses and midwives is the EU directive. However, every year 18 to 20 students in every class are sponsored by the Government to undertake nursing and they are paid a salary throughout the four years at a healthcare assistant level. How is that square with what the Minister said about the EU directive that does not for allow them to be paid or for those paid hours to count towards their training? If the issue is that they cannot be paid because of the EU directive, would it be reasonable to change the language and have a discussion about a decent bursary? In the UK and Northern Ireland, there is a bursary of £5,000 per year. They are out of the EU now but that existed before they left so if there is a will there is a way. Do we just need to change what we call it and then we could find a way forward?

I thank the Senator. On her first question, I will get her a detailed response. It sounds like a contractual issue. If I had to hazard a guess, which I am loath to do, I imagine it would be to do with pay that is specifically about the clinical placement. However, I will get a detailed response from the Department as to why that would be.

With regard to a bursary, the Senator referenced England, Scotland, Wales and Northern Ireland. At the moment, someone studying nursing or midwifery in Ireland will be paid, I am told, €17,400 over the four years. That is the amount they get paid during their time on placement. In England, Scotland and Wales, I am told it is approximately 10,000 - it might be pounds - over three years. The amount paid to the students over four years in Ireland is significantly in excess of the amount currently paid over three years in England, Scotland and Wales. I do not know about the other jurisdictions but my understanding is that in Scotland that payment or some of it is means tested as well, so for some students it would be significantly less. However, these are all fair questions and we have to make sure it is possible for people to complete their training. We want them to have the best possible experience during their training and to be the best graduates they can be. That creates something of a problem for us because they are highly valued around the world and other countries look to recruit them. However, it means we get the best possible graduates coming into our system. The review that is about to be kicked off, which is looking at structural issues around the placements, will consider exactly those issues.

I would appreciate an answer on, particularly, how we have 18 to 20 students being paid a healthcare assistant's rate.

It is being done through a Government-sponsored scheme. I am interested in hearing how that tallies with the EU directive and how the arrangement does not work There needs to be a conversation. We need only listen to some of the points made, including here today, on why graduates are leaving. It is all well and good for us to have the best education system in the world but if all our students are skedaddling out the door, we are not benefiting from it. We keep going around in circles. As I have said previously, it is just a bad business decision. Maybe we need to-----

I apologise for talking across the Senator. We want the students to stay. If they are leaving en masse, we need to understand why. If a student in Ireland is being paid significantly more than a student in England, Scotland or Wales while doing a degree at €17,400 versus €,10,000, according to the figures I have been given, it stands to reason that pay is not why they are leaving. They are paid more here during their time of study. We do need to understand, therefore, why they are dissatisfied when they leave the education system. We need to fix that.

We are perhaps comparing apples and pears. How much someone is being paid elsewhere is not going to affect student nurses other than to inform them they are perhaps being paid a different amount. There is very clearly a problem. I have told the Minister before that the Union of Students in Ireland has research on this. The INMO and SIPTU also have research. There is ample quantitative and qualitative research on the current circumstances of student nurses and midwives, why they are unhappy and their experiences in the workplace. I would certainly support the Minister in doing more research but there is existing research on why students are dissatisfied. Pay is the number one factor, and working conditions also feature.

I will finish on this. I am sorry as I do not mean to be taking up the Senator's time. In our very productive debate in the Seanad recently on her Bill, one of the questions I asked the Department was whether it could find for me any country in the world that paid more to students during their nursing and midwifery degrees than Ireland according to an arrangement not based on an apprenticeship model. Germany, for example, undoubtedly pays more but it has an apprenticeship model. At the time, the Department was not able to come back with any country that paid more. If it is the case that Ireland is paying as much or more than any other country, it does not stack up that the amount paid while doing a degree is the reason students would choose to work in other countries.

They are choosing to work in other countries because they get paid better when they leave.

That is a separate issue. It is also definitely worth considering.

Let me jump to another question because my opinion is fairly set on this topic. Can the Minister give an update on the backlogs in the screening services, particularly for BreastCheck and CervicalCheck? I realise this has not been flagged. Does the Minister have an update on how the backlog will be dealt with? People have been in touch with me to say they are very worried about it.

I thank the Senator for that. We are all concerned about it. I am aware that BreastCheck has restarted. I want to make sure that I have the very latest information on the matter so I might revert to her with a written note, if that is acceptable.

That is absolutely fine. I would appreciate a note on it.

I confirm I am present in Leinster House.

I apologise for not being present earlier. A number of meetings were clashing today. Well done to the Minister. I can see that he is surrounded by his Ministers of State. Collectively, they are doing a really great job at a difficult time. It is extremely difficult. We are just a shade below peak crisis. We had peak figures a few weeks ago and now the whole focus is on containing the situation, driving down intensive care numbers and, most important, getting the population vaccinated. I will start on the latter point, making reference to the case of a 91-year-old constituent whose circumstances could arise anywhere in the country. She is bedridden and cannot leave her home. The local GP and health service have not full certainty on the parameters in respect of them leaving the local dispensary to go to her home to vaccinate. Could the Minister clarify the position to some degree? Is it possible to go to someone's home to vaccinate him or her right now?

The Minister was good to take a call from me earlier in the day so-----

The whole point is that nobody will be left behind. Plans will have to be put in place to vaccinate people who are bed bound and have not left their homes for many years. Some of these plans have yet to be set definitively but the most important thing for the lady to know is that she will not be left behind.

Very good.

I heard last week the announcement that there may be 1 million vaccines administered per month in April, May and June. It is such a positive announcement. In total,18.5 million vaccines will be purchased by the Government. Given that the plan for this year will be extensively implemented and Covid is not going away, has the Government a plan for the population to be vaccinated in a second round in 2022?

I thank the Deputy. That is an excellent question. The answer is that the experts do not know yet. The scientific and medical communities around the world are waiting to find out how long the vaccines last. It may differ for each vaccine and it may differ based on the intervals between vaccinations. What I can say is that we have pre-ordered just under 18.5 million doses, as the Deputy mentioned. If it is the case that boosters are required next winter or at the same time as the flu vaccination, or maybe this time next year, we would certainly have enough to provide them based on our current orders. However, there is an additional complication, which is that the vaccines may need to be adjusted. The flu vaccine we take every year is different each year. It is based on different mutations of the flu coming across from Australia and that part of the world every year. There is still a lot of uncertainty over whether we will need a rolling programme and, if so, what it will be like.

I appreciate that. How does the Minister envisage international travel resuming? As vaccination of the world population starts, we need to see a resumption of international travel, particularly aviation. What does the Minister envisage in this regard beyond phase 5 of lockdown?

That is a good question. To an extent, Ireland and the rest of the world will have to wait and see. The strategy right now is to put in place very robust controls around international travel. Even before hotel quarantining is introduced, the measures we have in place will put us at the forefront of the EU. When we introduce hotel quarantining, which will be here very soon as the legislation passed through the Seanad last night, we will have, by quite a stretch, the most robust quarantining and international travel measures anywhere in the EU, very much in line with the UK. That is one part of the strategy. At the same time, we need to continue aggressively suppressing the virus here. Very good progress has been made, thanks to people sticking with level 5. We got good, heartening evidence from the ESRI to the effect that while people have been finding it really tough, they have understood that we absolutely must keep going.

If the vaccines are delivered from April onwards, we will be able to administer in excess of 1 million doses per month. If the supplies come in, it will have a big effect on case numbers in Ireland. The chief clinical officer in the HSE gave figures some days ago indicating that the Covid infection rate among hospital staff had reduced by 95%, which must be partly due to the vaccines. The big unknown is the variants. What happens with variants around the world, their characteristics, the question of whether they are resistant or partially resistant to the vaccines, and their level of severity will influence, to an extent, the border controls we will have to keep in place.

I thank the Minister and his colleagues for attending today. My question focuses on mental health in respect of the HSE national service plan, so it may be for the Minister for State, Deputy Butler. It pertains to transparency and accountability. I must say that I am very pleased to see the attention to detail and focus on the Sharing the Vision report. The report is groundbreaking and the focus is on closing the gaps and filling the multiple cracks that mental health services currently have. I am very pleased to see that it is the main point of reference for the 2021 national service plan, as well as for Connecting for Life, Ireland's national strategy to reduce suicide. It is most welcome.

One of the most fundamental parts of reforming the mental health services is taking on the critical task of driving transparency and accountability in the area of mental health investment and expenditure. In particular, we must examine how and where the funding is allocated and what outcomes are achieved from this investment. How should we do that going forward, as we implement these new commitments from the national service plan? In other words, how do we ensure that these commitments are more than just promising words in a report? Where will the extra €20 million go in mental health supports? How do we effectively show transparency when it comes to investment and expenditure going forward? There is a whole clatter of questions there and I hope the Minister of State was able to catch them all.

I want to thank the Senator for her interest in mental health. She chairs the sub-committee on mental health and we have had several conversations in the Seanad and otherwise, and I want to thank her for her continued support.

She is quite right about Sharing the Vision, which is the new mental health policy for the next ten years. It is a whole-of-government approach with strong service user and voluntary and community sector representation. As the Senator knows, the national implementation monitoring committee was established in November 2020 and it has already at three times. Various sub-committees will be set up in the next number of months to look specifically at issues in respect of child and adolescent mental health services, CAMHS, and minority groups. For example, we are looking to set up a Travellers group. We are also setting up another committee to look specifically at the challenges that women face in relation to their mental health.

However, the Senator is quite right that we need transparency and accountability. The most important thing with a budget is ensuring that it is spent correctly. I will provide some examples. This week is national eating disorder awareness week. Yesterday, I met with those involved in the national clinical programme, led by Dr. Michelle Clifford, to discuss eating disorders. In the past three years, there was criticism that the budget was not spent sufficiently. Some €3.9 million will be spent this year on specialist eating disorder posts. The three teams that are already in place, and which have not yet been fully populated, will be populated. We are also seeking to set up a further two to three teams this year because currently, not all areas of the country are covered. It is most important that we have that accountability.

The €23 million that I secured in the budget with the support of the Minister means that 153 whole-time equivalent new staff will be put in place. For example, 29 of them will be working with CAMHS to help support the waiting lists. There are currently 2,500 children on the waiting lists. Some 39 new posts will be put in place for adult crisis resolution services and there will be six new whole-time equivalent staff places for the clinical programmes for early intervention.

As I said, I have already met representatives of the HSE on this issue, because the recruitment of stuff must happen in parallel with the Covid pandemic. Last year, for example, many things fell away, because the situation was so new to us that we were learning. As we know now that we have to live with Covid, the most important thing we can do is to ensure that the staff are recruited and that they are trained up quickly. For example, the staff recruited to provide CAMHS supports may already be trained in providing adult mental health supports but they will have to be retrained to provide supports for children and adolescents. It takes two to four months to recruit the staff. Recruitment for the eating disorder teams and for CAMHS is already under way.

I want to ask one more question of the Minister, if there is time.

The Senator has gone over the time allotted, but she may go ahead.

I would appreciate it if I could get a written answer to the question. It concerns Johnson & Johnson one-dose Covid vaccine. I know that the European Commission has stated that deliveries of this vaccine are expected to begin in early April 2021. Can the Minister provide us with an update on this one-shot vaccine? It does sound like an answer to our prayers, in one way. What is the current strategy for the vaccine roll-out? Does the Minister have a strategy for the roll-out of that particular vaccine?

The short answer is that we must await the guidance of the European Medicines Agency, EMA. The process is as follows. The vaccine is under consideration at the moment and we all hope that it is approved. When it is approved, the EMA will issue highly technical guidance to our own experts here. They look at that guidance and provide advice on the best way to use it. For example, with the AstraZeneca vaccine, when the technical information was issued with the EMA's authorisation, NIAC looked at it and then made various recommendations to NPHET in respect of the age groups suitable for the AstraZeneca vaccine. Therefore, we must await the guidance of the EMA.

The Minister is most welcome to committee. I want to follow up on two questions. First, I want follow up on Deputy Shortall's question regarding information on the vaccines. The Minister worked in the private sector before going into politics. To be quite frank, the flow of information on vaccines from the Department is not acceptable. In the private sector it would not be tolerated. I have been in touch with officials in the Department on this issue. I want to know why a report cannot simply be issued on a Monday morning, containing information on the number of people vaccinated in the previous week, the number of vaccines delivered, and from which companies, and the number of vaccines in stock. It is not rocket science. I want an answer from the Minister as to why that cannot happen. Can the Minister make it happen?

The Senator and other members of the committee have asked for daily numbers to be provided previously. The daily numbers of people who have vaccinated, both first dose and second dose, are now available on the Covid data hub and on the Covid tracker app. On top of that, I requested that a daily briefing go out to each Member of the Oireachtas as to what is happening with the vaccination programme. Forgive me, if Members have not yet received them. I hope that they have.

The important point is that while we are getting the figures of the numbers who have been vaccinated, we also need information on the number of doses that have been delivered to the country in the previous week, and the number of doses that are in stock that have not been issued to GPs or other facilities for administration. That is the transparency that we need. It is easy to get the figures of how many have been vaccinated. However, in my view, the transparency is needed in respect of the timeline of the delivery and distribution of the vaccines.

That is an issue that I am very happy to pick up with the task force and the HSE. What I can say is that as of today, we have taken delivery of 520,320 vaccine doses. It is forecast that approximately 500,000 will have been administered by the end of the week.

As for my second question, we are holding this meeting online and it is working out pretty well. It never ceases to amaze me that the Minister's officials and NPHET must hold in-person briefings twice a week, while other countries are holding such briefings online.

Does the Minister believe it is appropriate that NPHET would continue to hold face-to-face briefings with journalists in the Department of Health twice a week?

My understanding is that the meetings of NPHET, which I am told by survivors of NPHET can be marathon sessions that go on for many hours, are by visual communications, VC. The Senator rightly points out, however, that the NPHET briefings with the media are face-to-face. They follow very strict protocols. Very few are allowed in the room. I have been involved in a few of them. There is physical distancing. It is a big, well ventilated room but I would be more than happy to bring that perspective back.

I appreciate that because this is about leadership and setting a standard. I have no doubt whatsoever that there are strict protocols in place but when we expect the rest of the country to use every mechanism possible to work from home, stay out of buildings and not to congregate, the inability of the Chief Medical Officer, CMO, the deputy CMO and other senior officials to embrace modern technology and hold their briefings virtually sends out a bad message. Would the Minister agree with that?

I certainly will take that back. I would agree that we have to be seen to lead by example; there is no question about that.

Finally, overall, does the Minister believe his Department has succeeded in terms of communication? In a pandemic when we are dealing with people's fears and concerns, concise, real-time communication is very important. Does he believe his Department has been up to standard when it comes to that type of communication?

We must always strive to do better. There has been a good deal of commentary about the communications over the past while. Some would argue that some of it was unfair. Some of it is undoubtedly fair. The public have a right to the very best information quickly and they have a right to clarity also because as the Senator said, people have been through a brutal year. Many people have been very worried all year. Many people are desperate to find out when they will be vaccinated. We are dealing with a complex and fluid situation where the scientific information and information about the vaccines changes regularly. The delivery schedules change a good deal. The advice we are given from NIAC has changed on more than one occasion. We try to find a balance between giving as much information as we can and not disappointing people, because some of that information gets updated and changed. As to whether we can do better, we must always do better and communications are an essential part of both the vaccine programme and, as the Senator rightly said, the national response to Covid-19.

I thank the Minister.

I thank the Minister, Deputy Stephen Donnelly, and the Ministers of State for their valuable contributions. I have a brief question on third level education. The Minister outlined the projected vaccination schedule for the country. If that schedule goes according to the current plan will third level students be returning to the classrooms next September?

I do not believe anyone can accurately say right now what will happen in September. If things go according to plan, both in terms of the suppression of the virus and the vaccine roll-out, and what is increasingly positive information about the effectiveness of these vaccines, we would certainly be in a very different and much better place next September. There is no question about that. However, we have to temper all of that with the fact that there are many unknowns and variations. There are variants emerging now around the world. They are being studied very rapidly. The characteristics they will have in terms of increased transmissibility, increased severity, resistance to the vaccines is largely unknown. For example, information emerged yesterday and today around initial looks at one of the variants that originated in South America in terms of effectiveness of vaccines, higher transmissibility and so forth. All I can say is that if the vaccines arrive in Ireland to the agreed supplies and if the rest of the vaccines are authorised, by September the population would be largely vaccinated. If we add to that the fact that these vaccines appear to be highly effective and way beyond the sort of protection we get from the influenza vaccine and if there were not variants arriving that had immunity or whatever the correct scientific word is that could evade these vaccines, we would be in a much more positive space in September.

I thank the Minister for that information. There has been a major focus on getting primary school children, the leaving certificate classes and the other second level students back to education but we should focus then on getting the third level students back into the classroom. I am aware that prolonged absences from the classroom have affected their mental health but also their education. I would like the Minister's Department to do some kind of modelling on that, if possible, and give the students hope that they might get back to the classroom. Online learning for third level education is not ideal and it has been a very difficult year for that cohort of people. I know there are many variables and unknowns but if we could see some sort of modelling in respect of that elusive herd immunity there might be the possibility of all third level students returning to the classroom, which would be very helpful. I thank the Minister for answering my question.

I have a plethora of questions but I do not propose to ask all of them. I will put them down for written answer, which is probably the best way of doing it. My first question is on those who have other conditions who are now part of a backlog awaiting attention. Have all of them had online discussions with their GP or consultant? If only a portion of them have had such discussions, what is that portion? That is important in terms of dealing with the backlog. Arising from that, what plans are in place to handle that backlog? If there are 800,000 on a list of some description there has to be a means of breaking down the numbers, attending to some of them more urgently than others and so on. How is it proposed that that will be done?

Also, as we move towards the start-up of business again and all the community has been inoculated, are we aware of the fact that there will be a greater opportunity for health workers to emigrate to other jurisdictions? Are we prepared for that and what are we prepared to do to try to ensure that does not happen?

The last question is on student nurses to which Senator Hoey referred already. I find it difficult to understand how the existence of Covid-19 has not been regarded as an emergency in terms of the delivery of health services.

The question is whether the emergency is of sufficient urgency and severity to invoke other ways and means of dealing with the question of student nurses, who have a very understandable case and who feel more than a little disappointed. They feel obscured by the activity around them when compared with the UK and EU. I note the points made by the Minister on the higher level of pay and so forth but that does not take away from the fact that we are in this jurisdiction and we need to look at the matter again.

I thank the Deputy for his questions. He asked if online and telemedicine is being used and it is. It has been a real silver lining. If necessity is the mother of all invention, telemedicine has come to the fore. Many consultants who would not have used it previously are not only using it now but actively embracing it. It is something that will continue and as distributed technologies, remote sensors and so forth become more prevalent, more will be possible.

The Deputy asked how we will deal with the backlog and there are many different ways. I will ask the Minister of State, Deputy Rabbitte, to speak on this as she has led what is a spectacular success in respect of assessment of need. I would love her to update the committee on that. Essentially, there are at least two strands, with one strand building the permanent capacity in line with the Sláintecare vision of community-based care and so forth, and that is what the national service plan and winter plan are all about. The second concerns the access to care fund, which comprises targeted interventions. Last year, we were able to allocate €7.8 million and the Minister of State has used this to specifically address the very serious backlog for children with assessment of need. I will ask her to give the committee an update on that because thanks to her leadership, it has been an incredible success.

I thank the Deputy for the opportunity to speak a little about assessment of need. Last September, under Sláintecare, we managed to get €7.8 million as a targeted fund to specifically address assessments of need. A plan was put in place between the Department and the HSE through the nine community healthcare organisations, CHOs, with each CHO director of services putting a plan in place for the 6,500 young people under 18 who needed an assessment of need. From September to date, 50% of that has been achieved, with more than 3,400 young people having an assessment of need delivered.

This was down to the initiative between the Department and the HSE in trying to use private providers over time and bringing back some redeployed staff who had been on testing and tracing duties. Even during the second wave of level 5 restrictions and again in the current wave, we are still managing to get assessments of need done. It has worked through the use of assisting technologies, as mentioned by the Minister, and there has been combined working between the section 38 and section 39 organisations. There has also been support from schools when they have been open. This month has been a little more of a challenge as we need on-school oversight. It is nevertheless going very well.

It is important to finish on this note. All the assessments of need for CHO 1 have been completed and I hope that in March two more CHOs will achieve the same target. When we use targeted funding in combination between the Department and the HSE, we can really see the end result in this type of success.

I thank the Minister of State. Will the Minister address the question of the student nurses?

They Deputy will be aware that there are two reviews on this. The first is the review by Professor Tom Collins, who has made a series of recommendations to address the period during Covid-19. I have accepted all those recommendations, including the option to backdate the payment to the start of September. There is an ongoing conversation with the representative bodies and unions with the aim of reaching an agreed settlement. I would very much like to implement that.

The second element is structural review to look at placements more broadly and address some of the real and serious questions that the Deputy, Senator Hoey and other committee members have raised today and previously.

I must bring the meeting to an end. The Deputy indicated at the start that he would take written replies so if there is anything outstanding, the Minister and Ministers of State could respond in writing. We are over time and we must think of staff safety. Next Tuesday, the chief executive officer of the HSE, Mr. Paul Reid, will provide an update on the public health measures in place to address the Covid-19 pandemic. I thank the Minister, the Ministers of State and members for their co-operation today and I look forward to engaging with them again.

The joint committee adjourned at 6.07 p.m. until 9.30 a.m. on Tuesday, 9 March 2021.