Frank Feighan (Sligo-Leitrim, Fine Gael) | Oireachtas source

I welcome the opportunity to discuss long Covid health services and I thank the Deputies for tabling this Private Members’ motion. I am responding to the motion on behalf of the Minister for Health, Deputy Stephen Donnelly, and the Government. I am aware that long Covid is having a devastating effect on people. The Minister for Health, the Government and myself are committed to ensuring that care is in place for those who need it. Some €2.2 million was allocated for 2022 to put in place a service to support those with long Covid. Budget 2023 will facilitate an overall investment of an additional €6.6 million next year for the further development of long Covid services to ensure a full national service is in place.

As Deputies will be aware, Covid-19 is still a new disease and, therefore, information on it, its features and its course are still emerging. The natural history, clinical course and consequences of Covid-19 are still not completely understood, although a lot of work is under way nationally and international to improve our understanding. Fortunately, most people with Covid-19 recover well, but a proportion of people report ongoing health issues. Long Covid includes a wide range of persistent or new symptoms that develop after infection with Covid-19. To aid recognition and management of those affected, the WHO, through a global consensus process, proposed a working clinical case definition. The WHO defines long Covid as occurring within three months of the onset of Covid-19, with symptoms that last for at least two months and cannot be explained by an alternative diagnosis.The common symptoms identified include fatigue, shortness of breath, cognitive dysfunction and others that generally have an impact on everyday functioning. Symptoms may be new-onset, following initial recovery from an acute Covid-19 episode, or persist from the initial illness. Symptoms may also fluctuate or relapse over time. The WHO notes that this definition may change as new evidence emerges and our understanding of the consequences of Covid-19 continues to evolve.

The Deputies can see that addressing long Covid is complex. The symptoms and duration and severity of symptoms are varied as are the needs for care. Two people’s experiences of long Covid can be quite different. There is also a lot of uncertainty in the international literature about how many people experience these prolonged symptoms. According to the WHO, it is estimated that 10% to 20% of those with Covid-19 develop a variety of medium- and long-term effects such as fatigue, breathlessness, and cognitive dysfunction. A recent publication in The Lancetmedical journal indicates that at present at least 17 million people are estimated to have long Covid in Europe.People who have had Covid-19 are being given follow-up care by their GP or in hospital settings as clinically appropriate. Treatment is currently focused on management of specific symptoms. Those in the community who are concerned about persistent Covid-19 symptoms should contact their GP in the first instance.

As the Deputies will be aware, building on the services in place to support patients with post-acute and long Covid symptoms, an interim model of care for long Covid has been developed and is currently being implemented by the HSE to support those in need of care. The model of care involves the expansion of some existing services and the establishment of new services across a number of settings, including GPs, community services and acute hospitals. The first priority is to ensure there are long Covid and post-acute Covid clinics operating within each hospital group to ensure a national service. To date, five new post-acute Covid clinics have been established, including clinics in University Hospital Galway, the Mater University Hospital and Connolly Hospital Blanchardstown. These post-acute clinics are managing patients between four and 12 weeks after the initial onset of infection. Long Covid clinics are managing patients 12 weeks post onset of infection, and five new long Covid clinics have also been established. These include clinics in St Vincent’s University Hospital, Beaumont Hospital and University Hospital Galway.Both Tallaght University Hospital and St. James’s Hospital are operating combined post-acute and long Covid clinics. A dedicated long Covid clinic and a post-acute Covid clinic are due to be opened shortly in Cork University Hospital. The HSE is continuing to work with Letterkenny University Hospital and Limerick University Hospital to progress the opening of clinics at both sites. Some other hospitals are operating clinics on an ad hocbasis outside the model of care, in addition to the clinics mentioned above. These include the long Covid clinic in the Mater University Hospital and the post-acute clinic in St. Michael’s Hospital Dún Laoghaire. However, the HSE is continuing to work towards aligning all HSE clinics towards a national service. To support these services, there is a tertiary neurocognitive clinic in St. James's Hospital, led by a consultant neurologist with background in neurocognitive disorders that is accepting referrals from long Covid and post-acute clinics around the country.

Concerns have been raised by some colleagues around the fact that all clinics may not fully staffed. However, I reassure them that this does not mean these clinics are not operational and actually seeing patients. It is true that recruitment is ongoing at some clinics, but I assure the Deputies that they are operational, albeit not fully staffed as per the interim model of care recommendations. Where no staff have yet been recruited, patients are being seen by existing staffing and resources. The assignment of additional staffing and resources will support and enhance the work of existing clinics operational under the model of care. As Deputies may know, to care for those experiencing long Covid, clinical input is provided as needed, depending on symptoms, by a range of healthcare professionals and, therefore, clinical leads representing respiratory medicine, infectious diseases, neurology mental health, allied health professionals, community services and general practice have been appointed. The recruitment of additional posts, including consultants in the areas of infectious disease, respiratory medicine, psychiatry and neurology, allied health professionals, and clinical psychologists and administration will continue in 2023 to staff the full service.

These interdisciplinary teams guide and support patients through all aspects of recovery, supporting care for a range of primary symptoms. The development of effective therapeutic options for patients suffering from long Covid poses significant challenges. There is no proven drug therapy or evidence-based treatment option for long Covid per se. Current treatment consists of diagnosis, advice and support and onward referral to additional services as required. This includes ruling out and managing, if identified, other underlying medical conditions such as anaemia, asthma, sleep disorders, heart failure, and supportive care and rehabilitation if indicated through our allied health professions such as physiotherapy, occupational health and psychological medicine.

I assure the Deputies that the Minister and I will continue to develop an understanding of the implications of long Covid and to prioritise supports for those affected by it to optimise health outcomes for those impacted.

Deputy Canney raised the fact that children are being impacted by this and that there is a need for more dedicated specialist-led teams. I agree with him. Deputy Verona Murphy called for an independent review, as well as a restrictive covenant on those working for the HSE. I will bring that back to the Department. She also raised the fact that fatigue is affecting 21,000 people and the need to consider staffing levels. When one considers that so many people in Europe are affected, those figures are correct. Deputy Lowry referred to Emily, a teenager, and the challenges she is facing. Deputy Fitzpatrick talked about Liz and long Covid. I hear similar stories and testimony in my clinics and around the country. I thank Deputies Canney and Naughten, along with the other Deputies in the Regional Group, for raising this issue. The Government will not be opposing the motion.

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