Simon Harris (Wicklow, Fine Gael) | Oireachtas source

First, I will not make any partisan political comments. I used to be an awfully partisan politician and, really, this pandemic teaches one that everybody in this House in all parties and none is working their very best to save lives. That has been my experience of engagement with people here.

I think we are very lucky to have Dr. Tony Holohan, a public health specialist, as the Chief Medical Officer in our country. When he answered the Deputy's question on 12 March, of course he answered it entirely correctly, as a clinical expert, and I would rather he made the decisions than politicians. I think the public would too. He pointed out that the case definition provided by the World Health Organization that is being applied here is that we test people when they have two or more symptoms. I think it is fever and a respiratory condition. Given the definition, if a person working with an older person has the symptoms, of course he or she would get tested, but the definition at the moment does not allow for asymptomatic testing.

In fairness, the point Deputy Smith raises is a legitimate one, that is, as we broaden the testing whether we should be trying to test more people, in particular those coming into contact with vulnerable people and particularly vulnerable people. The short answer to that is "Yes" but that broadening of the case definition will be decided by clinicians at the national public health emergency team rather than by me or, respectfully, on the floor of this House. I expect the case definition to be broadened next week in line with the comments I made to Deputy Shortall. I agree 100% with the Deputy on the idea that we cannot allow a viewpoint to fester in any way that somebody who is in a private nursing home is not our responsibility. They are a citizen of this country. They are at particular risk to this virus. This is a virus that we cannot beat and stop in every circumstance but we can do everything humanly possible to protect as many lives as possible and we will not be found wanting in that regard. I know people working in HIQA and the HSE, public healthcare staff and nursing home staff will not be found wanting either.

For reassurance, I need to make the point that while 70% or thereabouts of nursing homes, according to HIQA are still Covid-19 free today or do not have significant outbreaks, 30% do. We deploy different strategies for those ones. For the 30% that do, we try to mitigate, help and support, and for the 70% that do not, we try to keep them Covid-19 free. Some of the comments I made recently about trying to test asymptomatic people, providing isolation facilities where appropriate for staff or for patients, and beefing up staffing through the redeployment agreement with the unions, who have been super, are some of the ways that is achieved.

I am pleased the Deputy brought up the hospitalisation of older people because it gives me a chance, which I think is what Deputy Smith wants, to put on the record of this House some clarity in that regard. These are clinical decisions. We have loads of empty beds. We have never had so many empty beds in the health service. We have ICU capacity. The health service is open for patients and there is no bar in terms of age or disability, as I have heard in recent days. Clinical decisions are made in nursing homes. The principle of the right care in the right place at the right time applies. I will not go into an individual case but it is about individual clinical reviews deciding if a hospital transfer is appropriate, talking to the resident about his or her wishes, and talking to the family and deciding if they want palliative care. People may have advance care planning in place too. These are clinical decisions and they should not be made by anybody who is not a clinician. Person-in-charge regulations for nursing homes make it clear that it should be a person with clinical training. People should not be worried or fearful in that regard, but I accept they are. If an older person needs to go to hospital he or she should be brought to hospital. I am conscious that many families and individuals are having these discussions too.

I very much welcome the fact that the coroner wrote that letter because we want to find as many cases as possible. The intention is not to suppress numbers. The more cases of the virus we can find and, sadly, the more fatalities we can find, the more we will know about it and the more we can deal with it. I am satisfied that we are reporting an awful lot more in this country than in other jurisdictions but we need to continue to strive to do as best we can. From memory, I note that the coroner did also say that she detected a very high level of reporting, but she is right and proper to be vigilant in the discharge of her duties.

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