David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I want to make a quick point on immunocompromised people. For many of them, March 2020 is still their lived reality. We need to look at a combination of therapeutic tools in order that we can support them. There are ongoing issues in the context of antiviral medications, medicines and so on. This is important because while the rest of us can get back to some level of normality, that is not the case for many of those people. It is a very frightening problem for them to have to battle with on a daily basis. When one considers the mix of flu, RSV and Covid in the community, one realise that these are the people who are most at risk. We need to do everything possible, where we can, using all of the necessary tools to support those who are immunocompromised.

Mr. McCallion inadvertently hit the nail on the head earlier regarding some of the problems we have. In responding to questions on the decision to activate the NCMT on 22 December and the additional escalation crisis-management measures that were put in place, he correctly stated that we have to be careful when using such measures because they are only to be used in the short term. He said that these are time-bound actions because we cannot expect staff to work the levels of overtime we are asking them to work on a continuous basis. We cannot cancel elective procedures forever. There are other time-bound measures that are not possible to do on an ongoing basis. The problem is that we actually need to have those measures in place for longer. That is the problem. The reasons we have to adopt these measures is because of all the capacity issues. Rather than depending on the crisis management responses - and then having to make the toughest of decisions as to when we activate them - what level of crisis needs to exist before we can make these additional interventions, we need to understand why they are needed?

Mr. Mulvany said we can learn lessons from the additional measures that were put in place and from what worked more effectively. I do not think there is a silver bullet here. Nothing will come from the past number of weeks that we do not already know. When there is a surge in demand, we do not have enough beds or staff, we do not have the diagnostic capacity in hospitals and we do not, despite what Dr. Henry stated about the community interventions, supports and multidisciplinary teams that are there to support older people, have the care in the community. That is true to an extent, but some of those beds that are in place are not fully staffed. For many people, we are not delivering the right care, in the right place, at the right time because we do not have enough of what is needed. All these things are going wrong at the same time. I would argue that rather than concentrating on when we should use those very serious, additional escalation measures, we should get to a point where we do not need to use them. We will get to that point by putting the necessary capacity in place.

Earlier, I asked Mr. Mulvany about the three-year plan for emergency departments and unscheduled care. The worst thing we could do is go off and develop another plan that would operate in splendid isolation from everything else. At this stage, we should know that there is a direct relationship between community services and people who cannot get access to GP care or a community pharmacist and people with chronic conditions who are not being cared for in the community; they end up in emergency departments. We talked about admission avoidance earlier. That has to be part of this. I would argue that if whatever plan is put forward involves a silo when it comes to acute hospitals, that would be a mistake. I hope it will be a plan that has community and primary care at its core, because that is what these regional health areas will do.

I have several questions arising from the earlier discussion. I mentioned the emergency department task force that only met twice. Is it the case that this crisis management team does not have trade union or representative bodies on it?