Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

I will answer as many of those questions as I can in the time allowed.

The matter of nursing homes and care homes is the burning, pressing issue at the moment and was the focus of this morning's meeting of the Cabinet sub-committee on Covid-19. That sub-committee, which was established over a month ago and is chaired by me, is the task force by which the crucial decisions are made on how we deal with this crisis. As the Deputy identified, a month ago there was huge concern about our hospitals and ICUs becoming overwhelmed, and about there being a shortage of ventilators. That has not happened - at least not yet - due, in many ways, to the public health measures that were put in place and the co-operation of the Irish people in flattening the curve. I thank them once again for that co-operation.

Today, the front line of this emergency is not just in our hospitals but also in our nursing homes and long-term care homes - public, private and voluntary alike. In some countries, nursing homes and care homes have been described as the forgotten front line. We need to ensure they are not the forgotten front line in this country, and they will not. They are very much at the front of our minds and actions at the moment. The kinds of things being done to shore up our nursing homes include a package of financial supports; additional PPE; more testing; extra staff, including staff being redeployed from other sectors of the health service; and the provision of expert advice on infection control. That is all happening, albeit not as much or as quickly as we would like. That is just a refection of the scale of the crisis and the amount that needs to be done by a relatively small number of people, who are being asked to do an awful lot.

We need to remember that this virus is in our community. Nursing homes and long-term care facilities are part of our community, and once in the community, the virus targets those who are old, infirm or have underlying medical conditions. For that reason, it is going to exact a significant toll on our nursing home population and the people who live there, as well as in long-term care residential settings. It is our job to make sure we minimise and reduce that toll and impact as much as we possibly can, by doing everything we can. This is a feature across Europe and the western world.

The latest figures show that just under 70% of deaths are occurring in hospitals, and around 30% or 35% in the community. However, many people move from nursing homes to hospitals when they get sick and subsequently die there.

The issue of congregated settings, such as nursing homes, homeless shelters, direct provision accommodation centres, and long-term care residential centres, has been always either on the agenda or been a topic for discussion since the Cabinet sub-committee was set up, and certainly since I have been chairing its meetings. The risks associated with such settings were identified early on, as were ICU capacity, the risk of infections spreading in schools, and travel controls. Identifying a risk is easy, but acting to mitigate it is much more difficult, and this is a very challenging issue. It was a topic for discussion at meetings of the national public health emergency team, NPHET, long before the Cabinet sub-committee was set up.

As the Deputy pointed out, our nursing homes are a mix of public, private, and voluntary. We have trouble in both the public ones and the private ones. I have seen no evidence as of yet that cases are more common in private homes over public ones orvice versa, or that the death rate is higher or lower in either. We need to be careful and responsible in our remarks on this issue because there are people in care homes and nursing homes who are really worried now. They are terrified about getting this virus, their relatives are terrified for them, and we need to be responsible in our commentary around this issue. People in nursing homes and long-term care homes are doing the best they can, but even with copious PPE, good staffing levels and doing all the right things, once a virus gets into such a setting it is very difficult to contain it.

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