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Cabinet Committees

Dáil Éireann Debate, Tuesday - 15 September 2020

Tuesday, 15 September 2020

Ceisteanna (3, 4, 5, 6)

Richard Boyd Barrett

Ceist:

3. Deputy Richard Boyd Barrett asked the Taoiseach when the Cabinet committee that deals with health will next meet. [22338/20]

Amharc ar fhreagra

Alan Kelly

Ceist:

4. Deputy Alan Kelly asked the Taoiseach when the Cabinet committee on health will next meet. [23638/20]

Amharc ar fhreagra

Paul Murphy

Ceist:

5. Deputy Paul Murphy asked the Taoiseach when the Cabinet committee on health will next meet. [23684/20]

Amharc ar fhreagra

Mary Lou McDonald

Ceist:

6. Deputy Mary Lou McDonald asked the Taoiseach when the Cabinet committee on health will next meet. [23700/20]

Amharc ar fhreagra

Freagraí ó Béal (13 píosaí cainte)

I propose to take Questions Nos. 3 to 6, inclusive, together.

The Cabinet committee on health was established by a Government decision on 6 July and held its first meeting on 28 July. It will meet again in the coming weeks. It will oversee implementation of programme for Government commitments in respect of health, receive detailed reports on identified policy areas and consider the implementation of health reforms, including Sláintecare and the development of mental health services.

In addition to the meetings of the full Cabinet and of Cabinet committees, I meet Ministers individually to focus on different issues. I regularly meet the Minister for Health to discuss priorities in the area of health and in particular our management and response to Covid-19. The Covid-19 pandemic has led to unprecedented interruption to normal healthcare activity, with both community and acute settings affected. Resuming health and social care services, and building our capacity and capability for the pressures of winter 2020-2021 and beyond, will be particularly challenging in a way that the health service has not experienced in living memory.

Earlier today, I launched our medium-term plan, Resilience and Recovery 2020-2021: Plan for Living with Covid-19, which frames Ireland's approach to managing and living with Covid-19 for the coming six to nine months. It aims to bring some clarity to help everyone to plan over the medium term. The plan contains a framework for restrictive measures, which is a risk management strategy for the next six to nine months. It is designed to allow individuals, families, businesses and services better understand, anticipate and prepare for the measures the Government might introduce to stop escalation of the transmission of the disease.

In the context of the health service, the plan sets out our approach and priorities for managing and living with Covid in a range of areas, including, among other measures, prevention of infection and protection of vulnerable groups, health system response and resilience, and the continued resumption of public service delivery, including non-Covid health and social care. It is important to recognise that many vital services have continued throughout the pandemic, ensuring that priority care needs were addressed and the most vulnerable protected even at the height of this crisis.

A range of initiatives have been developed, and as these continue to be rolled out in the coming weeks and months, we will see further service resumption and increased capacity throughout the community and acute hospital system. This includes implementing new initiatives, new ways of working and eHealth solutions to keep people safe and out of the acute hospital system, such as ePharmacy, ePrescribing and virtual clinics. Today, the Cabinet agreed to allocate a record €600 million for the 2020 winter initiative to ensure that our health service has the capacity and resources needed to deal with what is forecast to be a particularly challenging few months.

I was at the taxi drivers' protest during Leaders' Questions, so I have not fully studied the roadmap, but I want to know what the strategy is, as do the people.

Specialists in public health, immunology, infectious diseases and so on are saying that we should be pursuing a zero Covid strategy as against what appears to be, in this plan, a roller-coaster strategy, going up and down and up and down, with nobody knowing quite where it ends. Has this committee considered a zero Covid strategy, which I stress is not about a return to lockdowns but precisely a return to normality by the putting in place of resources and systems, in particular the testing and tracing regime, such that we can really chase the virus and isolate it? This is a clear objective that the people can get behind and understand in terms of where we are heading. Connected to this is the question of permanent healthcare capacity. The capacity of testing and tracing has a lot to do with permanent recruitment. Many of those engaged in testing and tracing were redeployed from elsewhere. What is the envisaged number of staff required to be recruited permanently and engaged in testing and tracing to get to the state-of-the-art testing and tracing regime? What are the plans in terms of permanent increases in capacity for ICU and the health service generally in terms of recruitment because it is trained people who are needed?

In terms of public health restrictions, would it not be best to have in place a hotline for workers in employment who are worried about encroachment on health and safety guidelines and so on such that they have a means of reporting to the HSE and a system that is responsive?

Earlier, I asked the Taoiseach about travel restrictions and the statement in the plan that those living in Dublin should be encouraged to limit their travel etc. The Taoiseach is probably aware at this stage that the Minister for Health, Deputy Donnelly, said the opposite on the "News At One". In regard to the elderly and those who waited for the peak season to be over and have booked a staycation for this weekend but who live in Dublin, what is the Government advice? It is an honest question. My colleagues and I, and I presume other Deputies, have received texts on this issue. What are such people to do? They are not in level 2 and are not in level 3.

What is the difference between this committee and the Cabinet Covid committee in terms of responsibilities? I welcome the €600 million but strange as it may seem to say this it may not be enough. On the winter plan, I ask the Taoiseach to comment on a number of issues. I understand the plan will be launched on Thursday. Perhaps the Taoiseach will confirm if that is correct. The situation in some areas needs particular attention. Limerick University Hospital is the topic on which I have probably spoken most in this House. The situation there has been ongoing for a decade. As things stand, the hospital is at crisis point today. We need a plan for this hospital and for Cork University Hospital, where the Taoiseach will know there are issues as well. The mid-west in particular traditionally has had huge problems so we need to focus our efforts there.

There are a few other issues I would like to highlight. The Taoiseach might come back to me, as he mentioned earlier, on the vaccine. We need to get other screening back up and running, including BreastCheck, otherwise we will have delayed issues. I have continuously raised the issue of people with disabilities, which the Taoiseach will acknowledge. Our planning for the coming months needs to be elderly and disability proofed. I acknowledge the plan to recruit in regard to the testing regime. It is crazy, as pointed out by my colleague, Deputy Sherlock, to have therapists, etc., doing the work which others could be doing. For example, it could be done by people who are retired or by students.

The general perception of people is that there is a lot of confusion around the public heath advice. There is a reason for this, namely, the public health advice is not followed consistently, but instead the interests of private profit are allowed to interfere and interact with it. I am concerned the plan for living with Covid-19 is being institutionalised with the establishment of the Covid-19 oversight group, which effectively functions as a buffer as I understand it between NPHET and the Government. This group receives the public health advice from NPHET, which works it out in terms of the impact economically, socially, etc., and there the interests of private profit can come to bear. I also have a concern that this group is going to delay the process in that it is due to meet weekly and then report to NPHET, which will then have to pass on that advice to Government at a time when speed and movement in terms of action on public health is necessary.

The message of individual responsibility is not the right message. What is required is collective responsibility and the Government needs to take public action. At the heart of that action is the testing and tracing system. By way of comparison, Denmark, which has a similar population to Ireland, is now testing close to 200,000 people per week. In Ireland, 75,000 tests were carried out last week and a few weeks ago fewer than 60,000 were being carried out. In Denmark, there are free testing facilities publicly available, with testing available to anybody who wants it, including at the airports, yet here we are not even testing everybody in a classroom when there is a known Covid case. It is absolute madness. We are six months into a highly contagious pandemic and the Government is still rationing testing because it is trying to do it on the cheap. We had the opportunity to get ahead of the virus over the summer months. Will the resources be applied to bring our testing and tracing regime up to scratch?

I want to ask the Taoiseach about the ICU beds in our system. The Minister for Health confirmed in recent days that we have 255 ICU beds in the system, which is half the European average per head of population and 15% of the ICU bed capacity in Germany, for example, We are an absolute outlier in this critical resource. In 2009, an independent report found that the public health service needed to increase ICU bed capacity by 45% yet since then capacity has fallen rather than grown. There is confusion within the hospital system as to what exactly the Government contingency plan is for ICU care in terms of Covid cases and non-Covid cases. We need a permanent increase in the baseline of ICU bed provision and, of course, the staff to service those beds. When will the Government publish a plan to increase ICU capacity to ensure the very urgent care for Covid and non-Covid patients?

I will take a brief question from Deputy Barry.

It is a matter of concern to me that anti-face mask protests have been organised across the country in recent weeks. I believe that those who are anti-masks and organising these marches are anti-workers because wearing a mask protects the worker behind the counter in the shop, the driver on the bus and so on. These marches, in most cases, have been organised by the far right. They have tried to build a base on racism and on homophobia and they are now trying to do it on the basis of frustration with coronavirus restrictions. They are being helped by some of the actions of the political establishment. Golf-gate created anger which swelled the marches.

The Deputy needs to leave time for the Taoiseach to reply.

Can the Taoiseach report on any initiatives from the Cabinet sub-committee in terms of promoting face masks? I believe there needs to be a mass campaign of worker activists on the left to challenge this development.

On face masks, let us give the people of Ireland credit. Everybody in here talks about confusion. There was no confusion among the people when we brought in regulations to make mandatory the wearing of masks on public transport and in shops. As Taoiseach, I pushed hard to make that happen. The compliance rate is 90%. Last April, only 16% of people were wearing masks. That is the answer to the far right. I agree with most of what Deputy Barry said in terms of the far right. The Government has nothing to do with it. What those involved are doing is wrong.

Deputy Boyd Barrett raised the issue of the zero Covid strategy. That is not our position. We do not agree with that strategy.

It involves severe lockdowns and let us not pretend it does not. The acting Chief Medical Officer has been very clear that it is not his view or that of NPHET that it is a realistic approach or strategy. Our strategy is to live with Covid, keep people safe, protect health, maintain economic resilience and jobs and restore public services with regard to keeping schools, crèches and higher education institutions open. We are seeking to restore health services while considering quality of life issues around the arts and sports and trying to keep games and live performances going as best we can within the restrictions. We want to support community well-being on the ground as well as mental health, which is critical. That will increasingly become an issue as the pandemic continues and evolves.

Lab capacity is an issue with testing. The numbers in the plan are to have approximately 3,000 people employed for testing purposes, including swabbers, contact tracers and the many more people behind the scenes who help in the administration of the work. There is a clinical need for call one, giving people results, and public health authorities insist on that. I take Deputy Kelly's point, which I have made to the Health Service Executive, HSE, that we need a permanent workforce and that we should not redeploy from within. That is how the process started and we came from a very low base when the pandemic started. I consistently made the point and it is now happening, with recruitment under way, with more people coming to the contact tracing side in particular.

The plan has been elderly-proofed, as it were, and we respect the elderly as, arguably, these are the cohort of people who have adhered most to the guidelines issued by public health authorities. The advice from NPHET at this stage is to encourage people in Dublin not to travel outside Dublin if possible. That is what NPHET has said at this stage.

The differences between the Covid-19 and health committees are clear. The Covid-19 committee deals with all aspects of Covid-19, and that is why the Ministers for Finance and Public Expenditure and Reform attend the Covid-19 committee, along with the Minister for Health and ministerial advisers. It is exclusively about all aspects of Covid-19 and it would have co-ordinated the plan published today. The health committee deals with broader health matters, including the winter initiative, as well as screening, health capacity and so on.

What about the Covid-19 oversight group?

The Deputy stated "interests of private profit are allowed to interfere" but that would be the antithesis of what is envisaged. The oversight committee is to be headed by the Secretary General of the Department and it involves other Departments. This is to ensure the process is practical. I will give an example. There was a furore in the House when NPHET advised we should enforce a provision to allow people to enter people's homes to control the numbers in a household. Everybody opposed such a suggestion, saying that civil liberties were at risk. There must be some filtering of advice in terms of how we make it possible.

With a week to go to the opening of schools, there was advice out of the blue from NPHET that we should go ahead with public transport at 50% capacity. The Government could not accept that immediately, and it did not, but we said we would try to follow that advice over time. We had been working with public health authorities on protocols to bring children safely to schools, including the identification of seat numbers for kids and all that. There needs to be some fine-tuning of advice when it comes to the practical implementation of it. We must co-ordinate Departments to ensure they are linked with stakeholders.

I know it is unsatisfactory but we have gone way over time. We must move on to the final round of questions.

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