Alan Kelly (Tipperary, Labour) | Oireachtas source

Given her County Tipperary genealogy, I welcome Deputy McDonald back to the House and wish her well.

Since we met last week, 4,124 people have been diagnosed with Covid-19 and, sadly, a further 337 have passed away. Our thoughts are with the families and loved ones of those who have passed away and we wish all of those who have been diagnosed with the virus a speedy recovery. I think, in particular, of my friend and neighbour, Kieran Maguire, who lost his life in the past few days. I think of his family at this time.

We are in the middle of the biggest public health crisis that the State has ever faced.

I wish to preface what I am about to say by thanking everyone in this crisis who is working hard across government, the National Public Health Emergency Team, NPHET, the HSE and society all the way down to, for example, retail workers in shops. I greatly admire them, as I know we all do. They are all heroes in our battle and we truly cherish them.

However, I am concerned about the transparency in decision making. I wish to concentrate on this matter. When the crisis broke, our party stood alone in asking for an Oireachtas all-party committee to ensure accountability and transparency. It did not happen and was dismissed by many in the House. Seven weeks later, I now correctly hear talk across politics of the lack of democratic accountability and transparency. The process that the Dáil is going through right now does not negate that fact.

I wish to ask about governance during the crisis and how decisions are being made. NPHET was convened by the Taoiseach on 27 January for Covid-19. It was previously convened in 2019 to deal with the carbapenemase producing enterobacteriaceae, CPE, superbugs. Interestingly, the terms of reference that time were significantly longer and more detailed compared with the Covid-19 crisis, which is ironic.

A Cabinet sub-committee has been set up by the Government to manage this crisis. It is serviced by a senior officers group and a communications subgroup. That leads to NPHET, which includes an expert advisory group and has 11 subgroups ranging from acute hospital preparedness, behavioural change and so on.

I looked up NPHET's membership. It seems to have grown substantially since it was established. Did the Government agree to all the new members and, if so, where is that documented? If not, who appoints NPHET's members? Is it a case of the chair or other members deciding what public health officials and others are to be invited to the group? What is the process for approving new members? For example, the third or fourth meeting note, entitled "Expansion of NPHET Membership", in minutes from, I believe, two months ago reads: "It was agreed to expand the membership of the team to include a general practitioner, an intensive care specialist and an infectious diseases consultant and invites will issue to join the meeting on Tuesday next, 3rd April 2020." Obviously, nursing homes were not included. How was one member picked over another? Who made those decisions?

Interestingly, only notes of meetings are recorded. Are these actual minutes, and if not, why not? There is a big difference. Minutes reflect the record of the meeting and must be agreed at the beginning of the next meeting. Notes could be a subjective view of what happened. Were all these notes agreed by the participants after each meeting? Future generations will want to know, and deserve to know, where people stood on decisions, but this is not transparent. Why are notes or minutes no longer being published since the end of March? I have searched and searched everywhere. The group meets twice weekly, but there are no minutes. We cannot see how decisions are being taken. This is not acceptable.

There is a large number of people on the committee now, yet no disagreements on any decision have been documented. That is noteworthy. This is something that each member should consider, given that all decisions will undergo historical review at some stage. The issues arising in the nursing home sector are the most obvious example.

In the last published meeting note, dating from 31 March, NPHET discussed the paper on childcare for healthcare workers. The note does not say why the paper was not agreed and does not transparently say what decision was made. The Government is still grappling with this issue, yet we cannot see why the paper, which the Minister for Health showed me six weeks ago, has still not got through.

How many subgroups are there in NPHET? Eleven are listed in the national action plan, but no minutes have been published for nearly any of them.

What are they doing? Can we see the minutes? Are there minutes? Will all of the market research and survey data from the communications subgroup be published? Who sits on the subgroup? It is referenced a number of times in the few sets of minutes we have but I would like to know what it is doing. Why, unusually, do the Secretary General of the Department of Health or director general of the HSE not attend? I would have thought they would be intrinsic members of the committee. What happens if either or both disagree with a decision?

A number of weeks ago, when the chief medical officer made the decision to set a target of 15,000 tests a day and 100,000 a week by 5 May, which the Taoiseach referenced earlier, the Minister, Deputy Harris, said he expected it within days. We will, however, stick to 5 May. Did the chief medical officer, through NPHET, do so with the agreement of the HSE, which is ultimately responsible for making such a testing regime possible in such a short space of time? I agree with it, by the way, but I am not certain, and I believe the Taoiseach is in the same position, that it can be delivered. Why was a decision made to announce this if the HSE did not believe it could deliver it? Of course, we cannot see this because there are no minutes.

Has the HSE or its board communicated in any way with the Taoiseach, the Government, the Minister for Health or the Department of Health regarding its concerns about overall governance of decision-making in this crisis? If so, will the Taoiseach tell us about it or publish any such communication?

To whom is NPHET ultimately accountable on a day-to-day basis? I understand it advises the Government. Who makes the final decisions? Must NPHET consult the Taoiseach or Minister for Health before making formal daily announcements that affect all of our citizens? I presume it does so and the Taoiseach might tell us how.

I want to make sure we have democratic accountability and scrutiny. To date, I and all of us in the House have fully trusted everyone, and continue to do so, but the lack of information on processes and decision-making, as I have just outlined, means I have to ask these questions on behalf of the public. Ultimate decision-making cannot be in the hands of the few. Elected office cannot be subservient in this crisis. We have to heed public health advice - this is absolute - but we also need to make sure that the formulas for providing this critical public health advice are working, robust and, most importantly, transparent. I trust the Taoiseach's belief they are working but they are certainly not transparent.

I say all of this today as we look to chart a roadmap out of the crisis. As I said last week, it is a roadmap that ultimately must be decided by the Taoiseach and the Government but shaped by the Chamber. The kite flying and mixed messages, which we had from the Taoiseach and Minister for Health last weekend, must end. The Taoiseach must remember that absolutely everybody in the country is hanging on his every word and pronouncement. The roadmap must take full cognisance of NPHET's views on Covid-19. However, critically it must also take cognisance of wider health concerns. We have huge evidence that participation in normal health procedures is substantially down and, I might add, screening is non-existent. This will, no doubt, result in secondary effects, with some of the population having negative health outcomes and loss of life resulting.

The roadmap must also consider wider public concerns, health concerns and social and economic concerns that have a wider impact on the health of our people and the future of our country. It must be holistic and this may mean on occasion the Taoiseach and the Government balancing decisions in a way they have not done to this point. I wish them well in doing so.

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