Mr. Paul Reid:

I thank the Deputy. I will reply to some of the questions and then call on some of my colleagues. I will be brief going through them to allow my colleagues make some comments also. First, in terms of nursing homes, I will make some general comments. We have said repeatedly that this is a novel virus and as it has spread across Europe, every country is learning about it. We, too, have been learning in terms of how it can spread, particularly in a congregated setting and among a vulnerable group. While we have been aware previously of symptomatic patients, what we have seen in the past few weeks of this pandemic in Ireland is that many in the more vulnerable and elderly population can be asymptomatic, thereby allowing the virus to spread within nursing home settings. We have had to learn from very different symptoms and, in some cases, no symptoms being shown.

On the specific question about testing and nursing homes, we have completed a very significant testing process throughout all of the long-term residential care areas. We have completed all of the nursing homes, both public and private, the mental health facilities and we are well advanced in the disability sector also. A very significant programme has been undertaken by our community and national ambulance services.

We are currently getting some guidance from our public health lead in the country who is developing a strategy that will be recommended to NPHET shortly. That will set out our entire testing process looking ahead to the coming weeks, both in terms of long-term residential care settings and other vulnerable groups and areas of people we would proactively test. That will be part of the recommendations that will go to NPHET. I might ask Dr. Colm Henry to make a couple of comments on that issue.

The second question related to the transfer of elderly patients from acute settings to nursing home settings. As I said in my opening statement, we should cast our minds back to the start of this pandemic. The experience, particularly across Europe, was that a massive surge had impacted hospital and acute settings. Where we needed to provide massive supports also was in acute settings. We would have had an ongoing process of what we would call delayed transfers of care where people are deemed clinically fit and not suitable to be in an acute hospital setting for the transfer of those patients, and in most cases elderly patients, out of that care. That is a process we would have done, and that was the right thing to do at the point in time of doing it.

Third, on the PPE and supply generally to nursing homes overall, as we said a couple of times, this is a very different way for the HSE to work completely with the private nursing homes to the way and extent we have done in the past few weeks. The supports we have put in have ranged from, in some cases, a very significant number of staff. More than 450 staff are now redeployed across long-term residential care settings, including private nursing homes. We have another range of supports in terms of clinical specialists including geriatricians who would go in. Generally, we have multidisciplinary teams who would go in and give advice around infection control. Where outbreaks have taken place, our public health teams have gone in directly to those locations, including private nursing homes, and obviously the State-funded support scheme for private nursing homes has been part of that. We would have put in a range of supports, including PPE. I would make the point briefly that in the past few weeks the vast majority of our PPE has been distributed not to our acute settings but to long-term care settings, primarily nursing homes and, increasingly, home supports.

I will make two brief comments and I will then ask my colleague, Dr. Colm Henry, to comment on screening services. We are anxious to get back to non-Covid levels of service in many of our services, in particular screening services. This will be a very difficult period because we have to restore some of our services in a way that protects the public. Nobody will thank us if we restore services in a way that means we see public health outbreaks of the virus. It is a big challenge to get back to previous levels of services, particularly in cancer treatment. I repeat that if people have symptoms or feel they have symptoms, the clinical pathway is to definitely go back to their GP. Referrals are still taking place for support for people with symptoms. Restoring screening services is one area that Dr. Colm Henry is leading on with my colleague, Ms Anne O'Connor. They will come back with recommendations on how we can restore the range of services in a way that is safe for the public.

I will ask Ms O'Connor to comment on masks but I will make a brief comment to give some context. The NPHET definition on the wearing of masks by homecare workers has changed. During this pandemic, we have been distributing approximately 200,000 masks per week to healthcare workers. Now that the definition has been extended to all healthcare workers, that figure has gone up and we are now distributing 1.2 million masks per week to healthcare workers across a range of settings, extending far beyond the HSE. I will ask Dr. Colm Henry to comment on screening and Ms O'Connor to speak briefly as well.