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

I will certainly seek advice from the National Public Health Emergency Team, NPHET, on mayfly fishing. The issue of solitary fishing in general - people fishing on a local lake or river on their own - has come up on a number occasions. It is something that I will seek advice on.

Deputy Harkin mentioned the issue of domestic violence. There is a concern at present that the fact that people are at home so much more than they would normally be poses a real risk of an increase in both domestic violence and child abuse. That is something we are most aware of. Everyone can understand the concerns. It is something the Government is attuned to. In terms of domestic violence, there are two new women's refuges that have opened in recent months, in Galway and in Dublin. However, the north west is an obvious and gapping gap in the provision of domestic refuges for women and I hope that is something we can sort out sooner rather than later. In the meantime, hotel accommodation can be used. I do not see why rent supplement could not be used, and I will get that checked out. That is a good suggestion.

In terms of the pay agreement with the nursing unions, I have seen reports in the media about that but I will get that checked out this week. The pay increases that were agreed with the nursing unions are linked to a new contract, reforms and the adoption of more modern work practices in the interests of patients and taxpayers. There is a linkage. However, I believe that public bodies should honour the agreement, as unions should.

On the issue of the capacity in hospitals, our private hospitals are 33% occupied, our public hospitals approximately 80% occupied, our intensive care units, ICUs, approximately half-occupied and Citywest largely unoccupied. That is not necessarily bad. The reason that is the case is because we wanted to be prepared to make sure that our hospitals and ICUs were not overwhelmed the way those in other countries were. It is good that we had such spare capacity. We may need it yet. This could yet go wrong. I would not like us to make the mistake of relinquishing that capacity only to find out in a few months' time or over the winter that we really need it. It is possible over the next couple of weeks to use some of that capacity to bring back online some elective healthcare treatments and other interventions that should be happening but we need to be wise about it. We would all like to see more orthopaedic operations starting again but some of those operations can take up an ICU bed for 12 days and the position can change quickly in 12 days when it comes to this virus. We need to be smart about that. It is not bad that we have spare capacity in the health service. It is an unusual experience in Ireland, not necessarily bad. We should retain some spare capacity for as long as we can.

Deputy Eamon Ryan spoke eloquently on the issue of nursing homes, which have been badly affected. That is extremely sad and tragic. We see across Europe between 40% and 60% of all deaths are occurring to people who had been residents in nursing homes. If one thinks about it, a nursing home is really one big household with many staff coming in and out and it is hard to keep the virus out. Once it gets in, it is easy for it to spread. If we were to cocoon people in nursing homes the way we have at home, one would essentially, as Professor McConkey pointed out, have to put the nursing home into lockdown and have the staff stay overnight and not see their own families. That would be extremely difficult, and possibly impossible, to do. It raises questions for the future as to what our nursing home and elder care models should be. I think we all agree that we need much more investment in homecare so that fewer people must go to nursing homes as early as they do. The Government was able to increase funding for homecare by 40%. I doubt the next Government will have that kind of money and we will have to come up with a new model for funding homecare to make sure that it is an option for more people for longer. What we have been doing for a long time is moving towards much more modern nursing homes, replacing nursing homes with 150 or 200 bed, single-room occupancy nursing homes. Maybe that was not the right answer.

We have seen some outbreaks happen in some of the most modern nursing homes, places like St. Mary's Hospital in the Phoenix Park, a facility with almost all modern buildings and single or double rooms that is under public control, linked with the Mater Hospital and with consultants on site. Maybe we need to consider a different model, something similar to what we have done in the disability sector, with people placed in houses of three, four or five rather than big nursing homes of 150, even if they are all single rooms. Maybe I am wrong, but that is the kind of thing we are going to have to think about.

The other issue is that of clinical governance. The view until now has been that everyone who is a resident of a nursing home is a resident and should be allowed to have the GP of his or her choice. The effect of this has been that a nursing home of 120 or 130 residents could have 20 or 30 different GPs but no one person who is in charge as a medical director. There is a person in charge but that person is not a medical person. We have a lot to think about across Europe about the future of nursing care and nursing home care as a consequence of this.

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