Matt Shanahan (Waterford, Independent) | Oireachtas source

I congratulate the Minister of State for progressing this legislation which was a commitment in the programme for Government. It is very welcome, particularly for rural communities, farm families and people with businesses. The fair deal scheme has been successful, very important and vital in providing community care settings for people. As the Minister of State knows, the scheme has been criticised in the past for the difficulties with qualifying and the numbers that are on it.

It is a sad demographic fact that our country's population is ageing and the care burden is going to increase. What is also salutary for all of us to consider is that family sizes are getting smaller. It would traditionally have been recognised that the care for elderly parents would have fallen to sons and daughters. They might have shared that burden and indeed do every day but there are fewer of those coming through and the burden of care is getting greater. Also we are living longer, thankfully, but that means we have different needs at different stages and later in life. Therefore, we must look to try to enhance community care, elderly care and residential care. That also extends right across the other spectrums of population that are implicated in that, particularly the disability sector.

As I said, I welcome this legislation and hope it will go on to improve things but it cannot go far enough in trying to expand it. It is also the case that every sector of the economy, particularly every sector providing a public service, is looking for more money, and there is not endless money. We therefore need to prioritise where money should be spent. We must also create efficiencies in public service spending. That is an area where we have probably taken our eye off the ball in this last year of crisis. Certainly, at the end of this crisis we will face very significant challenges to the Exchequer and public payroll. We are going to have to really get down to the minutiae of how we are spending our money and what we are getting for that spend.

It is also the case that people would like to stay living at home for longer, where possible. I hope the Minister of State will look at this again and particularly at new technologies. There are a lot of new technologies that are allowing people to carry on living at home for as long as possible. I know of very few people who would be rushing into nursing homes if their quality of life was such that they could remain in their own place. Most of us would like to remain in our own place as long as we possibly can. We can see now where technological advancement is going, particularly with home monitoring systems, which have revolutionised the care of people at home. I am aware of this in rural areas of County Waterford. Relatives of mine have been facilitated to spend longer in their homes because of home monitoring systems and these should be looked at. I know there are grants available for those who are challenged but again, we should look at spending more money in this area rather than trying to divert people into community settings, where their care costs much more.

In the context of Covid, I raise the reaction of both the public and private sectors with respect to community care of the elderly and people with disabilities. When it came into the country, the main danger of Covid was that it was targeting the elderly. I will not rehash the problems we had with elderly people perhaps finding themselves in settings where they were at risk. I want to give a special shout-out to the health service in general, and those in residential care settings in particular, for the Trojan work they have done over the past 12 months and that they continue to do. With that in mind, last year the Government announced it would give a temporary assistance scheme to nursing homes, particularly private ones - nearly 80% of the burden falls on them - to support them with costs. That was done at the outset to provide, in the main, for PPE. It also went into creating isolation space and also with recruitment. Those challenges have probably abated somewhat but the money is very much required. At present we are operating visiting guidelines within the nursing homes and they are being facilitated by the temporary payments because people have been brought on to act as visiting co-ordinators. This is because we are trying to check whether visitors are vaccinated and to determine what setting the residents are going to see them in, be it in the resident's room as per the protocol, or perhaps outdoors. We need people to manage all that. I understand this scheme is due to finish. Has the Government thought about that or how it is going to support nursing homes to continue these protocols without that money?

The other thing that has been going on for quite some time is the HSE and Health and Safety Authority, HSA, were doing screening testing where outbreaks occurred. Again, I understand that is to be stood down soon. Essentially, the HSE has taken a position that where 80% of staff are vaccinated, this testing will finish. We must be mindful that we have vulnerable people there. Happily, we have done very well on the vaccination front, especially with the elderly. Everybody in those settings should now be vaccinated but one imagines there may still be a risk, perhaps with temporary staff cycling through those settings, where someone may carry an infection from one facility to another.

I ask the Minister of State to look again at that money.

Beyond that I will mention the existing supports. I was a member of the Special Committee on Covid-19 Response and the question of nursing homes and congregated settings came up quite a bit. There was a massive bias on the committee at times in favour of public nursing homes as opposed to private operations. Private nursing homes were often presented as being purely for profit, which is not a fair representation. I know many people in the private nursing home business and they are excellent carers of elderly people.

In the private care setting there are people who get €1,000 per week in support but in public settings those supports can go up to €1,500, €1,700 or €2,000 per week. In providing exactly the same care, there is a difference in the country as we support public costs more than private. As I stated, nearly 80% of the care in the sector is provided by private operations. That does not make sense to me and tells me there is inequity that should be looked at. It is very hard to stomach talking about the lack of adequate care in the private sector if we are going to pay them 50% less for doing the same job. That is something that must be considered.

The Minister of State is aware of the expert review panel convened to look at concerns in nursing care. There were 84 recommendations made in that report and perhaps the Minister of State will return to the House at some point to provide an update on where those recommendations are now and on the number that have been implemented?

Another matter topical in the media for some time is rapid testing. I am on record as saying I brought the idea of rapid antigen testing to the National Public Health Emergency Team, NPHET, in May 2020 but to date we still have not implemented antigen testing. A recent debacle saw a senior person in NPHET describing rapid antigen testing, which is approved by the US Centers for Disease Control and Prevention, as "snake oil". That is more than regrettable and it also demonstrates a medical bias.

In the past 14 months of the Covid-19 pandemic, I have engaged with senior specialists, some of whom were using antigen testing informally in hospitals to try to guide Covid-19 pathways in their hospitals because there were not sufficient beds. Those doctors were more than happy to use the test and reported 100% success in identifying people in danger of transmitting the disease. Nonetheless, the HSE still appears, under NPHET guidance, to have taken advice that it will not use antigen testing, or it is at least very slow in adopting it.

I know the Minister, Deputy Donnelly, when he participated in the proceedings of the Covid-19 committee, supported rapid testing. He has probably moved base slightly in the past few weeks. I heard Dr. Holohan describing the Cochrane report as saying antigen tests are effective only 50% of the time but that is absolutely not the case and it depends on what is being measured. They are effective 100% of the time when detecting transmission levels or when a person is in danger of transmitting Covid-19.

In this country we are now trying to figure out how to open the economy and get aviation operating in some way in the country. We have a proven test, and in America testing has been done on more than 300,000 antigen processes, with the rate of false positives at one in 10,000. The rate of not detecting virus at a high load was zero. Nonetheless, we are still trying to figure out how we are going to do this.

Professor Mark Ferguson from Science Foundation Ireland undertook a report on antigen testing at the behest of the Tánaiste and the request for such a process to be introduced. He was asked how many Departments engaged with him but only one did so, which was the Department of Further and Higher Education, Research, Innovation and Science. The Minister, Deputy Simon Harris, was looking at the possibility of using antigen testing for the back end of the year and the reconvening of universities. On top of this legislation I ask the Minister of State to go back to the Department and consider the matter again.

Another question raised recently at the health committee was vitamin D supplementation. There is a large body of international evidence suggesting the major benefits that can be found by supplementing vitamin D, but this does not happen overnight. Most of us in this country are low in vitamin D levels because we live in northern latitudes and none of is outside enough. Perhaps from now on we might get adequate sunshine to generate vitamin D but we have not had that up to now so we should have this supplement. It is a very cheap fix for many problems and it is well regarded and known to benefit immune supports over years.

I have spoken with a number of doctors who have used vitamin D deficiency as a marker in determining patients who could have adverse outcomes from Covid-19. Some of those doctors gave a presentation to the health committee and, to be fair, that committee produced a very substantial report on the benefits of vitamin D. Despite that, we cannot get NPHET to make any public pronouncements that people in general in the country should have these supplements. It is a cheap process and it is a small number of people in different patient cohorts who need to watch their vitamin D levels. They can do that in conjunction with GPs. The levels being spoken about for the majority of the population are in no way dangerous and could be beneficial.

Not alone has the message not got out but it has been obstructed, like the message on antigen testing. That has been obstructed by NPHET and I do not know why. I have said many times before on record in this House and in committee rooms that the test is used widely everywhere. We must seriously consider how to revive the economy. I am thankful we are making good progress on the vaccination front but we will still need rapid testing and ways to test in case of future outbreaks, potentially of variants. Antigen tests will play a part in that. Will the Minister of State take back that message to the senior health officials, including those in NPHET? They are not listening to me and do not seem to be listening to the wide body of science or other medical opinion outside of what is in their own think tank. That has been a problem for some time.

I congratulate and say "well done" to the Minister of State on the legislation. I welcome it.

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