Mr. Paul Reid:

I thank the committee for the invitation to come before it. I am joined by my colleagues, Ms Anne O’Connor, chief operations officer; Dr. Colm Henry, chief clinical officer; Dr. John Cuddihy, interim director of the Health Protection Surveillance Centre, and Ms Niamh O'Beirne, national lead for testing and tracing.

Over the past few months, we have focused on restoring services that had either reduced or suspended activity following the NPHET decision of 27 March. The HSE winter plan, launched on 24 September, aims to ensure that our health service is prepared for these expected pressures while delivering services in the context of the continued presence of Covid-19. It is increasingly evident that we can expect, and should therefore plan for, subsequent waves of Covid.

A community first approach to the delivery of care will be central to delivering safe, efficient and effective services through winter and beyond. While service delivery will be reorientated towards general practice and primary care services, we are making substantial investment in our community and acute services, including additional home support and enhanced home support packages, community healthcare networks and community specialist teams, GP diagnostics, community based rehabilitation and step-down beds, and acute bed capacity.

By implementing this plan, we aim to support people to receive care at home or close to home, particularly older people and those with chronic diseases, and to enhance patient flow and patient experience in our acute hospitals.

Public health expertise is centrally important in leading the flu vaccination programme, advising on infection prevention and control in acute and residential settings and, crucially, in the identification, management and suppression of outbreaks. The first deliveries of influenza vaccines to GPs, pharmacists and nursing homes started on 17 September. All shipments are expected to be delivered before the end of October. We secured sufficient doses to vaccinate all of the at-risk groups. This winter, the vaccine will be offered to children aged between two and 12 years, delivered as a nasal spray, and will be available from GPs and pharmacists from this week.

A difficult winter season, coupled with a resurgence in Covid, is the worst possible scenario for our health services. While this is an eventuality that we hope to avoid, it is also a scenario for which we have been carefully planning. The HSE board and I acknowledge that the Government has committed significant resources to our winter plan to support us in managing the extremely challenging period ahead. The winter plan and our testing and tracing model endorsed by the HSE board on 25 September are two major components of our overall pandemic plan for the health services. Funding of the pandemic plan will be considered by Government as part of the Estimates process.

On testing and tracing, it is important to emphasise that we are meeting all testing demand. We will continue to modulate all aspects of our response to Covid and to size our testing and tracing operation appropriately, relative to that demand. Ireland is one of a few countries which automatically test close contacts and we conduct serial testing. We are among the highest ranked in Europe on testing per 1 million of population, having done more testing than Germany, France, Norway, Italy, etc.

In terms of surge, we have increased our domestic laboratory capacity from about 70,000 samples per week to over 100,000 per week. We are also fortunate to have additional surge capacity of 2,000 per day provided by our German laboratory partner. In order to speed up test notification periods we are also looking at additional equipment, robots and process methodologies to increase our domestic testing capacity and turnaround. To date, we have completed well over 1.12 million tests and last week we recorded 87,940 tests. Our highest weekly test figure has been 90,000. Last week, we completed over 15,381 contact tracing calls, our highest number to date. The median end-to-end turnaround time in community settings over the past seven days is two days and 90% of people tested in the community received their result within this timeframe.

For community tests we have a median of 1.2 days from swab taken to laboratory result communicated. We continue to improve turnaround times using IT-enabled processes and increased staffing and swabbing capacity. Transition to a more permanent model for testing and tracing is under way. Recruitment is ongoing, as is engagement with our stakeholders. We are also looking at better system automation and integration. It is important to re-emphasise that although testing and tracing is a key tool to protect against transmission of the virus, the primary line of defence is the public health measures that we must all take, all of the time. Admissions to hospital are definitely rising, with 108 patients admitted to hospital with Covid-19 - the figure is 114 this morning - and there are 17 confirmed cases in ICU. The age profile of patients that has characterised the resurgence in the disease has been lower, but that will change unless community transmission is controlled.

Finally, even with a vaccine, the reality is that we will be dealing with Covid for a long time yet. We must all adapt the way we live our lives through a combination of behavioural, societal and healthcare delivery changes. The HSE needs a functioning society and economy in order to thrive. Healthcare staff also know this and they continue each day to rise to the challenge. The response of our staff to Covid-19 has been truly extraordinary and we owe them a huge debt of gratitude. It is crucially important that we continue to support them in the months ahead. The best way to do that is to commit, every day, to supporting and following public health advice.