Joan Burton (Dublin West, Labour)
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Just as the country recently prepared for Storm Ophelia through public announcements and putting safeguarding arrangements in place, we need to prepare for what could turn out to be one of the most challenging winters facing the health services in decades. All the indications are that Ireland is at high risk of a health crisis this winter due to a combination of a flu epidemic and concerns over the spread of the super bug, CPE. I, therefore, call on the Minister for Health to establish a single task force to deal with the possibility of a deadly combination of the two. It also means that community care will be more important than ever this winter in order that the most vulnerable, in particular, will not have to attend hospitals and, preferably, will not need to stay in hospitals.

The national public health emergency team needs to be convened to deal with this risk. We also need advice for families and people at home, institutions such as nursing homes and day care centres and all health care facilities. Efforts need to be stepped up to ensure the message is getting through in the public information campaign on the anti-flu vaccine, in particular to health care workers and to those working with elderly people to ensure that as far as is possible they get the vaccine. I have had the vaccine and while it does not give complete protection against the viral strain that appears to be coming from Australia, it will give significant protection. It is vital that we have clear thinking about keeping all our health services open and functioning. The Minister needs to keep under review hygiene and cleaning arrangements in hospitals, and for hospital staff, in order that every effort is made to minimise the risk of infection. It is important that we put a plan in place for vulnerable people, whether they are older or younger.

Billy Kelleher (Cork North Central, Fianna Fail)
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Forewarned is forearmed and we are trying to impress on the Minister of State the importance of ensuring all the mechanisms of the State are available to deal with this potential public health policy challenge, which could have a major impact on our health services and on the health of vulnerable people. Professor Sir Malcolm Grant of the NHS recently said that they were preparing for a catastrophic flu strain arriving in the UK that could have huge implications for the delivery of health care. If that is the case, we have to do the same. The national public health emergency team met in response to the CPE super bug and the same response is required to prepare for the eventuality of a flu virus reaching Ireland, which a vaccine will not necessarily prevent. We have to ask ourselves what we can do. We should consider opening additional intensive care beds. Isolation rooms will be critically important and community geriatricians and nurse specialists should be deployed in the community in order that elderly and vulnerable people who are primarily in the community care setting or nursing homes will not have to transferred into the acute hospital system through our emergency departments. They are overcrowded and we can predict that there will be huge overcrowding problems during the Christmas period and especially in the first few weeks of January when there will be massive cancellations of elective surgery and major surgery for cancer patients and others who have been waiting an extraordinary time for scheduled surgery. That will happen again because the Government does not seem to be capable of preparing for eventualities that will almost certainly happen. The combination of the flu virus and the super bug could overwhelm our health services.

Damien English (Meath West, Fine Gael)
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On behalf of the Minister for Health, Deputy Simon Harris, I thank Deputies Burton and Kelleher for giving me the opportunity to update the House on this issue. The Minister sends his apologies for not being able to be here.

As Deputies are aware influenza can be a serious illness for people in at-risk groups and can lead to hospitalisation and death. At-risk people include those aged 65 years and older, those with chronic illness requiring regular medical follow-up, those with lower immunity due to disease or treatment, pregnant women and residents of nursing homes and other long-stay facilities.

The priority for this winter is to increase take-up of the influenza vaccine in at-risk groups and in health care workers to reduce and control the incidence of flu and outbreaks in the community and health care settings. As Deputies will recall, the HSE launched its immunisation and Under the Weather campaigns for the 2017-2018 season earlier this month. By reducing the incidence of influenza, we reduce the need for people to seek treatments and, consequently, reduce the demands on health services. The HSE has put in place significant measures to ensure it is prepared for influenza this winter. A national steering group is in place to co-ordinate the response. Each hospital group and community health organisation has submitted a flu plan based on the evidence of last year’s successes and areas for action over the oncoming season. Each long-term care facility and private nursing home has received a detailed communication on how to prepare for and deal with flu. Additionally, each hospital group and associated community health organisation were requested to produce a winter plan which includes a specific section on flu. These plans were reviewed at a national meeting earlier this week. The HSE must be commended on the preparations it has made for this winter. Those preparations will significantly reduce the impact of influenza on the health services.

I take this opportunity to address concerns relating to the effectiveness of the vaccine and the impact of influenza in other parts of the world. The strain currently circulating in Australia is similar to the one which dominated in Ireland last winter and the vaccine for use in Ireland contains this strain of the virus and should afford protection. The latest surveillance reports relating to Australia indicate that the peak week of national influenza activity was comparable or higher than in recent years. However, clinical severity was low to moderate and the proportion of hospitalised patients admitted directly to intensive care units has been on the lower range reported in recent years. These latest reports also indicated that the vaccine was a good match for the circulating flu strains.

In Ireland, flu activity, as measured by influenza-like illness rates, is currently low, similar to other European countries. While it is too early to comment definitively on the efficacy of the seasonal flu vaccine, the Centers for Disease Control and Prevention in the United States have indicated that it is 50% to 60% effective in preventing hospitalisation in older people and 80% effective in preventing death in the elderly. Also of note is that no particular concerns were expressed in relation to either the current flu season or vaccine effectiveness at the EU joint meeting of chief medical officers and chief veterinary officers on influenza preparedness earlier this week.

Finally, I remind Deputies that vaccination remains, as Deputy Burton said, the most effective means of preventing infection by seasonal influenza viruses. We ask people to engage with the HSE's campaign of recent weeks.

Joan Burton (Dublin West, Labour)
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Critically, there is no reason anyone in a nursing home or who attends community care day centres, on a daily or weekly basis, should not be facilitated with the vaccine. By and large, the people attending those centres are older. Second, we have the more recent reports of the carbapenemase-producing enterobacteriaceae, CPE, bug. The HSE has acknowledged that it is extremely difficult to treat and already it has caused a significant number of deaths. A combination of this bug in hospitals and vulnerable people, both older and younger, going into hospitals as inpatients means a much higher risk in terms of mortality in that those who are ill with flu can get pneumonia and are highly exposed to the risk of developing the CPE bug. The HSE message is not being communicated sufficiently to people, including the HSE's own staff, where there seems to be a reluctance to get the vaccine. I urge the Government to act and minimise the damage and harm to people.

Billy Kelleher (Cork North Central, Fianna Fail)
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The Minister of State said it, namely, that at-risk people include those aged 65 years and over, those with chronic illness requiring regular medical follow-ups, those with lower immunity due to disease or treatment, pregnant women and residents of nursing homes and other long-stay facilities. The key component in all of our health services is front-line staff. The HSE said that there has not been a great level of take-up. One has to ask why the HSE is not being more informative to its own employees, who are at risk of infection and infecting. I urge the Minister of State to ensure that the immunisation programme for all these high-risk categories is rolled out in a robust way and that the HSE will engage with staff, through advocacy groups, unions and worker representatives, to ensure that there is a big take-up. It is a critically important component in ensuring that there is herd immunisation in the context of the flu vaccine.

Damien English (Meath West, Fine Gael)
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I will ask the Minister for Health to contact Deputy Burton about the superbug because I do not have the data on the threats associated with it.

Deputy Burton is correct about the communications plan. A stronger campaign is required. The campaign was launched on 2 October, with an initial focus on health care workers. The radio adverts, which will run for three weeks, commenced on 9 October and there will be a further two weeks of the radio adverts when the flu goes over the threshold. Those aged 65 and over and pregnant women are the primary audience for the radio campaign, which will also reach medically at-risk groups and health care workers as they make up a more generic radio audience as well. The trend is that increasing numbers of health care workers are availing of the vaccine, with the figure increasing from 22% last year to nearly 32%, although the figure is probably still not high enough. Fourteen hospitals have exceeded the 40% national take-up target, compared to seven in 2015-2016. Therefore, there has been an improvement although I understand what Deputies Burton and Kelleher are saying. It is still not enough and we need to do all we can to encourage our own workers, who are working with vulnerable people, to try to increase the level of take-up.

Let me repeat that the vaccine is available free of charge from GPs for all people in the at-risk groups and from pharmacies for everyone in at-risk groups aged 18 years and over. An administrative charge may apply to people who do not hold medical cards or GP-visit cards. Again, I stress the need for people to engage and to get the vaccine.