Simon Harris (Wicklow, Fine Gael) | Oireachtas source

At the outset I just want to say that we will need to have a very serious conversation about the way we care for older people at the end of this pandemic. The Deputy is 100% correct that the current model is not fit for purpose. I would love to talk about that for longer; we do not have the time now but it is not fit for purpose.

On the issue of transparency, Deputy Shortall has been constructive throughout this. She is right in that we need to continue to put out as much information as possible. I am making the point that we are striving to do that. We have carried out 19,646 tests so far in Ireland. We are testing more per head of population than most countries and I believe people recognise that. We are consistently testing in the top five in Europe and in the highest quartile in the world. The demand at the moment is approximately 2,700 tests per day. The Deputy is right to point out that the figure represents suppressed demand because of the case definition. It is made up of approximately 1,200 from general practitioners per day and approximately 1,500 from hospitals, but it varies from day to day. I am saying this without making political commitments but the HSE chief executive told me as of today that the HSE expects to have laboratory capacity for 10,000 tests from next week. That is on foot of bringing on the German laboratory.

That represents progress but I want to - we all want to - focus on the turnaround time rather than the actual number. This is because some days we will need to do 10,000, some days it might be less while other days it might be far more. The turnaround is crucial. The question is whether we can test everyone that Dr. Tony Holohan would like to see tested. Can we test them quickly? Can we get the results quickly? Between now and the end of the week the HSE is doing a body of work - I welcome the fact that the HSE has appointed one person to co-ordinate end-to-end testing - to set turnaround targets for each of the three stages. The three stages are swabbing, laboratory testing and contact tracing. We need to re-engineer all three stages to enable a turnaround target to be set from end to end. We need to list any of the constraints that exist in the processes and remove them. Then those responsible will model the various volumes of testing and run through the process to assess robustness. Then, from next week, the national public health emergency team will alter the case definition. However, we need to line up capacity with the case definition so that we do not end up in the situation we ended up in on 18 March.

Deputy Shortall's first question related to nursing homes and the breakdown of figures. The categories that I have been given are nursing homes, community hospitals and residential settings. The details include 245 deaths in nursing homes, 28 in community hospitals and 17 in residential institutions. That comes to 290 tragic deaths. Our hearts and prayers are with all of them.

I am glad Deputy Shortall brought up the issue of clusters. I have been making this point for a long time but people are getting the wrong impression. If two people, for example, the Deputy and her husband or someone else, live at home and they both get Covid-19 and are doing well, they are still a cluster. However, that does not tell us much. That is very different from a situation involving an uncontrolled outbreak. The phrase "cluster" can be misleading. Up to 80% of us will get this virus in a mild manner, so the term can be misleading. I agree with the Deputy's point on the Health Protection Surveillance Centre data and the question of why we stop at 65 years and use 65+ from there upwards. I will follow that up with the HPSC.

The Deputy asked who makes the decisions, and this is an important point. The question related to who makes the decisions on what should happen in terms of the clinical care of a person. The decision is made by what is classified as the person in charge. The person in charge is meant to be a healthcare professional. The definition is outlined in the Health Act 2007 and the associated care and welfare of residents in designated centres regulations. I will send the details to the Deputy in writing in the interests of saving time. Following the terrible tragedy in Portlaoise, one thing I was pleased to hear was the confirmation this morning from Dr. Ní Bhriain that consultants from the local hospital were involved in the decision-making on whether people should move to hospital and that palliative care consultants were also provided. That has to be our obligation during this pandemic. It cannot be based on what setting a person is in. It is a question of how we care for the person whatever setting that person lives in. That is the approach we have to take.

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