Matt Shanahan (Waterford, Independent) | Oireachtas source

We offer our condolences to family members who have been bereaved by Covid-19 and again give thanks to front-line healthcare workers and all those in the healthcare sector who are doing so much at this very difficult time. On 24 April in this House, the Minister expressed to me his wish to see the second Waterford cardiac cath lab built, with a construction tender to be awarded as soon as possible. Last Thursday in the House, the Taoiseach also committed to seeing this project get over the line while acknowledging the inordinate delay it has suffered since it was first announced on 18 September 2018. I thank both of them for their public commitment to this project. This development has suffered inexplicable delays since the Minister's original order to approve it. In fact, 20 months have elapsed and we have yet to approve a formal build tender for construction.

Given the inordinate, unexplained delays, on behalf of the people of Waterford and the south east, will the Minister provide Oireachtas Members from the south east a contact liaison within his Department concerning this project? The Department has circulated completely new timelines for this development and I believe elected representatives could provide support to ensure that further slippage in proposed delivery schedules are avoided. I believe everybody in the House understands the significant Covid pressures that are dominating health planning at present. Appointing a Department liaison available to Oireachtas Members from the south east would deliver enormous comfort to the people of Waterford and the region while we await the second cardiac catheterisation laboratory and the improved standard of regional care it will help to deliver.

I refer to other health matters relating to Covid risk and disease management. On 23 April, I asked in this House why senior nursing staff in residential care settings were not being tasked and trained to take Covid swab tests of residents in their care. I believe it is happening in a small number of centres, but clearly on-site staff managing that activity would help improve the turnaround times that are so critical to the safe running of residential care homes. It would also minimise the trauma to vulnerable patients by having invasive swab testing taken by people known to them. As well as taking patient duress into account, faster response times improve the management of isolation needs and possible staff shortages where self-isolation is required. Faster test times also reduce the Covid care burden protocols where a negative test result is found.

Can we agree that it should not take weeks of deep analysis to decide if we should let nurses nurse? I know that for some a small amount of training will be required, but I believe every qualified nurse working in residential long-stay and short-stay settings is more than capable of managing this task, and would be happy to do so as a proactive infection-control measure to safeguard the patients in their care.

I also highlight another significant headwind affecting the private nursing home sector. More than 100 small nursing homes are facing insurance renewals over the coming weeks and months. They have been advised that no business interruption cover or liability cover is on offer for anything Covid-19 related. Lack of liability cover is a major concern as these operations do not have the financial reserves to protect them against a significant Covid-related injury claim. Many of these homes are already losing revenue because they are keeping isolation capacity available. Allowing them to be further unsupported because of our dysfunctional insurance environment will force many to close their doors permanently. It would be ironic if Government action to save residential care lives could not be harnessed to support these same patients who are at risk of losing their present care facility and their quality of life because of insurable risks. I ask the Department to seriously look at this matter.

The Minister recently announced the creation of a Covid-19 nursing home review panel. The panel complement does not have a contributing member from the nursing home sector with recent direct and material experience of the challenges that befell nursing homes following the arrival of Covid-19. As I feel this is a lost opportunity to examine and fully understand the sectoral problems, I ask the Minister to consider the appointment of such a person to this review body.

As part of continuing NPHET Covid planning, the Department may wish to extend the private hospitals contract for a further period. I and other Members of the Regional Group are of the opinion that conditions and terms of this contract need to be reviewed and significantly revised before the Government commits to any further extension. Given the significant cost involved at €115 million per month, bed occupancy and service activity at private centres must be maximised where currently they are well below available capacity.

Although some elective procedures and day case services have been decanted from public hospitals to private hospital settings, these are largely being carried out by public doctors. This is because a significant number of clinicians, operating as private subcontractors in the private healthcare area, have found themselves presented with changed working conditions to which they cannot agree as they have no offer of recompense for the cost overheads they are forced to carry.

The private hospitals deal secures the facilities but not all the staff to provide the clinical services. These private consultants operate on a fee-per-procedure model, reimbursed by private health insurers, but since this contract was initiated, insurance fees have not been payable for such activity. This is having a significant effect on both public and private waiting lists as these doctors could be treating both hospital patient streams under the present arrangement if revised. As a member of the Regional Group, I ask the Minister that if he is minded to extend the private hospitals contract, he should sit down with the private health insurers, VHI, Irish Life and Laya Healthcare, to devise a new temporary service contract arrangement to include these subcontracting clinicians.

A new arrangement could ensure both our public and private patient streams can benefit from maximum participation of all medical care givers.

As we welcome the continuing phased release from required lockdown measures, many are cognisant of the possibility of a future upsurge in Covid infection rates and a possible increase in hospital activity. That said, it is fair to state we have learned a great deal about the transmission, management and mitigation options in respect of the disease. Hopefully that will guide us towards finding appropriate balanced strategies in the future. One analytical tool required for greater understanding of the impact of Covid is the publication of patient range data, by decade of life, for Covid infection rates and clinical outcomes. The data, purely for statistical analysis, should record just gender, age, care pathway and clinical outcome and would not create any issues in respect of data privilege. The information is needed to risk-assess future strategy. I ask the Minister to prevail on NPHET to publish these data to allow greater and wider analysis by our healthcare experts.

As we get further into 2020, society is coming to terms with living with Covid-19 while we wait for a scientific breakthrough to overcome this virus. We must begin to rebuild our shattered economy with specific attention on the small and medium-sized enterprise sector. Possession of these pertinent data will allow both public and private thought leaders contribute to best planning, mitigation and treatment strategies in the future. It will also allow for more effective public health policy planning and in so doing, hopefully will ensure we will have learned from some of the avoidable mistakes of the past and will have made adequate provision for the future.

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