State Response to Recent Spike in Covid-19 Cases (Resumed)

I welcome the Minister for Health, Deputy Donnelly, and his officials to the meeting and apologise for coming to them considerably later than anticipated. We are doing our best with time. I will not go through the statement on privilege if that is okay. The Minister has sat through enough meetings at this stage to have a rough idea of where we stand in that respect. I ask him to make his opening statement and confine his contribution to five minutes to allow as much time as possible for questions and answers. I thank him again for his forbearance and apologise for being late.

I welcome this opportunity to update the special committee on Ireland's ongoing response to Covid-19. The committee heard earlier today from the HSE, the acting Chief Medical Officer, Dr. Glynn, and Professor Nolan about Ireland's operational response to Covid-19 and the prevalence of the virus in our country at this time. I will take this time, therefore, to update the committee on Ireland's approach and the priorities from now until Christmas.

Earlier this year, Ireland and countries across Europe locked down as Covid spread relentlessly through our communities. Around the world, tens of millions of people have been affected and hundreds of thousands of people have lost their lives. Many lives have been lost here in Ireland as well, and we mourn every single one of them. It has been a very difficult year for everyone and absolutely heartbreaking for those who have lost family and friends due to Covid-19.

Staff across the healthcare system have worked tirelessly to prepare an already overburdened health system to cope with Covid-19. The people of Ireland worked every day and sacrificed much to comply with the lockdown, keep essential services running and flatten the curve.

As countries across Europe began to open up, Covid-19 started to spread again. Countries across Europe are now acting to suppress the virus and here in Ireland we are doing the same. The first chapter in our fight against Covid-19 was focused on flattening the curve. The country was locked down. Schools and colleges were closed. Businesses were closed. Much hospital and community care was stopped. People isolated by staying at home. Sports, arts and community activities were cancelled. This approach did flatten the curve but, as we all know, it came at a considerable cost.

We are now in the second chapter of the fight against Covid-19. From now until at least Christmas, our focus will be on suppressing the virus to allow us to reopen society and schools, colleges and health services and to protect jobs and those who are most vulnerable to this awful virus. Because we know more about the virus now, it has been possible to bring in localised measures where cases grew locally and to bring in national measures as necessary to limit the suppression of the virus through targeted national measures. Because tens of thousands of tests are being done every week, it has been possible to act quickly and suppress the virus as it tries to move, once again, through our communities.

Last week, we learned something very important. Thanks to the amazing efforts of the people of counties Kildare, Laois and Offaly, we know that localised measures can work. Without doubt, the people of Kildare, Laois and Offaly have saved many lives.

They have saved lives in their own community. By helping to suppress the spread of the virus around the country, they have saved lives all over Ireland. For that we owe them a debt of gratitude. We know that measures that avoid lockdown by seeking out and minimising the situations in which the virus spreads are what we now want to use. That is the approach we are using across Ireland. It involves targeted measures to suppress the virus while keeping as much of our society and our economy open as possible.

In the Department of Health we are preparing for the winter. A comprehensive winter plan is being developed with many measures already in place. As has been the case since the first day Covid-19 arrived in Ireland, Government decisions are informed by the recommendations and advice of NPHET, which monitors the evolving evidence in Ireland and around the world. NPHET, in turn, is guided by the recommendations of the World Health Organization and the European Centre for Disease Prevention and Control. We are grateful for their assistance.

I thank the Chairman and the members of the committee for this opportunity. I look forward to a good discussion with them in the coming hours on Covid-19.

I thank the Minister for his opening statement, and I thank him for being so timely. Deputy Cullinane is taking ten minutes.

The Minister might have seen that I was wearing my 24-7 cardiac care for Waterford mask. I am sure he has not forgotten about that campaign. I welcome the Minister and his team. I have a lot of questions to get through in my ten minutes. As an experienced politician, I am sure the Minister will know that I need distinct answers to the questions if that is possible. I know we are dealing with very complex issues.

I shall first turn to the preparedness for the coming weeks and months in our acute hospitals. We are dealing with Covid care, non-Covid care, missed care, the need for catch-up care and so on. Given that hospitals cannot exceed 80% capacity to ensure we have surge capacity, and given the required infection control and social distancing measures, what is the anticipated shortfall in acute bed capacity? Will the Minister say how many beds make up the anticipated shortfall, if he has that figure?

I thank Deputy Cullinane. Can I give the Deputy the critical care capacity first? The HSE and the clinicians are strongly focused on the figures for surge capacity for Covid-19. As we know, before Covid-19 arrived the critical care bed capacity in our system was 255 beds. This is 204 intensive care beds in ICU and an additional 51 high dependency unit beds, HDU. At the height of the surge, the capacity for critical care beds was approximately 500. As of this morning the total capacity in critical care beds is 302 beds.

I will stop the Minister there. I welcome that, and we need as many critical care beds as we can get, but I want to bring the Minister back to the number of acute hospital beds and the advice he has been given on the anticipated shortfall or anticipated lack of acute bed capacity due to the rule of not exceeding 80% capacity and due to the social distancing guidelines. What figure has the Minister been given?

The winter plan is the process by which the HSE is doing the detail-----

I know that. I have asked the Minister for a figure.

The winter plan is the process by which the HSE is doing the detailed modelling on that. The reason-----

Does the Minister have a figure today?

The reason there is no figure today is that we are learning very quickly about this. On the Deputy's question, when he and I learned about this first, the figure we were both given was that the hospitals could not operate at more than 80%. That was based on a variety of advices from the HPSC, including the 2 m distancing. Over the last weeks and through the next few weeks a lot of detailed work is going on, which is why we do not have a figure yet.

Did the Minister read his own ministerial brief?

Does he know what the figure is in the ministerial brief?

What I am saying is-----

I am asking a very straight question because this is a very serious issue. Did the Minister read his ministerial brief, and if so, will he outline the figure that is stated as the potential loss of capacity for all those reasons?

The HSE has approximately 11,000 beds, 20% of which is approximately 2,200. What I am telling the Deputy-----

That is not what the brief states. I will read it out for the Minister.

What I am telling the Deputy-----

I will read it out for the Minister so that we are clear on what the figure is.

The 80% figure is an old figure that does not apply. For example, occupancy in the acute system at present is approximately 96%.

We can go only on the information we are given by the Minister's Department. His ministerial brief states the HSE estimates an 20% decrease in the number of targeted inpatient cases for 2020. It has also estimated there could be a shortfall in capacity due to safe distancing requirements and a reduction in utilisation to 80% of 4,700 beds, based on a current baseline of 11,000. I submitted a parliamentary question seeking a breakdown on a hospital-by-hospital basis. The response stated, with regret, that the information was not collected in the form I required and, therefore, was not available as requested.

We cannot even get a breakdown of what that will mean in each hospital or in each hospital group, and we are trying to plan and support the Government in terms of what solutions are in place. Whatever the figure is, I think we can agree we are going to lose capacity. What people want to know, and what front-line healthcare workers want to know, is how we will replace that capacity. If the figure is as bad as the brief suggests and it is 4,700 beds, how is that shortfall in capacity going to be made up, and where is the plan to do so?

The Deputy read out that the HSE has 11,000 beds and we need to move from about 100% occupancy, which is unfortunately where we were, to about 80% occupancy. That would require about 2,200 additional beds. What I am saying to the Deputy is that, thanks to an awful lot of good work at every hospital and by central HSE working with the HPSC, the additional number of required beds has reduced from that high figure. There is not yet a final figure and it is being produced with the winter plan. As the Deputy and I-----

Whatever the figure might be, my question now, given that we can work only on the figures we are given, is that there is going to be lost capacity, so how are we going to replace it? What are the options on the table? Every winter there is a crisis in our acute hospitals, and if we are to deal with Covid, non-Covid and catch-up care, as well as reduced capacity, a perfect storm is coming at us and we need more beds and staff in the system. First, in terms of beds, how is the Government going to inject more beds into the system?

The challenge is wider because it is not just acute beds; it is primary care, community care, inpatients and outpatients. This is exactly what the winter plan seeks to do. It is being produced several months early, it will be the most comprehensive winter plan that has ever been launched and, because of the costings involved, as I am sure the Deputy will appreciate, it will not be cheap. It will require discussion by the Government-----

I have produced my own plan and I sent a copy to the Minister's office. I appreciate there needs to be a winter plan but, with respect, the question I am asking is what are the options for increasing bed capacity. While we need more investment in primary care, while there are more supports for people with disabilities and while we need to do more in nursing homes, I am dealing specifically with acute hospital beds. The Minister cannot give me the figure of exactly how many beds will be lost, but surely he has an idea about how he is going to replace that capacity.

I do, so let me outline some of the steps that are already being taken. The following are all Covid measures. Home care packages have been increased by 2.6 million hours and community assessment hubs have been introduced, with 29 teams. The number of acute hospital beds has been increased by 400 this year to deal with the additional capacity, and I am seeking funding to ensure that all 400 of those beds stay open. We have additional critical care capacity of 42 beds and 1,600 nursing staff have been upskilled to support critical care.

There has been an increase in the number of intermediate care beds, with 700 open. I am seeking that they will all stay open. As the Deputy will be aware, there has been enhanced infection prevention and control, PPE, cleaning and disinfectant. Part of his reasonable question is on how we increase bed capacity. The other part is how we keep as many people as possible out of hospitals. The clinical hubs are working well and we are looking for them to continue. The mental health support desk has been working well and we are looking for that to continue. Obviously, we are upgrading many other supports around that at the same time, that is, supports for GPs, new GP contracts, safe staffing levels for nursing and many more complementary measures as well.

The ministerial brief also states that even if we were to take all the capacity in the private system, it would still not be enough to make up the shortfall. There is an urgent need to bring this plan forward.

I have two final questions for the Minister. I refer to the Be on Call for Ireland initiative. According to the latest figures I received at the end of July, 1,639 front-line staff were available to come into the system, including 260 nurses, 341 doctors and 228 healthcare assistants. Since the end of July, how many of them have been offered work? People find it extraordinary that we have 1,600 front-line workers who could be brought into the system. We are also being told some beds are not operational because we do not have the staff. People are just amazed as to how we can have nurses, doctors and healthcare assistants available in what is called a "pool" to come in and they are not there.

Finally, he will be aware that there is a high-profile campaign by cancer patients and others to secure medical cards for terminally ill patients. A report is due on the Minister's desk in the next number weeks. When will that arrive? Is this something he still supports and is this something we will see in the budget later this year?

Will the Minister answer the first question on how many people have been employed as it should be a short answer, and provide a written answer to the rest?

First, I agree wholeheartedly with Deputy Cullinane on the winter plan. The challenge we are facing cannot be underestimated and, as he pointed out, there is a real reduction in capacity in the public system. I look forward to engaging with him and the Oireachtas on that plan.

I will send the Deputy a detailed briefing on front-line workers but my priority regarding nurses is that we reach the safe staffing levels agreed last year. Nurses and midwives went on strike. The Deputy and I joined them on the ballot for that strike. A Labour Court recommendation was agreed. The progress has not been made. My priority when it comes to nursing and midwifery staff is that the agreement should be honoured and we reach these safe staffing levels much quicker than has been happening to date.

On the Deputy's specific question, how many of the Be on Call for Ireland people who came back from Australia or wherever have been employed?

How many of them have been given a contract?

I will get the committee a detailed briefing on that, Chairman.

Today is Wednesday - perhaps by the end of this week?

I am sure that will be no problem at all.

The next speaker is from the Fine Gael party. Deputy Burke has five minutes.

I will be followed immediately by Deputy Durkan.

There will be a Fianna Fáil speaker in between.

I thank the Minister and wish him well in his role. It is not an easy task. I also wish all his staff in his Department well.

He stated in his submission that a comprehensive winter plan is being developed with many measures already in place. I am surprised we did not get a list of those measures. Could he set out in writing what new measures are in place because it has not been given to us? Could that be sent on to us?

The second issue I want to raise relates capacity in hospitals. In Cork a few years ago we had difficulty with a significant waiting list for gynaecological services. A lot of them were day care procedures and space was rented in the Mater Private Hospital. Consultants went down there and did the day care procedures. Is any provision being made whereby space can be rented in other medical facilities to allow, in particular, day care procedures to be dealt with?

What plan has been put in place in that regard? Has there been engagement with the private sector in relation to getting space? It is not necessarily about getting consultants in those facilities to do the work. A lot of consultants have complained to me about not being able to get operating time and not being able to get day care procedures done. What is being done in that regard?

The second issue relates to consultant pay in the context of recruitment. What progress has been made on that issue? If the Minister is not able to give me an answer on that today, I ask for it to be provided in writing at the earliest possible date. Regarding the recruitment of consultants, has there been any fast-tracking done to address the vacancies that currently exist?

The third issue relates to nursing homes. A support scheme for nursing homes is already in place. I raised this matter with the HSE earlier and am seeking clarification, which could be set out in writing if necessary. I seek information on the situation with regard to additional costs for nursing homes. We must remember that they are caring for between 24,000 and 25,000 people. Can I get clarification on that?

The final issue relates to the composition of NPHET and the fact that a sector that looks after over 25,000 people is not on NPHET. Is that going to be revised? I am talking about a representative from the nursing home care sector being on the team.

In terms of the measures that are in place, I listed several of them for Deputy Cullinane earlier but will provide a full list of the measures that are already in place. In terms of the private hospitals a €25 million bridging fund has been created and the HSE is using private hospital facilities right now, right across the system, based on medical priority. Tenders have issued from now until Christmas and potentially beyond to all private hospitals. We are tendering for diagnostics, services and surge capacity and I have no doubt that the example the Deputy gives of tendering for facilities but not necessarily for consultants is incorporated into the thinking on that. I want to make sure that we avoid the situation we were in earlier this year, although I fully understand why it was done at the time, in the heat of moment in a full-blown crisis. I am not criticising the action taken but it is clear that it did not work in terms of ongoing support, although it did work in terms of creating surge capacity very quickly. I want to make sure we avoid the block purchase of resources that happened the last time.

In terms of consultants, a lot of progress has been made but let us remember that we have over 500 consultant vacancies right now. We have one of the lowest levels of consultants per head of population in the OECD and if we are to get to a decent level, we will have to do an awful lot more than just fill the vacant posts. C contracts have been signed off recently, which had not been done for quite some time. I hope to have news to share with the committee soon on public health doctors and transitioning them to where they should be and where they deserve to be, namely, as consultant-grade doctors. The Sláintecare contract is a priority for this term for the Government and we are also looking at the new entrant pay inequality issues that have been discussed in the Dáil for some time.

The Deputy will be aware that with the permission of the Dáil the nursing home support scheme was extended. That move had the support of Nursing Homes Ireland, NHI. We will provide a full briefing to the Deputy on that. The nursing homes expert group report was launched recently. That report was very comprehensive and contained 86 recommendations across 15 themes. The implementation team has been set up and we have continuity advising that team from people who were involved in the expert group. We will be putting a package of recommendations together which I will bring to the Oireachtas for debate.

The next speaker from Fianna Fáil is Deputy Murnane O'Connor, who has five minutes

I thank the Minister. Are we conducting random testing at our airports and are we considering random testing in schools?

This is very important now with all our schools going back in the next few weeks. It is welcome that the Dáil is sitting next week but I am asking the Minister about legislation. Over the past few months, we have seen that the Garda did not have any legislation to enforce the restrictions that needed to be imposed. Is it a priority of the Minister's that we get this legislation through next week so that the Garda has the power? I think they are called primary laws. We need them. We need to make sure that we have someone who can actually go out if there is a house party or people overcrowding. We need to give the Garda the laws allowing them to do this. It does not have the power at the moment. A garda told me recently that gardaí do not know where they stand at the moment. It is not their fault. Like the Minister and his officials, they are doing a great job.

The Minister spoke about care homes and nursing homes. He and the Minister of State, Deputy Butler, launched the policies and plan going forward on nursing homes. I am dealing with care homes that are section 39 organisations. There are serious issues with them in terms of funding. On the bigger scale, regarding the community employment schemes, they are finding it hard to get workers. If we do not get funding for the section 39 organisations I fear some of them will have to close.

What is our roadmap for the GAA sports clubs, our wet pubs which have not yet opened, and our dance studios that have contacted us all? They normally had 50 indoors, then 15 and six. If we can deliver on legislation, information and testing, we could give people back the confidence they need. We are doing well but we need to do a lot more. We could make sure people know this is our message. We are going to get over this and we will do that.

I thank the Deputy for her questions. I will cover as many as I can and will get written responses for the Deputy if we do not get to them all. With regard to testing and tracing, it is a key weapon in our arsenal. We rank well by international standards. The HSE has been ramping up very significantly. We had approximately 52,000 tests or thereabouts last week. One of the days last week saw the highest number of tests ever conducted in Ireland. We have serial testing being rolled out in nursing homes, direct provision centres and meat processing plants. There is a lot of community testing going on as well. As the Deputy says, randomised testing will be introduced shortly to the airports. With regard to schools, the public health advice is against that. We are obviously led by the public health advice in that way. If there is more information that can be provided to the public and the Oireachtas on an ongoing basis in terms of testing and tracing we will certainly endeavour to do that. If the committee has views on that as to how we can be helpful, Chairman, please let me know.

On wet pubs - can we just call them pubs? - the public health advice is very clear. Pubs cannot open right now. I really do understand the pain, anguish and suffering that is causing for so many publicans and their staff around the country. Based on public health advice and what is required to suppress this virus and avoid a second lockdown, that is the very clear position of the National Public Health Emergency Team. They have said that restaurants can open. It is not "wet pubs". It is pubs and restaurants. Some pubs are operating as restaurants at the moment, which is good and fine. The international evidence is that we do not see a lot of clusters coming from restaurants, which is why the recommendation from NPHET was that they open. However, it is my firm view that the moment it is deemed safe for the pubs to open, they need to open.

With regard to the GAA, I heard a lot of criticism from the GAA including singling out the acting Chief Medical Officer, which I have to say I take exception to. The acting Chief Medical Officer's job is to advise me and Government. His only focus is on saving lives. The easiest thing in the world for NPHET would have been to advise us to just close down all sports. We are at a tipping point, we could be looking at another national lockdown and we have to take this deadly seriously. It would have been quite reasonable for NPHET to say for the next three weeks, in order to protect the country and lives, we simply have to stop sports. To its great credit, it did not do that but recognised the incredibly important role sports play in our communities and for our country.

It said for that reason everyone can train and all matches can go ahead. The advice it has is that playing of the matches and training is not where the virus spreading. All it recommended was that for three weeks people did not spectate. Obviously people can attend for child protection and safety reasons. I hope that message is heard is by the amazing sporting institutions in this country, be it the GAA, the FAI, the IRFU and so on. The public health advice was to protect these organisations and to protect sport and ask only that for a short period spectators not attend because the evidence is that there are cases associated with activity before and after training and matches.

The next speaker is Deputy Durkan.

I thank the Minister for attending this session. I compliment him and his staff on the work they are doing and I wish them well. Taking the Kildare example, if the Minister was to identify a single issue that might have contributed to the upsurge in Kildare, what would it be? Would it be a lack of attention to social distancing or, given that the pubs are not open and will not open in the near future, house parties or was it a lack of attention to hand hygiene and so on? I would welcome a response from the Minister on that question.

Given that we are facing into the winter, and arising from the possibility that a single issue was a contributory factor in the recent outbreak in the midlands-Kildare and adjoining counties, can the Minister be certain of the ability of the system to deal with any further outbreaks that might occur in the community, in schools or adjacent to schools, in clusters or in meat factories and does it have the capacity to do so quickly?

A number of people have raised the question about the pubs. I acknowledge what has been said. In the absence of pubs as a social centre for the public there is a tendency for people to seek alternative locations that are not under any control. What does the Minister say to the publicans who say they can achieve social distancing without any difficulty? There will be some pubs that cannot do so but those that can are prepared to provide a service that is supervised as opposed to unsupervised and, as a result, safer places for social outlets for the public. What does the Minister say to their submission?

My final point is in regard to the winter plan, special needs children and the ability to provide the necessary services for them, particularly in regard to children with autism. There is strong evidence to suggest that owing to the lack of speech and language therapy, for example, their condition has deteriorated sharply. To what extent can the Minister address that in the short to medium term and does he intend to do so?

I thank Deputy Durkan. The Deputy's first question, understandably, relates to what happened in Kildare and the reason for so many cases so quickly. The advice I have is that it is a combination of factors, including high-risk workplaces in terms of Covid. That is the experience in Ireland. Nearly half of the workplace clusters to date, before this happened, had been in meat processing plants. That is the experience around the world. It is believed that travel may have played a part in terms of workers sharing commutes to and from work. It is believed accommodation also played a part in terms of congregated settings. When I ask the public health experts this question they are at pains to say that there are a lot of other unknown factors. For example, there may have been a super-spreader or several super-spreaders but they do not know that. I am sure the Deputy will agree with me that it is very important that in trying to identify what happened we do not lay blame anywhere.

The only thing to blame is a deadly virus and we are in the middle of a global pandemic.

Much good work was done in testing and tracing. The committee has done good work in this area in its earlier sessions. Due to the speed and significance of the number of additional cases in Kildare, Laois and Offaly, the tracing time slowed down. We need to ensure that it does not happen again. It happened for an understandable reason, namely that front-line clinicians were deployed back to their jobs. However, the tracing team is ramping up from about 50 or 60 around the time of the Kildare outbreaks to more than 150 by the end of the week. As the schools go back and we seriously ramp up testing for meat processing plants, direct provision, nursing homes, and as our community testing is now high, our priority must be to maintain very high turnaround times.

May I have written replies on the special needs supports for children and the winter plan?

The next speaker is from the Green Party.

I have four questions which I will try to get through quickly in five minutes. A colour coded alert system is being introduced as an alternative to the previously published roadmap for reopening. Does the Department have a date for its publication? What can the public expect from the system? Will there be restrictions tied to specific colours and so on?

Second, data on hospital-acquired Covid-19 infections was released at the end of June. There were 265 cases, so approximately 8% of all hospitalised Covid-19 cases. The latest data from the health protection surveillance centre has identified 8,563 Covid-19 infections in healthcare workers which is about 31% of all Covid-19 cases. As we move towards a potential second wave of Covid-19, what work is being done to reduce its spread within our healthcare facilities? Will there be a lessons learned report on hospital-acquired infections and the high levels of Covid-19 infections among healthcare workers?

Third, how is the Department ensuring there will be minimal disruption to medical services in the event of a second wave? Is the Department considering using the private hospitals as before? Finally, at its Thursday 6 August meeting, NPHET discussed alternative testing pathways for children. The standard nasopharyngeal specimen is upsetting and offputting for many children and their parents and guardians. The alternative, less precise, oral fluid or saliva specimen was discussed in recognition of this being more appropriate for children. Will the Department clarify if it has received recommendations from NPHET on alternative specimen types for testing children? As we move closer to the reopening of schools, could the Department prioritise this?

The colour coding system is a proposal from NPHET for consideration at Government level. The Government is putting together the new detailed roadmap which will be available for debate and discussion in the Oireachtas in the coming weeks. Regardless of what is decided in the new roadmap, between now and Christmas we are in a new chapter. The strategy is: follow the public health advice, suppress the virus to keep society and the economy open, use localised approaches where we can which, thanks to the people of Kildare, Laois and Offaly, we know work, and critically target the measures at the areas and activities where we know the virus spreads in order to protect everything else in our society and the economy staying open.

On infections among healthcare workers, I agree the number looks very high. Any infected healthcare worker is one too many. There is no doubt but that the level of infection, prevention and control measures that are now in place were not in place previously.

That is not a criticism of the occupational help provided or of the amazing healthcare workers in our system. It is a novel virus and it hit us quickly. We had not dealt with anything on this scale before. I assure the Deputy that very rigorous infection prevention and control measures are now in place. However, we must never stop and say that enough has been done. We have to keep going every day and week and we have to keep tightening up on the protections, not just for our healthcare workers but for our patients also, not just for those working in the nursing homes but for the residents also, and so on.

The Deputy asked an important question that weighs on my mind a lot, which is what happens to healthcare services if there is a second wave. The short answer is that nothing good happens. As we all know, before Covid-19 arrived, we had the longest healthcare waiting lists in Europe and the new information on how long they have become because of the elective care that had to be paused makes for sobering reading. One of the reasons the winter plan we will propose is so comprehensive is in order that we will be able to deal with Covid-19, have surge capacity, get the healthcare system running to deal with day-to-day demand and, ideally, start looking at these waiting lists as well. We will minimise the disruption to healthcare but we have to be clear that if we are dealing with a serious second wave of Covid-19 in this country, healthcare services will, for a second time, be severely curtailed. That is why it is so important for us to get the message out that we are at a tipping point and that if we all comply with the healthcare advice from NPHET, as the people of counties Kildare, Laois and Offaly have shown, we can suppress the virus. The best way we can all protect healthcare workers and the best thing we can do to make sure our hospitals and community settings stay open is to suppress the virus in the community.

I will get the Deputy a written response to her question about saliva tests. The short answer is that the matter has been discussed by NPHET.

I am perplexed as to what is happening in this session. When we asked the Minister to come to the committee a few weeks ago, he was unable to do so. He is here now. I am not sure if he is aware of this but he is the main event today, not just for the committee but for the people of Ireland who want to see a plan and some certainty. The committee received a three-page opening statement, which was well spaced out with a lot of gaps, half an hour before the session began. There is no submission or further detail, and even within these three pages - and a lot can be said within three pages - there is nothing that gives people any kind of clarity or guidance on what they will have to do until at least Christmas, to use the Minister's timeline. That is deeply concerning.

The Minister spoke about a winter plan a number of times today. The chief executive of the HSE explicitly stated earlier that the HSE is not referring to a winter plan this year. He pulled me up on that earlier and said the HSE was looking to manage its services through winter and into next year and that it is in a totally different realm. I am wondering if the Minister and the HSE are even talking to each other.

In the Minister's opening statement, there is no mention of direct provision, meat plants or travel restrictions and how travel will work. There is no mention of a roadmap either. The Minister mentions Kildare, Laois and Offaly, which is quite disingenuous. If Kildare, Laois and Offaly are to be the pilot system for what we will be doing between now and Christmas, I am deeply concerned. The previous speaker asked about a roadmap and the Minister said a roadmap would be presented to the Oireachtas for discussion in the coming weeks. How will that work? Will we all thrash out a roadmap across the floor of the Oireachtas for a number of weeks before it is delivered? It is up to the Minister, on the advice of NPHET, to deliver a roadmap so that we all have certainty. We require leadership on this. I am at a loss as to where we are going.

To take what little detail the Minister has provided, on the localised county-by-county approach, how would it work for a county such as Dublin? God forbid there will be a big outbreak in Swords or Balbriggan.

Is the whole of Dublin city and county going to be closed down in that scenario? Will Dundrum and Shankill, and the people there, be shut down while Ashbourne and Drogheda, only three or four miles away from those towns, remain open? How is that going to work?

I thank Deputy Duncan Smith for his questions. I would like to correct several incorrect statements which he made. First, I was available to come to the committee. The Chair and I had detailed communications on that and I am more than happy for Deputy Smith to discuss that with the Chair. That suggestion, therefore, is absolutely untrue.

Deputy Smith, and not the committee, has also suggested that is it unacceptable that I come here with a plan that is still in development. I imagine that the Labour Party has not finalised its alternative budget yet. It is not outrageous for the Deputy to not be able to present that alternative budget plan because he and his colleagues are still working on it.

The budget is in six or seven weeks. The pandemic is happening now, and the Minister has been mentioning this roadmap for weeks. The schools are back today. I am not here just to make a scene. I am genuinely worried and perplexed as to why we do not have more detail. I am genuine about this issue and this is not for show.

That is fine. I will try to answer then. Let me take the Deputy as asking his question in good faith. The schools are opening this week. It is positive news. There is a very detailed plan for the reopening of schools and an enormous amount of work has gone on in that regard. I am sure Deputy Smith would agree with me on that aspect.

The winter plan is happening months before it has happened in any other year. I would love to be able to give the finalised plan to the Deputy today. What we are doing is accelerating it by several months. It will be more comprehensive than anything ever deployed in Ireland before. We must get the plan right and, as I am sure Deputy Smith will appreciate, it has to be fully costed because I need to come to the Oireachtas for the money for it.

Turning to what we are looking at from now until Christmas, there will be detail. I am sure it will be appreciated that, just as in the case of Deputy Smith and his colleagues in his party regarding their alternative budget plan, we have to put that detail together and test it. When that is done, I do not believe that it is a lack of leadership to come to the Oireachtas. I believe it is the role of the Oireachtas to interrogate the Government and I look forward to the debate with Deputy Smith and colleagues in the Oireachtas on this issue.

Chairman: I thank Deputy Duncan Smith and the Minister. The next speaker is from the Social Democrats. I call Deputy Shortall.

I welcome the Minister to the committee. Earlier, I think I heard him saying, in response to another Member, that randomised tests were being rolled out at airports. Is that right?

What is the point in having randomised tests at airports? It is not as if we are talking about drink driving, where we have randomised tests as a deterrent because people hide the fact that they are drink driving. Why would we have randomised tests for Covid-19 at airports?

The purpose of randomised testing is to be part of a full suite of measures at the airports. Essentially, what we want to do is discourage non-essential foreign travel. For those who do need to travel, and for those who arrive here, we want to ensure that there are as many biosecurity measures in place as possible. Randomised testing is one part of a suite of measures to that end.

Is the Minister aware of randomised testing being done anywhere else?

I will get a briefing note on that, but I believe there are other countries doing randomised testing.

It seems to be a very strange approach to discouraging travel. Why would there not be a tightening up regarding incoming flights, or have stricter rules or enforcement of the rules, which has not been done in recent months? It defies logic that there would be randomised testing for Covid-19 at airports. What kind of percentage are we talking about regarding random testing?

Regarding the Deputy's broad point on foreign travel and discouraging non-essential foreign travel, which is exactly what we are doing, we need to bear in mind that 97% to 98% of the cases in the country are not coming from abroad.

I know that. I am asking the Minister what exactly the point is of rolling out this measure which, I presume, will cost a great deal of money. What percentage of people does he expect would be randomly tested?

The randomised testing is being rolled out as part of a suite of measures. It is not our objective to test 30%, 40% or 50%. It is not a mass testing measure. It is part of one of the measures that we are bringing in. The e-locator passenger form was launched this week.

What is the purpose of having randomised testing at airports rather than on Grafton Street, for example?

The purpose of randomised testing at airports is to provide an extra security measure in the context of testing and tracing people coming into the country.

I do not understand that rationale. I ask the Minister to send me a note on it.

It does not seem to make sense. I also struggle to figure out what exactly is happening with regard to testing and tracing. I raised this issue with Paul Reid this morning and asked him why the 100,000 tests per week capacity that is currently available is not being used. He told me that NPHET determines the testing that is done. I asked NPHET about the matter and was told that it is important that testing capacity is protected and ready to go when it is needed. Does the Minister understand what that means? I would suggest that this testing capacity is absolutely needed now. All one needs to do is to look at the outbreak in Cahir, for example, where there were 22 cases in a meat factory and 16 other associated cases. Why were we not using that spare capacity to test in the high risk settings?

I can answer the Deputy's question regarding 100,000 tests. The recommendation from NPHET was not that we should be doing 100,000 tests every week.

The recommendation from NPHET was that we have the capacity to do 100,000 tests if that is required.

Last week, more than 57,000 tests were carried out. What is happening right now is the exact answer to the Deputy's question. We had a much lower level of testing approximately two months ago when we were down to approximately 20 positive tests per day. As the Deputy is aware, there was a big programme of work involving weekly serial testing for nursing homes which was very useful but provided a very low positivity rate of 0.13%. What has happened in recent weeks is that there was an outbreak in County Kildare and it was right and proper that serial testing for meat processing plants was rolled out. It was right and proper that serial testing for direct provision was rolled out and-----

With respect, I am not arguing-----

------it was right and proper that serial testing for nursing homes was rolled out.

What I am saying is that in those circumstances-----

On top of that, we have a very serious capacity requirement-----

We are only using the capacity------

------for schools and we have a higher level of community testing. That has brought us up to 57,000 tests. I heard the Deputy's interactions earlier with the representatives of NPHET. What NPHET is saying is that we must have spare capacity in the system such that we can implement measures such as this in response to outbreaks and our evolving knowledge of the virus.

Why must we protect spare capacity if there is capacity for 100,000 tests per week? The only reason one would have to protect it would be if there was an issue about funding or reagent, for example. Why would it not be used now when it is needed?

We are using it now. It is needed now. Last week, 57,000 tests were carried out. Last Friday, the number of tests carried out was the highest in any day since this virus arrived. The HSE acted on the advice of NPHET. It moved heaven and earth to ensure we could scale up rapidly to 100,000 tests and we are now moving in that direction. Last week, we hit 57,000 tests. What we are seeing right now is a vindication of NPHET's advice and of the HSE having that capacity ready to deploy as we need it.

I disagree. The capacity is there. That was confirmed by Paul Reid. There is a need for that capacity to be used now because we know there are high-risk settings, such as in Cahir. Why must the capacity be protected? Is it a question of inadequate funding or inadequate supplies of reagent, for example? Why are we talking about protecting something when that capacity needs to be used?

I thank the Deputy. Does the Minister wish to briefly reply?

I thank the Chairman. It seems like Deputy Shortall is getting hung up on a word that somebody else used. I can tell her that NPHET has said that we need a testing capacity of 100,000.

That does not answer my question.

We have had serious outbreaks, we are now at a tipping point and we are rapidly scaling up and beginning to use a lot of that testing capacity of 100,000. It seems to me that the system is doing exactly what it was meant to do.

My first question relates to what has happened in the past six months in nursing homes. There are five separate inquiries ongoing in that regard and the data make for extremely grim reading. There were 971 Covid-related deaths in nursing homes and 56% of all such deaths are associated with nursing homes clusters. Of the 5,608 confirmed cases of Covid-19 in nursing homes, only 422 patients were hospitalised. As I said, it all makes for really grim reading. Will the Minister commit to a public inquiry into the catastrophe that has happened in nursing homes? Such an inquiry is owed not only to the people who died in those homes but also to their relatives.

We may well end up at a public inquiry into what happened in nursing homes. I know Deputy Kenny and many other Deputies have been advocating very strongly for that. The loss of life is heartbreaking and, understandably, relatives are asking whether all that could be done was done. We have to look at this now, not with the benefit of hindsight but with the benefit of understanding that what was done happened in a crisis the likes of which had not been seen before. I am aware, as is the Deputy, of some very serious incidents, both in terms of individual nursing home residents and of very high mortality rates in particular homes. As the Deputy said, the various agencies of the State have been looking very closely at what happened. I am sure Deputy Kenny has seen the HIQA report which looked at the half of nursing homes that did not have Covid outbreaks and how prepared they were before the pandemic. I have asked the authority to do the same report for the other 50% of facilities. Most important, we have had the nursing home expert group report, which contained 86 recommendations.

I hope the Deputy agrees that the number one priority for us all right now is making sure everything that can be done to protect nursing home residents and staff is done. The focus now is on what we have learned, what has worked well here, what has not worked well here, what has worked well in other countries and whether we are doing everything we can to protect the people most vulnerable to this awful virus. At the same time, it is absolutely proper and essential that the families of the residents who have passed away or become very sick get full transparency as to what happened. I do not believe that now is the time to start a public inquiry because we are focusing on keeping people safe. However, I am most definitely open to the idea. I want to see what happens over the next while, work with Nursing Homes Ireland, the expert group and the implementation committee, focus on keeping people safe and saving lives, and then see what is the most appropriate way for families to get answers to their very reasonable and pressing questions.

Will the Minister commit to a public inquiry, during his tenure as Minister for Health, into what happened in nursing homes? All the evidence points to the need for such an inquiry into each one of the deaths that occurred and why there was such a catastrophe. Behind the statistics I gave are grandmothers, grandfathers, fathers and mothers. The data make for really grim reading and they warrant a public inquiry at this moment in time.

I absolutely share the Deputy's concern and heartbreak about what has happened.

What I will commit to is that the right approach will be taken to answering the questions that need to be answered for the families. In CervicalCheck, for example, the right answer was deemed not to be a public inquiry but the most excellent work that Dr. Scally did. That led to many recommendations which are being implemented and to the setting up of the tribunal which will happen in the next few weeks. It is a discussion for the Oireachtas and for Government to see what the most appropriate mechanism is. The Deputy and I were very involved in CervicalCheck and I think we would all agree that the work Dr. Scally did was the right approach in that instance. We need to consider what the best approach is for the families of the people who have passed away to ensure their voices are heard and they get answers and transparency and that this is done in a timely way and does not kick on for years.

The former Minister for Health said last March that there was no room for private healthcare during the pandemic. I was contacted by a person yesterday. To get a Covid test in the public health service, it would take this person 24 hours to get an appointment and 48 hours for results. That is three and a half days, I think. However, someone who pays €250 to the Beacon Consultants Clinic would get a result in 12 hours. How does that match up when we have paid €350 million to private healthcare arising from the pandemic?

The median time in the public system from a swab to a lab result is 30 hours or 1.25 days. I do not have the details but I am happy to look at them. When people talk about median times of approximately three days, it includes several days of contact tracing that takes place afterwards. The median time at the moment for the HSE from a swab to a test result is 30 hours.

I do not think I have had an opportunity to congratulate the Minister on his elevation. The grass may be greener but I imagine it is just as difficult to cut on the other side. I want to bring up a matter that is within the remit of the Covid committee as it relates to hospital inpatient stays, elective days and hospital capacity. I refer to the issue of having a second catheterisation laboratory at University Hospital Waterford. We have seven cardiologists in the centre trying to access all of their patient schedules through a single cath lab. The Government has given a commitment in the programme for Government to develop a project. A tender will be issued in September and it will take four months to evaluate who the contract should be awarded to. It requires an Office of Government Procurement review. Will the Minister give a commitment to short-circuit that process? There is no need for it to take four months. This project is heading for two years and we have yet to award a grant of tender build.

I thank the Deputy. I acknowledge the ongoing work he did before he was a Member of the Oireachtas and continues to do now. The Deputy and I both know that his question is not within the remit of the country's response to Covid-19. Nonetheless, I know it is something that is very important to him, the other Deputies in the Waterford area and, most important, the people of Waterford and the region. The programme for Government gives specific commitments on this matter. Deputies Shanahan, Butler and Cullinane and the other Deputies and public representatives in Waterford deserve great credit because they have fought a hard fight for that. As Deputy Shanahan and I both know, there has been significant pushback. The second cath lab being put in place is a massive win. The time it takes to do this is based on the appropriate guidelines. I am happy to ask for a report and see if the project can be accelerated because I am all too familiar with how important having the facility up and running is to the people the Deputy represents.

To the patients as well, most importantly. I thank the Minister for that. He and I discussed the type A contracts that were to be offered at the time of the private hospitals deal and I heard the Minister refer earlier to funding being put aside for additional capacity.

If contracts have been written with the private hospitals, will the Minister again seek for private fee-charging consultants to be included or will they be excluded from providing a service under that arrangement?

To clarify, does the Deputy's question relate to a future contract with private hospitals in the context of Covid for the coming months?

All options are on the table. Tenders have been issued to all private hospitals. This is not being done in a co-ordinated way by the association this time. Tenders have been issued for services, beds and surge capacity and are being negotiated hospital by hospital by the HSE. It is entirely possible that, as well as procuring beds and diagnostics, we will procure services on a procedure-by-procedure basis just like the NTPF does, which would involve the people currently working in those private institutions.

That would represent the best value for money.

I wish to raise a further point about the lack of consultants. The Minister will be aware that a large number of mainly foreign doctors have been residing in Ireland for many years at registrar level. Is there an opportunity to consider providing additional training or fast-tracking some of these doctors? They have the experience, but it would appear that, for other reasons, they are not being appointed to consultant positions. The Minister does not need to give me an answer. This is just something he needs to consider.

Although we have been discussing Covid and the deferment of elective patient procedures and so on, there are significant resourcing issues in the National Ambulance Service, NAS. New ambulances and additional capacity were tendered for. We need to look at this issue long and hard before the winter arrives.

My time is up, so I will send the Minister a document that I imagine has been sent to many Deputies and Senators. It relates to a submission that has been backed by Professor Michael Levitt, a Nobel laureate from Stanford University. It is worth discussing with NPHET. It challenges some of the perceived wisdom that obtains currently. It is important that the submission be looked at by outside health experts so that we can all agree that we are following the best path.

I thank the Deputy.

The next speaker is from Fianna Fáil, Deputy Pádraig O'Sullivan. Then it will be Deputy McGrath. Deputy O'Sullivan has up to ten minutes.

Five should be sufficient.

I welcome the Minister's attendance to answer our questions. I have a number of queries, which I will keep brief, as I am interested in hearing the answers. Recently, we came across the omission of post offices, credit unions and banks from regulations on face coverings. I assume that this relates to security concerns at such facilities. Will the Minister provide clarity on this matter?

There is an issue for those aged over 70, on whom the recent guidelines have impacted the most. They are restricting their movements and returning to some degree of cocooning. Will the Minister provide people in that age bracket with some practical advice as to what is expected of them, how they should go about their business and how they should restrict themselves daily to ensure that they are adequately socially distancing and so on?

Many elderly people have appointments in the North under the NTPF. In a time when we are asking people in that age group to socially distance and cocoon, has the advice changed for those who have appointments in the coming weeks and are under such impositions?

My final question is on meat plants. The majority of testing seems to be pre-announced rather than random testing of employees. What is the rationale behind that? Will the Minister explain the distinction?

I thank the Deputy. The short answer to the question on face coverings in financial institutions is "Yes", for the reasons the Deputy has outlined. As I am sure the committee will appreciate, I want to avoid sounding like I am the Chief Medical Officer by providing direct public health advice. I will do my best to paraphrase the advice of the acting Chief Medical Officer. The advice is essentially to use extreme caution right now. We know from the data that people who are more vulnerable to the virus, those over 70 or with underlying conditions, are being extremely careful. We know that because as the number of cases has gone up and up, the number of fatalities, hospital admissions and intensive care unit admissions has thankfully remained stable and very low. We know that people who are more vulnerable to this disease are already exercising their judgment very well and very effectively.

The message during this period, which will hopefully last just three and a half weeks, is to be even more careful. What does that mean? It means people should limit their number of social interactions and limit the number of people who come into their homes. Shopping should be done during the times designated for more vulnerable people, if that facility is available. If it is not, more vulnerable people should seek other ways to have shopping brought to their houses. People have asked me if they can still go on their holidays in Ireland. The answer is absolutely "Yes", but they should take all the precautions they would take at home. Social interactions should be limited, face coverings should be worn and others should be asked to wear them and so on and so forth.

This is not just up to people who are vulnerable. It is up to everybody else as well. We all have a role to play. The Chief Medical Officer spoke passionately this morning about the need for solidarity. The best way to protect people who are vulnerable to this disease is to suppress the disease in our community. That means keeping our distance, limiting the number of people we meet with, washing our hands, wearing face coverings and following the other measures. That is the message I want to send and which I hope everyone in this committee will relay. We have to do this together and we can do it together. We know that it works.

People can absolutely still go to Northern Ireland for health appointments. The Deputy had a final question about serial testing in meat processing plants.

At present, many of those tests seem to be prearranged or preannounced, as opposed to random testing. Will this practice change or will it continue?

There are two aspects to this. There are randomised inspections, which the Health and Safety Authority, HSA, have now stepped up, as is right and proper. Then there is mass serial testing. When the National Ambulance Service comes to a plant, it is important that its staff can carry out testing quickly. That means notice must be given. However, no concern has ever been raised about providing notice of testing. The concern was that inspections needed to be more randomised. That is beginning to happen.

Sorry, I mean to ask about randomised inspections.

That is happening more.

If I may ask a follow-up question, is it happening much more? The imbalance between the treatment of the meat plants and every other sector of the economy was striking.

Agreed. I will get the exact figure for the committee, but I believe I read this morning that something like 22 of the last 27 HSA inspections had been unannounced. I will provide the committee with a full briefing on that.

I would like to comment on that point. The Minister was quoted as saying at a recent press conference that in one weekend 6,000 pubs were inspected and 26 were found to be non-compliant. That can be compared with the meat plants. There is one in my own home town of Cahir. Only 39 inspections were carried out in meat plants and 30 of those were preannounced. Those figures are stark. They are the Minister's own figures. Those pubs were inspected in a single weekend. An Garda has enough to do without visiting pubs. What does the Minister have against pubs? They have not been found guilty of anything but they have been blackguarded and destroyed.

I refer also to dance schools, musicians and artists.

They are being left behind and crushed. There is also the cohort of people with disabilities, especially those on the autism spectrum and special needs children. They have really suffered and they are not fully back up and running yet. Huge attention must be given to them, which is very challenging. They must be supported because they need that.

There was a situation at Walsh Mushrooms in Golden. Why is testing not done at the plant, given there is ample space, rather than going into the middle of a village and frightening people by setting up a camp there? I salute everybody who did that and salute the community for its engagement. There is further testing next Saturday but it should be done at the plant, where there is plenty of space away from the local village. It puts fear into people when they see the Army and Garda arrive with the whole entourage. The inspections are pretty stark.

There is also the whole situation regarding the treatment of publicans who have opened. The Minister can call them what he likes today, and he can call them restaurants, but they are pubs. Many of them do food and many are forced to do food because, apparently, the €9 worth of food is better than any antidote or cure. Food is the cure.

The Minister is giving out mixed messages, which are very wrong and very damaging. I put it to him that he and the Taoiseach have dropped the ball since they took over. I wished them well when they took over but they have dropped the ball and lost public confidence. Some of that was due to the Minister's own response at a press conference where he equated the virus to children being on a trampoline or people driving a car. Those are pretty silly things to say, or else the virus is not that serious. It is one or the other, and the Minister might explain.

I thank the Deputy. I have the figures regarding the Health and Safety Authority. There have been 23 meat plant inspections in August to date, and 22 of the 23 were unannounced. I want to note the Health and Safety Authority does not fall under the remit of the Department of Health but, obviously, we are working very closely with it.

That figure is a big jump from the figure we were given here by the Health and Safety Authority two weeks ago.

I agree. Deputy McGrath asked whether we need more Health and Safety Authority inspections. That is a question directly for the Minister, Deputy Varadkar, but I can give the Deputy my opinion as Minister for Health. As we look at the meat processing plants and other high-risk areas, I want to see as many inspections as possible to make sure high-risk workplaces in particular are compliant with the protocols that have been put in place. My preference is for unannounced inspections, for obvious reasons.

The Deputy asked why the pubs are closed. I share his frustration. It is not fair for publicans around the country, and I know that. The reality is we are dealing with a virus that is close to having us lock down the country again. The public health advice is that we are at a tipping point and we are doing everything we can to suppress this virus to stop a second lockdown, get the schools open, which we now have, keep businesses open, protect jobs, get the hospitals open and so forth. The public health advice and evidence are that in other countries, unfortunately, where the pubs have opened, they have been associated very quickly with outbreaks. That is the reason. I really do not want to be here saying that. I would like nothing more than to be announcing, and hopefully I will as soon as possible be announcing, that they have to be reopened.

The same applies unfortunately to dance schools. It is not about going after anybody; it is about trying to save lives. The measures the Government has brought in for this three and a half week period are based on the evidence that the National Public Health Emergency Team has on where and how this virus spreads. What it has found is that large indoor gatherings are one of the areas where this virus spreads, unfortunately. In being able to target that, what we are able to avoid is much wider shutdowns because our experts know more about the virus than they knew four or five months ago.

I fully agree with the Deputy on disability services, which are an absolute priority.

With regard to Golden, I want to respectfully push back. The Deputy has made comments about why it was set up there and that people are intimidated by the Garda and the National Ambulance Service coming in.

What happened was that an outbreak was detected very quickly and the healthcare services of the State were deployed in Tipperary almost instantly. All workers were sent home, isolated and tested. As a result of this ability to move quickly and comprehensively, we have the best chance of stopping the virus from spreading into the community in Tipperary. I understand the Deputy's questions and I know he is giving voice to the frustrations of the people he represents but on this particular issue I remind him that what happened in Tipperary was exactly what we have to see to suppress this virus, namely, the public health services working quickly and comprehensively to deal with the clusters as they emerge.

The factory in Cahir ten miles away was not closed. The tests were done by a private company behind closed doors. There was space in the mushroom plant. Why was there a difference between what happened in Golden and what happened ten miles away? The HSE did an excellent job, as did the Garda and everyone in Golden with the locals, and I compliment the local community. It was a whole different story in Cahir.

I cannot speak to an individual company that hires a private company for testing.

The next speaker is Deputy O'Reilly.

I am not sure where I am on the speaking list.

The order is Sinn Féin, Fine Gael and Fianna Fáil so it will be Deputy O'Reilly, then Deputy O'Dowd followed by Deputy McAuliffe.

I thank the Chairman. I just wanted to check that.

I thank the Minister for coming before the committee and answering questions. I have to say I was not especially impressed with the submission, given that it took quite a long time for us to get it. I understand there was an issue in the Department of Health yesterday but for future reference we would expect something a little more substantial given there was such a delay.

With regard to the roll-out of the flu vaccine for children aged under 12 in particular, I understand that GPs were sent an announcement from the company, Sanofi, that there has been a delay in the procurement. What impact will this have on the delivery and roll-out of the scheme? We know there will be a delay because there is a delay in the vaccine getting here to be distributed. What will be the delay in terms of weeks?

I thank the Deputy. With regard to a detailed submission, I was asked to make a five minute opening statement. As the Deputy knows, there was a very serious incident at the Department yesterday. Any information the committee wants we will get. What I submitted was the opening statement, which is the normal protocol in this case.

With regard to the flu vaccination-----

If there is any information Deputy O'Reilly needs, I ask her to let me know.

I will ask for a report specifically on how many weeks or days any delay will be but I can give the Deputy a decent answer on the flu vaccine and what is coming. We have 1.3 million doses on order, which is sufficient for a 90% uptake among the at-risk groups and healthcare workers, all of which will be provided for free. On the specific version referenced by the Deputy, we have 600,000 doses of the live attenuated influenza vaccine which, as the Deputy has said, will be delivered via nasal drops rather than injection. This will cover 75% of children aged between two and 12 years. We are targeting the groups most likely to be hospitalised by the flu.

The Minister does not know as yet what impact the delay will have. He said days but I am saying weeks because the delay is weeks so the impact will be weeks. By my guess, the first series of the nasal delivery vaccines will not start until October. Is that about right?

That is certainly not the plan. The plan is to administer this as quickly as possible. The original plan is September. I will get a detailed note as to what delays may occur but the plan as I understand it is September.

Is the Minister aware of the delay from Sanofi?

No, I am not aware of any delay.

It was sent to every GP in the State and it will have an impact. My estimation is that the impact will be weeks. I would appreciate a detailed note on it.

With regard to contact tracing, we were advised this morning that there are 100 people working on it today and the Minister said there will be 150 people working full-time on contact tracing by the end of the week.

Where are these people coming from? Have they been redeployed from other areas of the health service or have they been contracted to do the work of contract tracing?

They are being redeployed from various parts of the public sector, including civil servants from various Departments, the Army and other places.

Okay. Are some of them redeployed healthcare workers?

To the best of my knowledge, no. None of them will be redeployed healthcare workers.

None of the 50 who will begin work within the next couple of days will be healthcare workers.

Can the Deputy say that again?

According to the Minister, 50 people are due to be recruited, appointed or begin work in the next two days and 100 are in place. He said there will be 150 by Friday. The 50 extra people are not coming from the health service.

No, they are coming largely from the Civil Service.

Okay. That is excellent. With regard to the numbers on trolleys today, I have a series of questions on capacity. There are 130 people on trolleys. I assume the Minister, as he did until very recently, accepts the INMO figures and we will not have the usual ding-dong about it counting the figures one way and others counting them a different way. According to the INMO, which is usually good enough for most people, 130 people are on trolleys.

With 40% reduced capacity due to Covid-19 measures, have there been any modular builds to cope specifically with Covid? Can the Minister say where they are and what capacity they will add? I am asking about Covid specifically because he and I have taken issue with the previous Minister re-announcing stuff which had already been announced. I am aware of projects that were announced pre-Covid, as is the Minister. Will any projects specifically related to Covid provide modular capacity? How many extra beds will they add to the system?

I thank the Deputy. Like her, I am acutely aware of the number of people on trolleys. I also accept the INMO figures. I appreciate that the HSE uses a different model, but the Deputy and I have used the INMO figures for a long time.

With regard to reduced capacity, the figure is not 40%. Deputy Cullinane and I had a conversation about this earlier. The reduced capacity in terms of acute beds is reducing all the time. The figure we were given initially was 20%. That figure has now come down quite a lot thanks to the work of the HSE and individual hospitals working with the HPSC. It is closer to 40%, as the Deputy said, for some issues such as complex diagnostics and somewhat complex surgeries. In most cases, across the system we expect reduced capacity to be significantly less than 40% and some of the things we are doing to deal with that include extending telemedicine for outpatient consultations and so forth.

The specific numbers in terms of additional acute beds not yet announced this year comprise 400 acute hospital beds and 700 intermediate care beds. As the Deputy is aware, they have been brought on board from a wide variety of places. Some have come from the opening of closed capacity within full-time settings and others have been brought on board through the convention centre and other temporary places. The HSE has engaged very closely with the Department in putting together a very detailed winter plan. It includes consideration of the questions the Deputy has asked and how we turn the temporary additional beds into at least medium and, ideally, long-term beds.

The only modular capacity the Minister referenced is in the convention centre. Is that in UL?

Can the Deputy say that again?

I am referring to the convention centre in the University of Limerick.

What about the convention centre?

The Minister mentioned the convention centre.

The convention centre in the University of Limerick.

Yes. The Minister was talking about UL. That is what I wanted to clarify.

Apart from that, no additional modular buildings are being added. The capacity, when it comes, will come from closed beds already in the system. No new modular capacity will be put into the system. Is that right?

There very well may be. For example, we have 29 additional community assessment hubs which can be looked at. There are 700 intermediate care beds and 400 additional acute hospital beds. I want funding and resources so that all of the beds which have been opened can remain open. Obviously, the Deputy will understand that some of the additional beds, such as the intermediate care beds, have been opened in community settings which are not long-term.

However, part of the winter planning process-----

There are 140-----

-----is to look at exactly that question of additional modular capacity that can be brought on very quickly.

There is no modular capacity at the moment and the Minister does not know where it will come from, only that it might. How many beds are currently closed because of staffing issues and because the Department cannot staff them?

The hospitals are currently working at 96% capacity, so from a base of, I think, 11,000 inpatient beds, we are at 96% capacity. There is no breakdown of exactly which beds are closed because of staff shortages or infection prevention and control measures. As I am sure the Deputy will appreciate, the hospitals are now balancing an awful lot of different factors, including staffing, safe staffing, new protocols for staffing, and infection prevention and control, but we are at 96% occupancy. The remaining 4% is for a variety of reasons.

Where is the safe staffing model, as agreed with the INMO? Is it in place? Is it in place everywhere or in some places? Does the Minister have a percentage for me? We are running out of time, so I ask him to be brief.

The safe staffing levels the Deputy and I both advocated very strongly last year have not happened, unfortunately. What I found out was that while progress was being made, that progress was essentially stopped dead because of Covid. We are working with the INMO, and I have met INMO representatives and discussed this with them. We continue to work it through with them to get to safe staffing for nurses and midwives around the country. It is a top priority for the Government.

Can the Minister give a figure as to how many consultants are expected to be recruited before the end of the year?

I can tell the Deputy there are 500 vacant consultant posts-----

Those are vacancies. How many does the Minister expect will be filled?

I do not think anyone can answer that question right now. I would like to fill all 500, and we are doing a variety of things to that end. We have agreed some of the C contracts. We are moving quickly on the new Sláintecare contract, which is essentially like a super A contract. We are looking to do that in the current Dáil term. We will also look at ways to address the new entrant pay inequality issues which the Deputy and I have discussed many times before.

I will conclude on this. We know that up to 600,000 people have deleted the COVID Tracker app from their phones. Are there any confidence-building measures in play that will encourage people to download the app again? I am sure the Minister is concerned about this figure. I would be very surprised if he were not. It is in the newspaper today. Up to 600,000 people have deleted the app from their phones, so it is going backwards instead of forwards and the figure of 1.7 million I have heard is obviously no longer correct. Does the Department have plans to put measures in place to ensure that people will have their confidence restored in the app and that the uptake will start going in the right direction, as opposed to backwards, which is where it is going now?

We are currently at approximately 35% penetration in respect of the app. The international evidence suggests that we need 25% for it to be effective, so we are well ahead of that, and I thank everybody for that. I will urge a word of caution when the Deputy states that people have lost confidence. Let us be very careful about what we say about this. It is a very important weapon in our arsenal against this awful virus. It is being used and is proving effective. I do not believe there has been a loss of confidence in the app whatsoever. It is working very well-----

The Minister must have an alternative explanation as to why people are deleting it from their phones. A loss of confidence would be the obvious reason to me. If there is another reason and the Minister knows it, he can share it. I have the app on my phone. I have done as much as anyone to promote it, but if people are deleting it, they are not doing so for any reason other than that they have lost confidence in it. Let us be honest.

Neither the Deputy nor I knows that so, given the roles we are in, let us not jump to those conclusions. The app works. It was rolled out very successfully. It is providing valuable information to the contact tracers. It is saving lives. All the people who have it on their phones are doing their part.

I welcome the Minister. I appreciate that he has a particularly good grasp of the questions, the answers to which I have been listening. I wish to concentrate on issues he will have heard me speak about before. Most of the people who have died or have been seriously ill as a result of the coronavirus are older people or people with suppressed or impacted immune systems.

What additional steps is the Minister taking to ensure nursing homes, be they public or private, are ready for the winter, particularly for influenza and Covid, or is he satisfied that they are?

That is one of the most important questions any of us can ask right now. I acknowledge that in my time on the committee, the Deputy was a tireless advocate on exactly this question and making sure these measures were in place.

"Yes" is the short answer. We have a useful report from HIQA, which examined half of nursing homes that did not have Covid outbreaks and assessed them under a wide variety of measures regarding their preparedness for a second wave. I have written to HIQA and asked it to do the same for the other half.

We had a very comprehensive report from the nursing homes expert group. They made 86 recommendations under 15 themes. We launched it last week. We have set up an implementation team, including the stakeholders that need to be involved. They also have expert advice from people who were involved in writing the original report. They will come back to me soon regarding the additional measures that need to be put in place. The Government's goal is to make sure that everything that can be done is done for all nursing homes.

I believe the nursing home recommendations were superb. Some were short-term. In fact, we already have some of them in place. There were medium-term ones. They also took a look at the much broader questions around whether the regulation of care for older people in this country is good enough. It is a point the Deputy has raised repeatedly. The answer, of course, is, "No, it is not." They have also given us direction in terms of the work we must do in this Government to improve elder care, be it in nursing homes or in hospitals, or, of course, at home. We have seen some striking figures for other countries, particularly in Scandinavia, in terms of the percentage of people who can live in their older years at home as opposed to going into nursing homes if they have the supports at home they should have, and which we want to take a close look at making sure happens.

I welcome the Minister's comments. I hope that we have a full debate on them, perhaps next week or when we come back.

There is a commitment in the programme for Government to introduce a statutory home care package as quickly as possible. What progress has been made on that? I have spoken to a number of people, either in nursing homes or who have family members in nursing homes. Many of them would love to live at home if they could but, in fact, in the past, notwithstanding the increase in hours which the Minister spoke about, the facilities have not been there for them. As we move into winter, there will be an increasing demand for home care hours. Is the Minister satisfied that across all the CHO areas there will be adequate home care, both in terms of the hours available and the qualified persons to provide that to those people?

As part of the Covid measures that have been taken, 2.6 million additional home care hours have been allocated. That is to do exactly as the Deputy said. We have to do everything we can to keep patients, particularly those more vulnerable to Covid-19, out of hospitals. As the Deputy said, one of the most important ways of doing that is to provide adequate home care hours. An additional 2.6 million additional home care hours have been deployed and sanctioned. In the winter plan, we will look at a considerable additional number and bulking up the multidisciplinary teams required to support people living at home.

We have to do everything we can this winter to make it unnecessary for people to go into hospital and what we are doing is providing as much home care as possible. We are also looking at putting in place community hubs so that people with respiratory issues - perhaps people who get the flu - can be treated as they need to be treated, but not in the acute setting this winter.

In response to the Deputy's direct question on the fair deal scheme, it is something I absolutely want to see. The current situation does not make sense whereby if one is well enough to stay at home, the State will not provide the supports required but if one goes into a nursing home, the supports will be provided.

That is it in a nutshell. My time is short.

That is backwards healthcare. I want to work very closely with the Oireachtas and with Government to do something about that as quickly as possible.

I will raise that with the Minister in the Dáil or by parliamentary question. I welcome his comments.

Two issues that have upset me the most, most of my constituents and indeed most of the country. One concerns the man and his stepson ,both of whom lived in Kilbrew nursing home and both of whom died. We heard the appalling description of the maggots on the poor man's face and the way he was treated. That case cries out for justice. I understand the Minister is talking about other inquiries but I believe that he needs to appoint urgently a qualified professional to look into Kilbrew nursing home as a matter of extreme urgency. I know there were other deaths there. It requires a qualified person. Professor Des O'Neill did the Leas Cross nursing home report some years ago. It needs to be done. What I understand happened at Kilbrew nursing home is absolutely unacceptable. Part of the inquiry has to be into the correspondence between Sage Advocacy and HIQA. There were three or four notices of concern issued to them directly about this family. It is just appalling.

The second issue, which I asked about at this morning's session with the HSE, concerns the deaths in Dealgan House nursing home, which had the highest number of deaths in County Louth. For three months, half of the deaths in the county were in Dealgan House. Families are extremely upset. A report was done by HIQA but they have not had sight of it. They are not getting answers from the HSE or from the Department of Health. In their view, there is obfuscation and delays. They have spent hundreds of euro on freedom of information requests to try to get to the truth as to why the Department and HIQA, due to what they found, put the Royal College of Surgeons hospitals group in to run that nursing home. These people have lost family members and are traumatised by their deaths. They are deeply frustrated at the bureaucracy they have encountered. I ask the Minister the same question I put to Mr. Paul Reid this morning. Will he meet those families to listen to their issues? Will he appoint a competent and qualified person to look specifically at what happened in that nursing home on the particular grounds that he, the Department and the HSE had put in a special team to manage the home? One of the issues raised was that the majority of staff who worked there were unable to be on duty. Patients died. There is evidence that the HSE was aware of the fact that a significant number of workers were absent due to illness and other reasons, and while the executive gave assurances that it was acting, there was a delay of at least four or five days when a lot of people would have caught Covid-19 as a result. It is a very serious issue and I would appreciate the Minister's comments on it please.

I know I am out of time but given the sensitivity of the topic I ask the Chairman if I can take a short bit of time to respond to the Deputy?

Of course.

I thank the Chair. I share the Deputy's sentiment on what has happened. Along with us all, I express my sincere condolences to Mary Bartley Meehan, to her family and to Mr. Meehan's family, during what must be an extremely difficult time. HIQA is investigating what happened. They are providing a report.

That is my whole point.

To answer the Deputy's question, if I believe the HIQA report does not sufficiently answer the questions that the family has a right to know, then I will act.

If I could intervene. HIQA is the regulator. It did not regulate and did not act. It cannot be the decision maker in this. This is why we need an independent inquiry. I can send evidence to the Minister that may help him to make up his mind on that.

I thank the Deputy. He can feel free to do that. In the first instance, however, the only agency of the State that can do this is HIQA. That is the current law and regulatory environment.

HIQA was the regulator of the home and it did not do its job.

That is fine, but what I am saying is that in the first instance, HIQA has to investigate. I am sure the Deputy will appreciate that I am not going to make allegations about the inability of HIQA to investigate. It is the State regulator and it is very good at what it does. If I conclude------

The Minister's point-----

We cannot have a conversation over and back. We need to move on to other members.

I will finish on this. If I conclude that in either case - Kilbrew or Dealgan House - the very reasonable questions of the families have not been answered, we will take further steps.

I appreciate the Minister coming before us. When the invitation was issued 14 days ago, the meeting was scheduled to address the increased restrictions in counties Kildare, Laois and Offaly. Over the past 14 days, while it is disappointing that Kildare has not emerged from those restrictions, we have successfully managed the outbreak in those counties. By allowing the public health experts to take the lead, we dealt with the virus as well as we could.

Over the course of the meeting, I have taken away two lessons. The first was when I heard Mr. Paul Reid talking about us living with the virus and Dr. Ronan Glynn talking about how we can reopen sensibly. The strategy we are now engaging in, which is not a zero-risk strategy, is based on the idea that we must allow our economy to reopen so that we can go to school, engage with our health service and protect jobs, but with the balance always on the side of public health. If that is the case, the Minister's analogy of risk management, about which there has been some discussion, is actually a correct one. An analogy I have used many times, although I hesitate to use an analogy again, relates to the first time one lets one's child walk to the shop. One will never know when is the right time to do it. It will inevitably involve risk but the parent knows that the child must be allowed to grow and gain independence. Each time we go out into the world there are risks, and as we head into a world of living with the virus, that is what we are doing.

What we heard today, however, was the idea that while previously activities were judged on whether they allowed for social distancing and on the public health advice, we now seem to be moving into a different area where some activities, even though they allow for social distancing, are not permitted because they involve increased inter-household contact. That brings us into a difficult territory where we are making judgments about what is a good or bad activity. That is always a dangerous area for the Government to be involved in. If we are to live with this virus for long periods, perhaps we would be better off guiding people to have a prescribed number of contacts or a prescribed level of social contact, and to allow them to apply it, whether they want to go to a football match where they can stand 2 m apart or whether they want to go for a meal in a restaurant where the distance is only 1 m. Different people choose different things to do in their lives. I worry that if we are to stay with this virus for long periods, we may end up in a difficulty where the State dictates what is a desirable activity. I know that is not the intention at the moment as we unravel the advice, but if the virus is to be with us for several months, we will need to give more leniency and to get back to circumstances where people can more easily understand what is or is not permitted.

On the issue of comparisons of risk, during a conversation about getting schools open, I made a comment about our need to manage risk. I believe one of the examples I used caused a great deal of genuine hurt, anxiety and concern. It was in my head, as it happens, because it was how one of my kids had recently broken an arm. I was not for a moment suggesting that the risks were at all comparable. Nevertheless, I understand that in an environment where people are very worried, it caused anxiety, and I certainly did not mean to add to anybody's anxiety.

If I might provide some good news in respect of the point the Deputy made about children, the Royal College of Physicians of Ireland has just released its latest view on the impact of Covid-19 on children from a health perspective.

I will just read one paragraph, if I may. It states:

It is clear now that fortunately the vast majority of children who get SARS-CoV 2 infection do not develop severe COVID-19 illness. This also appears to be the case for children with underlying health problems, these children may get an infection with very few symptoms at all or they may experience an illness like, but usually no worse than, the seasonal flu. Children who are immunocompromised, or taking immune medications for inflammatory conditions such as arthritis or inflammatory bowel disease, also do not appear to have an increased risk from COVID-19.

We are all worried. I am sending my own children back to school tomorrow. There is, however, good, positive news emerging from the experts on this.

To address the Deputy's broader question on striking the right balance in managing the risk in society, we are all figuring this out as we go, as is every country. It was put to me by medical experts regarding counties Kildare, Laois and Offaly that because of early detection and what we now know about the virus, we were able to bring in much less restrictive measures than the countrywide lockdown we saw. The point was made to me by one expert that if that had happened four months ago, it would have spread into the whole country and we would have had to lock down the entire country. If the first piece of good news is that the medical evidence on children is reassuring, the second piece is that we are learning every day about this virus and are now at a point where, as proven by the efforts of counties Laois, Kildare and Offaly and the people living there, targeted localised measures can work.

I suppose the Deputy is now asking the next question, which is whether we can be even more non-specific than that. Perhaps, at this point, we have all internalised the guidelines, namely, to limit our social interactions, wear a face covering, obey social instancing and all the other measures we all now know. The answer is, hopefully, in time, "yes". If chapter one was flattening the curve by locking down the country, we are now at the start of chapter two, which is suppressing the virus in a targeted way so the rest of society and the economy can function. Perhaps, the Deputy is describing chapter three whereby it will become implicit in how we live, work and interact and that will be enough.

The expert view from NPHET is that we are not there at this point and based on the increasing number of cases in Ireland, the rate at which they are rising, the profile of those cases, which are in workplaces, homes and social settings, we are finely balanced in terms of a second wave right now. If there is a second wave, the Government will have to consider the blunt instrument which we know works, that is, a lockdown. We are doing everything we can to avoid that. Certainly, the public health advice right now it is that targeted measures are needed. I agree in spirit with what the Deputy is saying. We have to trust people. People know how to deal with this. In some of the targeted measures we are specifically targeting areas where, perhaps, the level of compliance is not what it needs to be and maybe simply just trusting everybody to do the right thing is not enough. We know, for example, there have been house parties and that they have been considerable vectors of this disease.

Deputy Lawless wants to contribute for one and a half minutes. There is no more time available, I am afraid.

I thank the Minister very much for engaging with me and others in County Kildare during the lockdown period. I appreciate that. I will ask a quick question as it is coming to the end of the session. I want to manage expectations. County Kildare is obviously still in lockdown. I discussed earlier with the acting Chief Medical Officer the possibility of the data sets being released in order that we can have granular data. I am told there will be an update later this week.

If the data is looking good, what are the prospects for the lifting of the lockdown a little earlier than 6 September?

While I do not want to take from Deputy Lawless's time, I have an answer to the earlier question on the flu vaccine delay, which is two weeks. We are pretty much still on target, but there is a two-week delay.

As Deputy Lawless knows, NPHET is meeting tomorrow. I have explicitly asked the team to look at the profile of what is happening in Kildare and if there is a public health case to be made that it is the right thing to do and it is safe to accelerate the opening up, then that is exactly the recommendation I should get. I cannot pre-empt that and I do not want to create any false expectations. As we all know, the rate is very high in Kildare. The cut-off point for Ireland's green list was a prevalence of no more than five cases per 100,000 over the previous two weeks. Kildare was at nearly 200 per 100,000. The rate was very high. We also know that thanks to the incredible work of people in Kildare, that has been stopped and is now being reversed. The seven-day rates are much lower. This is a very difficult call for NPHET to make because while the measures are working, the question is whether they have reduced community transmission to a point where it is safe to relax the restrictions. We know the restrictions are working and inevitably, there will be risk of community transmission spiralling again if they are relaxed too early. I salute what the people of Kildare have done and I deeply empathise with the fact that they are now the only county being asked to comply with additional measures. If the restrictions can be lifted early, based on public health advice, they most certainly will be but we need to be very clear that our absolute focus is on saving lives, which is what the people of Kildare have done, getting the schools open, keeping businesses and our health care services open and avoiding much harsher measures.

I thank the Minister. That would be such a relief and a reward for the people of Kildare. I appreciate that the public health advice is paramount but any ray of light would be such a relief and a reward to the people who have been compliant and who have done everything asked of them.

I am hoping the Minister will help me to understand the current strategy. At the beginning of this we were told that the strategy was to flatten the curve. We were told that the virus would spread, as viruses do but that we needed to flatten the curve to ensure that our health system was not overrun and we did not have scenes like those in Italy and Spain. At the time that the restrictions were introduced, numbers were rising from 170 in hospital to 440, from 50 in ICU to 80. Four months ago on 29 April there were 1,185 cases in hospital in Ireland, of which 120 were in critical care units. Three times today the Minister told us that we were looking at a complete lockdown and that we were at a tipping point. We have been hearing a lot about tipping points. We have heard about tipping points since June. We were also told today by the HSE that 22 patients were admitted to hospital with Covid-19, six of whom are in ICU. I accept that for those 22 patients and their families and particularly for the six patients in ICU and their families, this is an incredibly worrying and stressful time but what I do not understand is how the Minister can possibly talk about a national lockdown given those figures and given that our health system coped with 1,185 cases four months ago.

What is the strategy here? What are we hoping to achieve, if not that our health system is not overrun? I note that earlier this week Dr. Glynn accepted that we cannot eliminate the virus. That seems to be the general consensus. I accept that there are some who are calling for it to be eliminated but Dr. Glynn said that he does not think we can eliminate it here. There is a growing acceptance that we cannot eliminate it and even if we do, what do we do then? We open up and we go through the same cycle. The Minister talked about lockdowns and said a couple of times that they work but Argentina has been in a lockdown for six months and its figures are spiralling.

Earlier this week we heard Dr. Hans Kluge, the European director of the World Health Organization, on RTÉ news saying that lockdowns do not work. Where are we going? What is the strategy?

The Chairman is absolutely right that I have mentioned a tipping point several times. It is not me making that up. I am saying it because that is NPHET's position. It is natural that we all become fatigued with this. People have been through an awful lot. The reason I am emphasising and re-emphasising it is that we need to be on our guard. In terms of the Chairman's question about whether lockdowns work, we know they work. We did one here and it worked. They did them across Europe and they worked. If the purpose is to flatten the curve, we locked the country down and the curve was flattened. That has been the experience of most of the countries we have looked at.

We had no idea how many people are unable to bear this. The Minister talked about causing unnecessary anxiety by the use of the word "trampoline" and I very much accept his explanation yet he is talking about another lockdown in circumstances where we have - I repeat - six people in ICU. I regret each and every one of them desperately. I lost a very close relative earlier this year and I know that no matter what age somebody is, we do not want to lose somebody close to us. We are talking about national priorities. We have six people in ICU and 22 in hospital with Covid-19. At the height of this we had 1,100 people in hospital and 120 in ICUs yet the Minister is talking about a lockdown again. Has he any idea of the effect that is having? Forget about the economy for a moment. We cannot forget it about it for too long because something has to fund our healthcare system. They do not fund themselves in any country in the world. Has the Minister any idea what effect it is having on mental health, on people's psyches and spirits? How can he possibly talk about a lockdown given the figures? It flies in the face of reason. We all have eyes and a capacity to reason. We are all living in a post-Enlightenment world.

Of course I do understand the implications, which is why I keep saying it. It is why we brought in the measures last week, because we must suppress the virus in our community. A huge national priority has been getting the schools open for many of the reasons the Chair gives. That is now happening because the transmission has been reduced. I think the Chair's question is fair. The number of cases is going up and we know it is going up very quickly. For example, the key measure the public health experts use is the number of cases over the last two weeks per 100,000 of population.

That is the number of detected cases. We have no idea really what is happening outside of detection levels. Is that fair?

We do. There was a study done estimating that the total number is about 40,000 to 50,000 versus the 27,000 or 28,000 we have detected.

There are other studies that are being prepared.

The one the experts talk to me about indicated that we have detected probably a bit over half of the total cases. Returning to the figure they use, we were at three per 100,000 a while ago. Two weeks ago we were at 18 per 100,000 and today we are at 30 per 100,000. Let us be very clear that this virus is rising again quickly in our community. The Chair has very fairly asked how that is linked to hospitalisations. The cases are high but the hospitalisations, thank God, are low. Go back and look at the profile at what happened the first time, and what you will find is that at this point in the pattern, as the cases were around where they are now and rising rapidly, hospitalisations were also very low. The unambiguous message and advice from public health is that death will follow high numbers of cases. What we do not want to do is wait for the hospital system to be overrun.

We do not want to wait for fatalities to increase before we act. We have to act first and that is what we are doing.

The Minister used the phrase "deaths will follow an increase in detected cases", but that has not happened across North America. It has not happened, thankfully, to date at least, across Europe.

With the greatest of respect, the situation in North America is not one we need to be looking at to learn lessons.

I am not saying that Donald Trump is doing a good job. Please do not mischaracterise me.

I am not suggesting that.

What I am saying is that the increase in detected cases has not been accompanied with deaths. The trend for some time in North America and the Continent is that detection has not been accompanied by an increase in hospitalisations and deaths, thankfully. That is all I am saying.

I appreciate that. I refer the Chairman to the profile that happened here in March and April. If we were back in March and April, we could well be having exactly this conversation. The Chairman could be saying that case numbers are increasing but hospitalisations have not happened at a big level and, therefore, asking whether we need a lockdown to flatten the curve. As we all know, we have had nearly 1,800 deaths. The answer is that what we did was necessary.

There are no easy answers. We are moving early to stop the fatalities, the critical care admissions and the hospitalisations. I emphasise again that the success of Kildare, Laois and Offaly is that the communities there have shown that relatively reduced measures in comparison with a lockdown not only work, but work very quickly. That is simply what we are doing. I am more than happy to remain here for as long as the Chairman wants and to answer any questions but I would like to make one ask and to make a further point. Speed matters. How fast we moved in the three counties in question mattered, and how fast we are moving in terms of the national measures matters a great deal. Critically, how quickly individuals respond matters. There has been, rightly, a lot of focus in the committee on the turnaround time for testing. We will continue to reduce it. The other part is individual responsibility. My ask is that if people feel symptomatic, they do not do what we all do in the normal world and wait a few days to see if they improve but instead go immediately to their GPs.

If we all act and move early by going to our GPs to request a test if we have one of the symptoms, and if we follow the public health guidelines around social distancing, face coverings and so on, we will move through this crisis without the harsher measures, which is exactly what we are trying to achieve. We obviously have to reopen our schools but in my brief we have to get the healthcare system to a higher capacity that existed before because of the enormous number of men, women and children waiting for healthcare.

I note that in the coming days the Minister will provide the committee with the figures on how that capacity is to be increased and I thank him for that. I join him in asking people to behave responsibly, to take personal responsibility for their actions and to adhere to the measures that have been outlined. Speaking personally, I would caution against talk of another lockdown because there is a risk of unleashing a whirlwind. That is my personal view. I am not convinced that the Minister will bring the country with him on that.

I thank the Chairman.

That is not a committee view, it is a personal view.

I accept that and I accept the Chairman's view. We are in a world where there are no easy answers. We are dealing with a global pandemic and a highly effective, vicious virus that we know kills people. There is emerging evidence as to the some of the longer-term health impacts for people who do not die.

We are consistently told that young people suffer long-term effects. I have no doubt that is true. Do we have the figures on how many young people have long-term debilitating effects from Covid-19? Leaving aside young people, how many people who have overcome the virus to the point of being able to return to their day-to-day existence, be that as students, workers or retirees, are suffering long-term debilitating effects? Do we know what that percentage is in Ireland?

By definition, we do not. The virus has not been here long enough to be able to answer that.

The Minister should know enough now.

There are sobering case studies, which medical experts are examining, relating to long-term issues, including respiratory issues. We do not know the long-term effects. Doctors and scientists do not know if there are subtle, longer term health complications among people who get this virus. They will not know for a while by definition. However, they point to other diseases which have long-term impacts. I take the Chairman's points, which are reasonable, but given that this is a novel virus unlike anything he or I have ever seen, and given the loss of life it has caused and the serious warnings we have had from doctors and scientists saying there may well be longer issues, I hope he will agree that we must do everything we can to suppress the virus.s

He asked what the strategy was. Right now, it is to use the targeted measures, as we are doing, and to work as a nation in solidarity to follow basic but very effective infection control measures to suppress the virus and get on with opening our society, public services, and the economy and protecting jobs.

I have a question of local interest to me and do not expect an immediate reply, but the Minister might give me one in writing. Earlier, the HSE told us that the Department engaged the DAA to carry out the follow-up calls in respect of people coming into the country. What tendering process was done for that or how was Dublin airport selected over, say, Shannon, which is going through a round of redundancies? There is a lot of capacity there and sometimes it seems as though there is only one airport in the country when it comes to Irish officialdom. The Minister is welcome to reply now or in writing; it is up to him.

I will get more detail in writing but, in short, the Department of Health procured the contract.

With the DAA, but how ------

No, with a private firm to do the work. The DAA was originally looking at it but my Department has taken it over and procured the contract.

That is fine. I thank the Minister. There are some other issues I would like to raise, but I have taken up enough of his time.

I thank him for coming in and making himself available. I appreciate that is it a busy time for him and for his officials. I particularly thank Mr. Malone, who I know had to work through his holidays to organise today’s meeting, and Ms Sarah Cremin from the secretariat, who also put in a huge amount of work to make this session happen today. I thank them on my own behalf and that committee members.

The committee adjourned at 5.48 p.m. until 10 a.m. on Wednesday, 2 September 2020.