Thursday, 23 April 2020
Health (Covid-19): Statements
As of last night, we had 16,671 confirmed cases of Covid-19 in our country. Sadly, 769 people have so far lost their lives: people with lives and stories; people who made a contribution; people who mattered; and people who will be remembered. The Government is eternally grateful to all those working to combat Covid-19, and everyone is playing their part in this emergency, whether through their work or simply by staying home.
The good news is that we now estimate that the reproduction number of the disease is now between 0.7 and 1. More information will be provided on the modelling by Professor Philip Nolan later today. More people in Ireland have now recovered from coronavirus than have the virus, and more people have been discharged from hospital than are now in hospital as a consequence of coronavirus. This means that our collective national effort is working and that we are suppressing the disease in our communities. So far, 130 people, having recovered, have been discharged home from ICUs, and there has been no overall increase in the number of people in ICUs in recent days.
We have been battered by a wave of destruction but, as a people, we have endured. I know that all of this is coming at an enormous cost, with people suffering increased anxiety because of the restrictions, people who have lost their jobs and people who fear losing their businesses. The mission of the next Government must be to bring the same focus and energy to rebuilding our society as we have brought to facing this health crisis.
Today our new enemy is complacency. The real risk is that if we become lax in the next few days and weeks, we could lose control over the spread of the virus. So far we have not been able to slow transmission of the virus in every setting, and its impact in long-term care and residential facilities, both nursing homes and other care facilities, is great. Our most vulnerable citizens are at risk and we are now taking action to control outbreaks and minimise transmission to protect as many people as possible. This involves increased testing, now that that is possible; increased access to personal protective equipment, PPE; oxygen training; staff accommodation; and other approaches being undertaken. We are also providing financial assistance for nursing homes in order that they can better manage their response to Covid-19.
International best practice shows that an integrated strategy of rigorous sampling, testing and contact tracing is the best way of managing this crisis. Our approach in all these areas has been robust and will help us plan for when we can safely ease the public health and physical distancing measures. As of last Friday more than 105,000 tests had been processed in laboratories, including a laboratory in Germany. The National Public Health Emergency Team, NPHET, recommends that we should try to expand our testing capacity to approximately 100,000 tests per week. That is a significant increase but one that will be necessary as we plan to exit from the current restrictions and manage the aftermath. This is a big challenge. It might not be possible, but we will pull out all the stops to make it happen. The easing of public health measures will be gradual and will be done in a stepwise manner. It will require continuous effort by all of us to suppress and control this virus. Our easing of the restrictions will not necessarily mirror the manner in which they were escalated, and we must leave a period between taking each step so that we can monitor its impact and act if necessary. Certain stricter social distancing measures may have to be reintroduced if it looks like the spread of the incidence of the virus is increasing again. We have seen this happen, unfortunately, in Japan in recent days.
Public health criteria have been developed by the NPHET, based on the work of the World Health Organization, the European Centre for Disease Prevention and Control and the European Commission. The criteria set out are: the incidence of transmission, including in respect of outbreaks in residential and other healthcare settings; ICU occupancy as an indicator of transmission; public health capacity, that is, testing and contact tracing; and overall health system capacity, including access to healthcare workers, beds and essential products and equipment.
Extreme vigilance is required to limit the increase in new cases and to prevent more deaths. We must do everything we can to avoid a post-peak wave or a deadly second wave, which, as we know, occurred in the cases of H1N1 and during the Spanish flu pandemic in 1918. When this is over we will awaken our society and our economy, and the actions we take to do so must be taken in a safe, appropriate, phased and timely way. I look forward to hearing Members' observations and suggestions.
Our first thoughts today must again be with the families of those who have lost their lives during this pandemic. This virus has been every bit as deadly and destructive as was feared. Those who have been worst hit by it have, in most cases, not being able to receive the personal support and comfort that is so important at a time of loss. We have all witnessed the experiences of friends and others where the normal ritual of grieving and mourning could not apply or indeed where being with their loved ones at the end could not apply either. Our core duty remains doing everything we can to stop the spread of the virus, to care for those affected by it, and to support in every way possible the health workers, whose work has already saved thousands of lives.
Before addressing a range of issues concerning the public response to the virus now and in the months ahead, I welcome back Deputy McDonald. We hope her recovery will continue to be robust. It must have been a terrible time for her and her family. The lengthy delay in providing test results can only have made it even worse.
It appears that widespread community transmission of the virus has been contained for at least a few weeks. The fact that overall national figures have continued to be a concern links directly to a large number of specific care and other settings, which are referred to as hotspots in the reporting. Public support for comprehensive action has been strong from the beginning, which is one of the reasons exceptions to this have stood out when they have occurred. The strong political consensus behind action has been there from the beginning and remains intact. There have been many occasions where parties and Deputies have had serious concerns or questions, but the united response has been to raise these issues directly and to avoid allowing these issues to develop to the level of a public dispute. We have as a Parliament voted to limit our ability to work and to be a more active part of the debate about what is happening and what should be done. This has extended to much of the media, where there has been an active policy of seeking to raise concerns in a highly restrained way and to suspend many of the normally more assertive approaches to public issues.
What has not been commented on enough, though, is that this places a heightened obligation on Government in terms of the speed and transparency of its procedures and communications. Unfortunately, too often there has been a sense of resistance to being upfront about problems until a solution has been found. There have been too many cases of legitimate questions asked by Deputies and journalists being met by a lack of clarity or a deflection. In recognition of the extreme pressures being felt in parts of the system and a wish to protect the clarity and focus of the national response, these cases have not been allowed to accelerate into fuller disputes. However, it is important for everyone to understand that we are at a stage where the only way to proceed is to have a more open and inclusive debate about what is to be done.
There are a series of very significant decisions to be taken and we must move away from an approach that looks increasingly like one where decisions are to be taken first and discussion will only be allowed afterwards. Public and political support for decisions about what measures are to be taken can only be secured if there is a willingness to seek and listen to multiple views and if decisions, once made, are communicated more directly and with proper clarity as to the exact reasoning behind them. As we can see every day, there is a real and sustained debate in countries throughout Europe about future steps. This debate must be allowed here as well.
The key epidemiology statistics have confirmed that Ireland can now discuss what measures to retain, alter or lift. Equally, we must discuss what new measures may be required. Our first concern is that we have full, open and frank information about a series of critical issues. To understand the spread of the virus, to aid treatment and to be able to have confidence in reopening plans and gradually lift restrictions, we must have a comprehensive capacity to test and trace rapidly. What capacity is in place today and what is planned for the coming weeks and months? Is it planned to test the asymptomatic population, for example? What is the projected turnaround time in terms of such testing, because we know it is essential, as highlighted in several global papers?
The London School of Economics recently stated that the key to re-opening the economy and society is comprehensive testing with a rapid turnaround time.
Many Deputies have too often been contacted about emerging hotspots which have not been publicly acknowledged. As the Government is aware, the meat packaging sector has continued to operate due to its importance to food supply. Concerns have been raised for quite some time regarding the sector. There is a major hotspot in a plant, a significant cluster in the midwest, and this has caused particular concern. There are other such hotspots and I have raised them with the Chief Medical Officer, Dr. Holohan, and the Minister, Deputy Harris. What is the role of the Health and Safety Authority in this regard? There is a separate issue regarding an asylum centre in Cahirsiveen where there seems to be a lack of engagement between the health authorities and the Department of Justice and Equality. There is significant concern and tension building up there with a cluster emerging. What is being done to revise work practices in such sectors in order to reduce the number of hotspots? What is the level of engagement at sectoral level to ensure that workers and the wider community have suitable protection and that cases are rapidly identified?
Last week in the Dáil and repeatedly in private communications Fianna Fáil raised the issue of nursing homes. The comprehensive testing response and other measures are welcome. What is the exact situation in nursing homes? The funding package announced some weeks ago is too bureaucratic and not in spirit with this crisis. It involves significant paperwork which has caused much annoyance in the sector. What percentage of nursing home residents have been tested? Has the enduring issue of personal protective equipment, PPE, for staff been addressed? What information has been given to residents and their families? I raised that issue two weeks ago and the points I made were subsequently confirmed publicly. As all Members are aware, healthcare workers in all settings have been put in danger by the lack of appropriate PPE and they, unintentionally, have put others in danger as a result. After a terrible period, progress was made but, unfortunately, there are still reports of substandard and unusable PPE being distributed. I seek clarity on this matter. Is there enough suitable PPE? What is the assessment of need for the coming months?
The issue of when and how to lift restrictions is a dominant topic throughout Europe. To raise it is not to deny the priority of limiting the spread of the virus and helping those who have it. I do not detect any complacency among the public. The process to date for discussing this matter has simply not been good enough. It risks things being done poorly or in a rushed manner. For example, we need more clarity on the wearing of masks. Respected and reputable international experts are advocating the wearing of masks and people are anxious to get clarity in that regard. Although we cannot risk taking supply away from healthcare workers, other countries have found alternative approaches. Studies published in recent days suggest that protocols for wearing homemade masks can form part of revised measures. Is the current position being reviewed? Will it be changed? This is not an issue on which everyone should remain quiet until a plan is implemented. There should be no tolerance for half comments, off-the-record briefings or partially leaked memos. We urgently need clarity on the process and the exact benchmarks to be used to trigger action. What process will be adopted to consult on options? In Germany, governments at regional and national level have implemented a process of bringing in industry groups and a diverse range of academics to come up with options. It is obvious that some groups will lobby, but we need external disciplines which can advise impartially within the overall parameters set by epidemiologists. This wider group is using its expertise to look at ways of restarting activities within those parameters. Such a process should start here.
The economic impact of the pandemic and the response to it has been severe. The impact on unemployment, incomes and public finances has been dramatic. It should be put on the record that action must be taken to protect the rights of workers and creditors, particularly where businesses appear to be using the crisis to implement long-term actions. The treatment of Debenhams workers has been appalling. I see nothing wrong with the highly responsible and restrained demonstrations which the workers have undertaken. Demonstrations which respect social distancing rules are reasonable and should not be prevented. The contrast between those responsible demonstrations by workers made redundant and the actions of the group which gathered outside the Four Courts on Tuesday could not be more dramatic.
The situation in respect of public exams must be clarified once and for all.
Instead of partial announcements, we need some certainty, even if this certainty includes conditionality around the level of spread of the virus at different dates. I have not met any person who is looking for a light switch moment when it comes to lifting restrictions. Equally, there is no air of complacency among the overwhelming majority of the public. There is still a national resolve to get through this to limit the virus's damage and to protect ourselves from future outbreaks. We need clarity today about the current status of the virus in our community, our testing and tracing capabilities, and measures to protect healthcare workers. We also need much greater clarity on how we decide where to go from here. Just as our response to the pandemic has been a shared national effort, so too must be the process of planning and implementing measures to limit future risk and restart much of our daily lives.
Go raibh míle maith agat. I thank everyone who sent me kind wishes. Thank you all very much. It was very thoughtful of you.
Having been sick and having experienced the virus at first hand, it sharpens one's understanding of everything surrounding this public health emergency, most particularly the big gap there has been between, on the one hand, the very ambitious announcements that have been made and in many cases re-announced, and on the other hand, what was happening on the ground. I waited 16 days for a test result, and this was not unique - far from it. In fact, others waited longer times, and in some cases these were front-line healthcare workers. I think we can all accept that this is unacceptable and scandalous and that it needs to be fixed. The Taoiseach says that it is. I hope we see evidence of that fact. Just this week, I heard a woman tell her story on RTÉ radio, and she is still waiting for her deceased husband's test results. That man was tested on 27 March, and this woman said she cannot get a death certificate because of this delay.
The announcement and re-announcement of testing capacity never became a reality on the ground, and so now we have new targets. The Taoiseach said this morning that we have a target of 100,000 tests per week. That has to be real, it has to happen, it has to be seen to be happening and it has to be more than an exercise in collecting swabs and samples. The actual tests have to happen. We need efficient reporting and, crucially, contact tracing because contact tracing is reliant on the result of the tests being reported back.
The Taoiseach says he is concerned about complacency, and so am I, although it has to be recorded and said that communities, families and the Irish people have rallied magnificently to what have been difficult asks of them in very difficult circumstances. Nonetheless, I share the Taoiseach's concern on complacency. I am also concerned about mixed messages and kite flying from the Government. All of us want to see people back at work, businesses back functioning, schools and colleges and so on reopened. We all believe in that, but I put it to the Taoiseach that it is neither plausible, advisable or safe to unwind public health restrictions until we have a wide, comprehensive and efficient testing system and the follow-up contact tracing, because the mantra has been to test, isolate and trace. We know that is how we keep people safe. We know that this is how we manage to stay ahead of this virus, not just in the here and now but in the coming weeks and months until we have effective anti-viral medications and, ultimately, a vaccine. Until that time, however, we need to be clear. Precautions and measures will have to be taken to keep people safe and to avoid deaths.
I again record our sympathies for all of those who have buried their loved ones in such heartbreaking and incredibly difficult circumstances.
The good news, as the Taoiseach has correctly recorded, is that our health service has not been overwhelmed.
The good news is that we have collectively managed to flatten the curve. However, we must be cautious. Moving too quickly could allow the virus scope to spread and surge at a later date and perhaps even to mutate and become even more virulent. We cannot allow things to do that under any circumstances. There must be absolute clarity from the Government to all of us on that point.
Caithfidh mé ceist a chur ar an Taoiseach faoin ngéarchéim inár dtithe altranais. Mar is eol don Taoiseach, tá níos mó ná leath de na daoine a fuair bás sa Stát ó Covid-19 tar éis bás a fháil sna tithe altranais. Tá chuile cheann de na básanna seo fiúntach. I must ask the Taoiseach about the heartbreaking crisis in our nursing homes where more than half of the deaths in the State from Covid-19 have occurred. Every one of these deaths is meaningful, a life lost and a story ended in the most awful circumstances, leaving behind families and friends who are absolutely devastated. The Government's approach to nursing homes has been characterised by a lack of urgency and mistakes and I ask for clarity on several points. The lack of urgency gave rise to some very important issues that have not yet been answered satisfactorily. We still lack a clear answer about why the Minister for Health, Deputy Harris, refused to meet Nursing Homes Ireland in the early stages of the crisis despite its repeated requests. Why was this? The Minister only agreed to meet in late March when Nursing Homes Ireland went public with its frustrations. Why? There must be an adequate and clear explanation why the Department of Health criticised the decision of nursing homes to introduce a ban on visitors on 4 March. The Department said then that Nursing Homes Ireland was moving too quickly, but it is clear that was wrong, and the nursing homes were ahead of the system. Why did this happen when the World Health Organization was urging, almost begging, European Governments to move and to do so faster? Will the Government clarify the delays on the On Call For Ireland initiative, which has been very successful with health professionals responding to it in huge numbers. However, this time last week, only 1,300 applicants were processed through the system from a pool of 73,000, at a time when nursing homes in particular are crying out for staff as they are unable to fill rosters. Given the magnitude of what is unfolding in nursing homes throughout the country and other residential and congregated settings, we need clear and precise answers to these questions.
I will make some suggestions on what should be done for nursing homes and I would like the Taoiseach's response. Each acute hospital should be assigned the job of monitoring nursing homes and congregated settings in its catchment area and be fully resourced to allow for rapid local responses. The focus of the On Call For Ireland programme should be shifted to nursing homes and the process fast-tracked to ensure that they have the necessary staff. The HSE should use the spare and very expensive capacity in private hospitals to alleviate the pressure in our nursing homes where necessary. We should also make use of the community assessment hubs for this purpose. The supply of personal protective equipment should be accelerated to nursing homes and other residential settings from today. If we do these things now, and assess them and measure them, we have a chance to turn the tide of the emergency in our nursing homes and stand a better chance of saving lives. This is the very least that we owe to our elderly citizens and their families. As the Taoiseach has accepted, we have a particular duty to protect them and vulnerable groups in our society.
I wish to share time with Deputy Joe O'Brien. Our first thoughts are with families in nursing homes, where we have seen such a raging epidemic, and in other residential and congregational settings, such as in direct provision or religious orders, where we have heard stories about the number dying in recent weeks. That tragedy and the urgent need to continue to tackle these issues drive us to support the Chief Medical Officer and Government in taking whatever measures are needed to make sure we minimise the loss of life and put in place and implement, with absolute certainty, systems for testing, isolating and tracing at the scale needed to manage the virus and, at the same time, open up our economy. The job of the political system here is to strike a balance between the health imperative and the imperative to have our economy return to some sort of functioning order so we can pay for health and social welfare systems and ensure we can restore and protect our mental health, as well as our physical health, in response to the virus. I absolutely accept what Dr Tony Holohan is saying, which is that we cannot be presumptuous on this and that there is nothing decided yet on opening things up, but we do need to start thinking about and preparing for the economic recovery because it will be as important a part of the management of this crisis as everything else.
I hear people from the construction sector rightly say they are used to managing health and safety and that we should be working with them now to set up the mechanisms by which we can determine how to get workers to and from building sites and operate within building sites. I refer to proper distancing during breaks and to the availability of proper hand-cleansing and other facilities. I hope the sector will be one of the first to return to action. If at any stage we see an increase in viral infection due to increased activity, we will obviously have to scale back again. It is important, however, that we start to get construction workers back to work.
With regard to tourism, one of the biggest difficulties we have at present is the lack of expenditure. Our economy is contracting. At some point over the summer, we will have to see people spending, particularly for the protection of our small businesses and the development and protection of the economy in rural areas, which are so dependent on the tourism sector. Again, we have to be careful about this. We do not yet know the dates on which we expect people to be able to start going on holidays. We will have to manage this in a way that will not result in a pick-up in the virus. Not many from overseas will be coming to Ireland this year but, likewise, we are not going to be going away on our holidays. If we spent our time this summer walking, cycling, swimming, driving and having dinners, it would assist. I read today that the Restaurants Association of Ireland is going to try to set up mechanisms by which we can have facilities in this regard set up in a safe way. It is appropriate for us to start thinking about and planning for some sort of uptake in our economy or life in our country later this summer if the numbers associated with the virus continue to go down. This is important. It is important that we give some signal that there will be a chance for holidays at home this year. Maybe it will be a very different sort of holiday but maybe it will be one that really reminds us what is important and great about our country.
On the international stage, with regard to the meeting of the European Council today, I am glad the Irish Government is continuing to support the issue of eurobonds in response to this crisis. Just as we need a stimulus here to get spending going and produce an economic lift, we need a similar attitude and response at European level.
From my reading of reports in the newspapers today, it seems one of the items that may be on the agenda for consideration, in addition to eurobonds, is the potential for the European Commission to borrow on behalf of the European Union and leverage that for economic recovery. It seems, again from reports in the newspapers today, that the introduction of an EU-wide digital or plastic tax might help to cover future repayments on such lending. The Taoiseach should not be afraid of supporting such initiatives.
An expansion of the EU budget is in our interests. Such an expansion will be difficult for any one country to fund because of the constraints under which we are operating. That Keynesian stimulus and expansionary proposal is one we should support. We should be doing that on a cross-Continent basis, showing solidarity at this time. It is in the interests of our country, the EU and the wider world that institutions such as the European Commission show that they are capable of managing the economic response to the crisis in a way that inspires our people.
I wish to open by expressing my condolences to the family of the 31 year old carer who worked in a private nursing home in Swords, in my constituency, and whose death was announced in recent days. That underlines the issues and questions raised by other Deputies regarding nursing homes.
In many respects, the virus and the State's response to it have given rise to a type of human rights audit. Whose health protection needs and rights is the State responding to most slowly ? Those of asylum seekers and people in residential settings. Who are we leaving behind? Travellers, Roma, international students and undocumented workers. Few of us are aware of the fact that so many of the front-line workers in this battle against Covid-19 are undocumented workers, people unrecognised, unacknowledged and not appreciated by official Ireland. I recently spoke to two undocumented workers, and I want to represent their voices here today. Both are female live-in care workers who care for elderly women. They are cocooning with these ladies and tending to their every need during the crisis. Both have worked in this sector in Ireland for over a decade. They work in the shadows but provide an essential care service. There are likely to be many hundreds, if not thousands, of individuals in similar situations all over the country, undocumented migrants caring for elderly people and helping them to cocoon. This is just one sector.
As we move forward in developing a response to Covid-19, we cannot have people working in the shadows or being left behind, not only for their own sakes but for their sake of their rights. We need to develop a thorough and robust set of systems to allow us to eliminate and keep out Covid-19, but, also, it is only just and fair that those who contribute so much to fighting this battle are allowed to be full members of society. One of these women asked me to tell the Taoiseach: "We are front-line workers. We cannot go out, we are looking after our ladies, we are working all day, all night, 24-7 and we love them like our family." She said she knows hundreds of other women from her home country who are working in similar situations across Ireland. Can the Government set up a regularisation scheme whereby undocumented people can view a set of fair and reasonable criteria that they need to satisfy in order to be regularised? I am not alone in calling for this - Chambers of Commerce Ireland, the unions, the National Youth Council of Ireland and the National Women's Council of Ireland are on a list of bodies that are calling for it.
Bus Éireann employees are driving essential workers to and from their workplaces as we speak. Many Expressway and rural route buses do not have contactless payment machines. Coins and bank notes are being exchanged in close proximity between driver and passenger. This is a health risk for drivers but also a problem for limiting and controlling the virus. I propose that during this health crisis those Bus Éireann vehicles which do not have contactless payment machines operate fare-free for essential workers until another method, which does not involve the exchange of cash, is put in place.
Given her County Tipperary genealogy, I welcome Deputy McDonald back to the House and wish her well.
Since we met last week, 4,124 people have been diagnosed with Covid-19 and, sadly, a further 337 have passed away. Our thoughts are with the families and loved ones of those who have passed away and we wish all of those who have been diagnosed with the virus a speedy recovery. I think, in particular, of my friend and neighbour, Kieran Maguire, who lost his life in the past few days. I think of his family at this time.
We are in the middle of the biggest public health crisis that the State has ever faced.
I wish to preface what I am about to say by thanking everyone in this crisis who is working hard across government, the National Public Health Emergency Team, NPHET, the HSE and society all the way down to, for example, retail workers in shops. I greatly admire them, as I know we all do. They are all heroes in our battle and we truly cherish them.
However, I am concerned about the transparency in decision making. I wish to concentrate on this matter. When the crisis broke, our party stood alone in asking for an Oireachtas all-party committee to ensure accountability and transparency. It did not happen and was dismissed by many in the House. Seven weeks later, I now correctly hear talk across politics of the lack of democratic accountability and transparency. The process that the Dáil is going through right now does not negate that fact.
I wish to ask about governance during the crisis and how decisions are being made. NPHET was convened by the Taoiseach on 27 January for Covid-19. It was previously convened in 2019 to deal with the carbapenemase producing enterobacteriaceae, CPE, superbugs. Interestingly, the terms of reference that time were significantly longer and more detailed compared with the Covid-19 crisis, which is ironic.
A Cabinet sub-committee has been set up by the Government to manage this crisis. It is serviced by a senior officers group and a communications subgroup. That leads to NPHET, which includes an expert advisory group and has 11 subgroups ranging from acute hospital preparedness, behavioural change and so on.
I looked up NPHET's membership. It seems to have grown substantially since it was established. Did the Government agree to all the new members and, if so, where is that documented? If not, who appoints NPHET's members? Is it a case of the chair or other members deciding what public health officials and others are to be invited to the group? What is the process for approving new members? For example, the third or fourth meeting note, entitled "Expansion of NPHET Membership", in minutes from, I believe, two months ago reads: "It was agreed to expand the membership of the team to include a general practitioner, an intensive care specialist and an infectious diseases consultant and invites will issue to join the meeting on Tuesday next, 3rd April 2020." Obviously, nursing homes were not included. How was one member picked over another? Who made those decisions?
Interestingly, only notes of meetings are recorded. Are these actual minutes, and if not, why not? There is a big difference. Minutes reflect the record of the meeting and must be agreed at the beginning of the next meeting. Notes could be a subjective view of what happened. Were all these notes agreed by the participants after each meeting? Future generations will want to know, and deserve to know, where people stood on decisions, but this is not transparent. Why are notes or minutes no longer being published since the end of March? I have searched and searched everywhere. The group meets twice weekly, but there are no minutes. We cannot see how decisions are being taken. This is not acceptable.
There is a large number of people on the committee now, yet no disagreements on any decision have been documented. That is noteworthy. This is something that each member should consider, given that all decisions will undergo historical review at some stage. The issues arising in the nursing home sector are the most obvious example.
In the last published meeting note, dating from 31 March, NPHET discussed the paper on childcare for healthcare workers. The note does not say why the paper was not agreed and does not transparently say what decision was made. The Government is still grappling with this issue, yet we cannot see why the paper, which the Minister for Health showed me six weeks ago, has still not got through.
How many subgroups are there in NPHET? Eleven are listed in the national action plan, but no minutes have been published for nearly any of them.
What are they doing? Can we see the minutes? Are there minutes? Will all of the market research and survey data from the communications subgroup be published? Who sits on the subgroup? It is referenced a number of times in the few sets of minutes we have but I would like to know what it is doing. Why, unusually, do the Secretary General of the Department of Health or director general of the HSE not attend? I would have thought they would be intrinsic members of the committee. What happens if either or both disagree with a decision?
A number of weeks ago, when the chief medical officer made the decision to set a target of 15,000 tests a day and 100,000 a week by 5 May, which the Taoiseach referenced earlier, the Minister, Deputy Harris, said he expected it within days. We will, however, stick to 5 May. Did the chief medical officer, through NPHET, do so with the agreement of the HSE, which is ultimately responsible for making such a testing regime possible in such a short space of time? I agree with it, by the way, but I am not certain, and I believe the Taoiseach is in the same position, that it can be delivered. Why was a decision made to announce this if the HSE did not believe it could deliver it? Of course, we cannot see this because there are no minutes.
Has the HSE or its board communicated in any way with the Taoiseach, the Government, the Minister for Health or the Department of Health regarding its concerns about overall governance of decision-making in this crisis? If so, will the Taoiseach tell us about it or publish any such communication?
To whom is NPHET ultimately accountable on a day-to-day basis? I understand it advises the Government. Who makes the final decisions? Must NPHET consult the Taoiseach or Minister for Health before making formal daily announcements that affect all of our citizens? I presume it does so and the Taoiseach might tell us how.
I want to make sure we have democratic accountability and scrutiny. To date, I and all of us in the House have fully trusted everyone, and continue to do so, but the lack of information on processes and decision-making, as I have just outlined, means I have to ask these questions on behalf of the public. Ultimate decision-making cannot be in the hands of the few. Elected office cannot be subservient in this crisis. We have to heed public health advice - this is absolute - but we also need to make sure that the formulas for providing this critical public health advice are working, robust and, most importantly, transparent. I trust the Taoiseach's belief they are working but they are certainly not transparent.
I say all of this today as we look to chart a roadmap out of the crisis. As I said last week, it is a roadmap that ultimately must be decided by the Taoiseach and the Government but shaped by the Chamber. The kite flying and mixed messages, which we had from the Taoiseach and Minister for Health last weekend, must end. The Taoiseach must remember that absolutely everybody in the country is hanging on his every word and pronouncement. The roadmap must take full cognisance of NPHET's views on Covid-19. However, critically it must also take cognisance of wider health concerns. We have huge evidence that participation in normal health procedures is substantially down and, I might add, screening is non-existent. This will, no doubt, result in secondary effects, with some of the population having negative health outcomes and loss of life resulting.
The roadmap must also consider wider public concerns, health concerns and social and economic concerns that have a wider impact on the health of our people and the future of our country. It must be holistic and this may mean on occasion the Taoiseach and the Government balancing decisions in a way they have not done to this point. I wish them well in doing so.
I want to take the opportunity to express our sympathies to the families of all those who have died during the pandemic, some of whom could not be with their loved ones at this critical and sad time. This makes it so much more difficult. The number of deaths in recent days is a stark reminder that the virus is still in a very active phase.
We are being informed that the numbers can be accounted for by delayed notification of deaths but there are grounds for doubting that this is the only reason. While there are positive signs regarding the occupancy of ICUs and the number of people who have been hospitalised in comparison with what it might have been, a particular source of concern is the nursing home sector. Many of those who have died did so in nursing homes, where there continues to be a critical issue in terms of the prevalence of cases and the ability to manage them in light of the availability of nurses and carers. Many nursing homes have staff who are ill and some are in hospital. The individuals in question are doing their absolute best to provide care, often to people who they have been looking after for years and who they care deeply about. However, additional staff are needed.
The testing regime has been particularly problematic. In the absence of comprehensive testing, it was impossible to know who needed to be isolated. We have been told in recent days that the illness presents differently in older people so those who were not obvious cases were not picked up. Having talked to some staff and owners of nursing homes, I know they are shocked at how fast residents are succumbing to the virus. There has been an escalation in the number of deaths. We only have to look at the death notices to see that. While I do not do so routinely, I am looking at those notices at the moment. The position is quite shocking and it makes me question what we are being told in regard to these being deaths that happened several weeks ago.
The big ask is for staff for the floor, namely, for nurses and carers. These have been promised and the funding is there, but I am told it is not happening at the coalface. I have been talking to owners of nursing homes who tell me they are spending hours on the phone trying to get staff. If they were being provided with staff, or if there was a level of co-ordination to deal with this, they would not be doing that. Will the Taoiseach address this issue specifically? Staff can only work 16-hour days for so long, and that is what is happening at present.
A second issue on which we expected to see progress is childcare arrangements for front-line healthcare workers. While this has to occur in a safe manner, which I accept, there may be several solutions. We need the Taoiseach to give us some sort of indication of what the thinking is, what options might be available and whether parallel planning is occurring in terms of working with the childcare sector to match childcare workers with healthcare staff.
Direct provision is an area about which I have deep concerns. We have seen at least one confirmed outbreak following the distribution of a group of asylum seekers from a centre in Dublin to another centre in Kerry, despite the group having been exposed to a confirmed case. Surely, herding groups of people around like this, when they really have no choice in the matter, is against public health advice. It is difficult to see how that movement can be described as being in any way different to people going from one part of the country to another over the Easter weekend, for example, when there was a concern that individuals were going on holiday. That needs to be dealt with and we need to have an explanation as to why it is happening. There are also many other concerns regarding direct provision, such as people sharing rooms and having to buy sanitary materials.
If we are to get to grips with this virus and plan a transition out of the lockdown, it cannot be done unless we set some tests against which we plan that exit. Have those tests been set? A robust and comprehensive testing and tracing regime is essential and, again, we need to see the capacity. Is the modelling being done in the context of widening the definitions and how might that impact on the capacity? Given the speed at which this virus infects people, the Covid-19 app that is being developed might be very significant in the context of contact tracing, but it will come with a cost in terms of privacy and, ultimately, uptake.
If there is a doubt about its use and if there is a lack of transparency, there will not be the uptake. It requires a critical mass and that will not happen unless there is public trust. This is a measure one would not see except in the most extreme situations in which we now find ourselves. The public have to buy into what it is, how it is working, why it is being used and how it will be decommissioned. That is important. This could be a very useful tool if that public trust can be gained but that very much depends on how it is handled.
Another critical area we will have to consider is availability of hospital capacity, staffing and personal protection equipment, PPE. We hear yet again today concerns about the unusability of some PPE that has been provided. We will have to see also in that modelling a reducing of level of infection.
We need to hear about the kind of planning that is under way and the public need to hear that. Who is involved in the process, who is being consulted and what is the likely sequencing, while also acknowledging that health is the ultimate reference point for that? That is part of the reason some of us have sought more involvement in transition plans and a different involvement for the Dáil. The Committee on the Eighth Amendment of the Constitution is a very good example of where a cross-party group could get to grips with a complex issue and be helpful. We have got to do things differently.
We have a huge economic crisis because of the virus that cannot be fully evaluated in the absence of knowing how this virus will act and how it ultimately will be tamed. There is a third component, however, and that is one of social cohesion. While the public have been magnificent in the part they have played, that cannot be taken for granted. The public are central players. They have been passive because that is what they have been asked to do but their involvement in unravelling this in an organised and safe way requires their consent and requires public discussion and debate. It involves this Parliament not reverting to a traditional adversarial style of politics. A totally new approach is required, at least in the short term.
With respect to the economy, any transition arrangements will need to bring on board and engage employer groups and trade unions but there is also a whole cohort of people in the gig economy - workers who are not organised - who need to be involved. In many ways, the public have been way ahead on this issue and on what needs to be done. They were calling for school closures before the school closures happened. They were calling for the cancellation of events like the St. Patrick's Day Festival before they happened. They were largely appalled that the Cheltenham Festival went ahead. They are asking questions now about ports and airports and how they are managed. There is a complete understanding that goods have to come in and out of the country and there must be some movement but how they are being managed is an issue that has to be got to grips with.
None of us envisaged the voluntary lockdown, which was responded to extremely well. We had hoped that the powers that we passed in this House would not have to be used but, understanding what happened around Easter, they had to be used. The gardaí did what they have done in the full knowledge that policing is done by consent and that is largely how we have seen that happen. There have been a couple of incidents that would be of concern. One was referred to by Deputy Martin in respect of the Debenhams employees but the other about the contrast with the courts is a serious source of concern. That is the kind of issue about which there will be public discontent.
We know there is a Cabinet sub-committee. Other Members referred to that, but we need to know much more. There needs to be much heavier involvement, drawing in expertise but involving the public in that debate. Otherwise, there will be a breakdown of the consent that exists and which is so necessary in dealing with this pandemic.
I am sharing time with Deputy Barry. First, on behalf of People Before Profit, I again extend my deepest sympathies to anybody who has lost family or loved ones and my support and best wishes to anybody who has received a positive diagnosis of Covid-19. I also again pay tribute to all the front-line health workers and essential workers who are protecting us and to the wider public who have unquestionably, through sacrifice and hardship, succeeded in flattening the curve and protecting our health services from being overrun.
Clearly, people have genuinely embraced the idea that we are all in it together and the idea of solidarity that is necessary to overcome this challenge, but that must work both ways from the Government that called for it. I am frustrated at the failure of the Government to be fully transparent and communicative about key matters. My office was the only one whose representative turned up at the first NPHET briefing on 20 February last on the Covid-19 pandemic. At the meeting, my office's representative asked for the modelling in respect of the famous curve for capacity and likely infections. We never got it despite asking for it on multiple occasions. Directly following that meeting we asked, and have asked on multiple occasions, for the advice that the expert advisory group gave to NPHET on all the key issues. We never received it. This underlines Deputy Kelly's point earlier. We have been asking for five or six weeks to see the advice from the experts to the NPHET. Why have we not received it? I do not understand why, but it does not exactly engender confidence.
There are big questions about the deal with the private hospitals. We must have transparency on that deal. It would be absolutely unacceptable if some of the richest people in this country were to benefit or profit from this public health emergency and there are deep concerns and suspicions that this is happening. I hope I will get responses on those points.
Certain lessons that are simply beyond dispute arise from this crisis. First, there can be no question of a return to a semi-privatised, two tier, fragmented and under-resourced health service. That can never happen again. We have seen the cost with the nursing homes. The other day I met a general practitioner I know and with whom I play football. He told me his nursing home is overrun with Covid-19. Most of the staff and many of the patients have it. They have been trying to contact the HSE for weeks. As he said: "The ball was dropped and we were not on their radar". That is what happens when there is a fragmented health system with different parts under the control of different people with different motives. We must have a properly resourced, fully public, national health system and all healthcare capacities and services must be brought under that system. That must happen immediately and that commitment must be given immediately by the Government.
There can be no return to people living in overcrowded homelessness facilities or to the direct provision status quo. That simply cannot happen. It was immoral before this crisis hit and it is now completely incompatible with the protection of public health. There can be no continuation of a situation where empty properties are in the hands of speculators and vulture funds when people in overcrowded conditions need that own-door accommodation to protect their health. There can be no return to the disastrous austerity that followed the 2008 crash and the reliance on the market to solve key issues. That means we must protect workers.
I cited Debenhams and I have been specifically asked by the Debenhams workers to raise it. Bank of Ireland is a shareholder in Debenhams and the Government is a shareholder in Bank of Ireland. If we want to engender solidarity and that we are all in this together, how can we let Debenhams, which continues to operate and make profits in the North of this island and in Britain and in which the Government has a shareholding, treat workers like that? There needs to be intervention. There needs to be a guarantee that workers will not suffer loss of income and that workers will get decent pay and conditions and not pay the bill for the public health emergency we are now trying to fight.
I start by offering solidarity and my sympathies to the families and friends of those who have lost loved ones. I offer sympathy also to all of those who are sick, and solidarity to workers on the front line.
I will direct my more health-specific questions to the Minister for Health later today. The main points I wish to raise now relate to the crisis, the question of jobs and the approach. Debenhams has shut stores, put more than 2,000 workers onto the dole and now wants to flee the country without paying a single cent in redundancy pay to those workers. This issue is not just for Debenhams workers now. It is a test case for how workers in society are treated and for how workers in the retail sector are treated. Retail Ireland has said that 110,000 jobs are on the line now due to the crisis. We have already seen the closure of Oasis, Warehouse and Laura Ashley. How the Debenhams workers are treated very much sets a benchmark. I believe the State could and should intervene to try to save the 2,000 jobs. The State has a stake in Bank of Ireland, which is part of the consortium that shut Debenhams down. That stake should be used to try to reverse the decision to close. At the very least the State has a responsibility to ensure that Debenhams is not allowed to abandon these workers totally. The State should ensure there is a moratorium on company liquidations at least until such time as the lockdown is lifted. In taking that action the State could prevent the High Court from appointing a liquidator next week and help prevent absolving the company of its responsibilities to the staff. This company still runs an online business and still hopes to reopen the majority of its stores in the UK. Its representatives should meet with the representatives of the workers and, at the very least, pay a decent redundancy package from the company's profits and resources.
I want to ask the Taoiseach about the use of emergency powers by gardaí to disperse a disciplined, socially distanced protest by Debenhams' workers in Henry Street, Dublin on Tuesday. Not only did gardaí instruct the workers to disperse and to take down the signs, which they have asked me to hold up here today as they were refused the right to hold up this sign on Tuesday, the workers were threatened with arrest and threatened with being put into the back of a Garda van. They were escorted to their Luas and bus stops by the gardaí and the gardaí instructed a trade union shop steward to desist from conducting an interview - well away from the store - with a journalist. I understand that the Irish Council for Civil Liberties will publish an article this afternoon in the wake of Tuesday's events. The article will contain the following words:
The ability to demonstrate and raise a collective voice is the cornerstone of a democracy. The right to protest, therefore, must be protected and facilitated to the greatest extent possible [and goes on to say] Specific legislation has been passed to allow for the right to protest in other countries and to continue to be exercised during the current lockdown.
I have three things to ask the Taoiseach. Will the Taoiseach comment on whether he would support the idea of a moratorium on company liquidations, at least until such time as the lockdown is ended? Will he also comment on the point that is raised in the article by the Irish Council for Civil Liberties?
Does the Taoiseach agree with the comments of the Fianna Fáil leader that the Debenhams workers' protest on Tuesday was responsible and involved social distancing and that protests of that type should be allowed to proceed as a basic democratic right?
I join with other Deputies in extending my deepest sympathies to the families and friends who have lost loved ones during this shocking crisis. The country reached a shocking milestone yesterday; more than 1,000 people have died from Covid-19 on the island of Ireland. I thank all the men and women who are on the front line. They are working beyond the call of duty and are putting their own health and lives at risk for the most vulnerable. We owe them an enormous debt of gratitude we should not forget when this crisis is over.
I acknowledge all of the work the Government has done over the last two months. The management of this crisis as it developed has been very difficult due to its enormity and the fact that we still do not know all of the different behavioural patterns of this particular virus. The role of the Opposition, however, is to propose solutions, to scrutinise the Government and to push it at all times to ensure better outcomes for the Irish people. The mortality rate in Ireland is shocking. It is the 12th worst on the planet. We also have one of the worst mortality rates in the world for those in nursing home settings. This is doubly shocking given the fact that we are an island nation and that we saw this crisis unfold in other countries and had time to prepare. We had a headstart in preparing. We also have a young and dispersed population. All of this would lead me to believe that we were in a better position to deal with this crisis.
It was wrong not to stop flights coming from the north of Italy at the start of this crisis. It was wrong to tell people who were returning from the north of Italy at that time to continue on as normal if they did not have symptoms. It was wrong not to risk-assess these people at the airports. One might say that I am speaking with hindsight and that this is history but that is not exactly the case. Right now, seasonal workers are landing in Ireland to pick fruit this summer. I raised this issue last week and the Chief Medical Officer said that it was not good public health policy to allow this in the middle of a pandemic. Statements from the Taoiseach's office that day varied from, in the morning, that these were essential workers and should come to, in the evening, that the Taoiseach shared the concerns of the Chief Medical Officer and that he was seeking an urgent review into this practice. It has since transpired that the Government actually lobbied the EU to allow the movement of these seasonal workers right across the EU. Does the Taoiseach agree with the Chief Medical Officer? Does he believe we should adhere to a policy of restricting people's movement? Will he make a change to that policy? We are still only providing leaflets at airports. Is it not time to have medical professionals in airports properly risk-assessing people entering the country?
I raise the issue of the nursing homes. Nursing homes are in absolute crisis. Dr. Marcus de Brun, who was appointed to the Irish Medical Council by the Minister for Health, said that these are "the biggest political blunders in the history of the Irish State", that nursing homes "have featured as something of an afterthought", and that the timeline of inaction with regard to nursing homes beggars belief. At the start of March, many nursing homes instituted restrictions on visitors. On 10 March, however, the Government said "socially restrictive actions around hospitals and nursing homes are not necessary at this moment in time". Many nursing homes around the country opened up the next day and remained open for visitors for the next three weeks before visiting being banned by Government. On 17 March the HSE directed that nursing homes promote good hand washing and put up information posters. The number of people dead internationally on that day was 7,500. In March many nursing homes sought blanket testing for residents.
On 4 April the Government promised blanket testing for staff and residents but that is only kicking in now and half of the nursing homes around the country still have not been tested in this way. The tests that are finally happening are revealing a shocking picture. There are now 1,944 confirmed cases of the virus in nursing homes throughout the country. This is 61% higher than the Government's figure on Monday. The scale of this differential shows how important testing is, both with regard to the treatment of residents and workers but also in understanding the depth of the crisis in nursing homes. On 19 March, Nursing Homes Ireland, NHI, wrote to the Minister for Health seeking an urgent meeting or conference call. However, two weeks later the Minister for Health, in response to a press statement sent out by NHI that it still had not met the Minister, said that he looked forward to meeting its representatives soon. On 4 April we were also promised that a financial support scheme would be available to nursing homes but incredibly, yesterday we found out that not one cent of that scheme has been spent in any nursing home in the country as of yet. Staff at nursing homes and their representatives have been excluded from the NPHET. Obviously we are in the jaws of a crisis and we need to focus all of our attention on fixing it but when this crisis subsides, for the sake of future health policy I ask the Taoiseach to commit to an investigation of how the nursing home sector was handled in this country.
There will be no lifting of the lockdown until we are testing the outer ripple of the virus as it goes through the population. Testing is key to lifting the lockdown, saving lives and easing the financial burden on this country but testing also remains in crisis. On 19 March, the Minister for Health said that we would reach 15,000 tests in a matter of just a few days. One month later and we are testing at a rate of one third of that particular objective. People have been waiting for weeks for the result of their tests. Many medics will say that a delayed test means delayed treatment which in turn means delayed outcomes for patients. I too have worked with a family who lost a loved one. It was two weeks before the test result for the deceased came back to that family so they were unable to bury their loved one for two weeks. We had to chase up the test result for that family to relieve their stress. The criteria for testing at that point in the crisis were narrowed. They were not narrowed for clinical reasons but for capacity reasons and they still have not been broadened out again. Many people with symptoms of Covid-19 today will not get a test and the testing of asymptomatic people who have been in contact with confirmed cases, which is the Holy Grail in terms of actually solving this crisis, is still not even on the horizon. I understand that for a long time, testing reagents were simply not available in the quantities needed. Yesterday, startlingly, we found out that the State now has the capacity to test 10,000 people per day but how many is it testing per day? It is testing 5,000 people. We have the capacity to carry out double the number of tests that we are currently doing. That is an incredible figure given that we know how important testing is and that the WHO is saying "test, test, test". Capacity is no longer a brake on testing. Government policy is a brake on testing at the moment, which is startling news. I ask the Taoiseach to commit to testing at capacity immediately.
Finally, hospital avoidance is a radical problem at this time. It is a significant threat to the health and the life of people. I heard of one hospital that sent out 60 invites to individuals for elective colonoscopies but only four people turned up. I have also heard of a number of people, including cancer patients, who have had their particular engagements cancelled. I ask the Taoiseach to do two things today. Will he commit to ensuring that cancer patients will not have any of their treatments cancelled in this State and to a public information campaign telling people who are in need of elective procedures not to avoid hospitals?
It is estimated that a good chunk of the excess of deaths occurring at the moment are not Covid-19 related but are related to significant hospital avoidance.
On testing, we are all aware of the situation as mentioned by all of the Deputies who have spoken. I offer my deepest sympathies to all of the people who have died as a result of Covid-19. I apologise to the families of friends whose funerals I could not attend owing to the restrictions in place. Not being able to say their final goodbyes to partners, relatives and friends at that time has been difficult for all families. I apologise for that.
I commend the Government on its quick response to Covid-19. It did not get everything right, but it has done its best. There are talks underway between all parties and none on a programme for Government. I have repeatedly made the point that when it comes to the appointment of Ministers those appointed must have expertise in the area for which they are to be given responsibility. In terms of the Covid-19 pandemic, the Taoiseach's medical background was significant to the early identification of many of the issues.
I commend our front-line workers for all of the work they have done, often without suitable PPE equipment. Much of the PPE equipment we have was imported from China, where Covid-19 was first identified. Companies in Ireland whose factories are closed but have the machinery and the know-how to make PPE equipment or to alter the equipment that we received from China have offered their services to Government but there has been no uptake of this offer. I have contacted the offices of Ministers about this but only some Ministers have come back to me on it. I am disappointed that some of them have not bothered to text, email or telephone me in response to the very important questions I raised. As a Member of this House I expected at least a response by text or telephone call such that I could put people in my area at ease.
The position in regard to farming and farm work that needs to be done is unclear. People have asked for permission to do essential work on their farms. The harvest season for farming is almost upon us. Under environmental regulations farmers are obliged to lay silage slabs, work which had to be postponed for the last number of weeks. They are now being told by some people in government that they cannot get concrete or other basic materials to do this work, while others are telling them they can go ahead. We need clarity on this issue.
There are people renting houses in rural settings who are building houses in respect of which there is a small amount of work to be completed. These people are making rent and mortgage payments for which there is no relief.
Where social distancing can be upheld on these rural sites, where there is probably a week or two weeks of work left to be done, I ask that people be allowed to give back the rental houses and move into their new houses. They are being told they cannot do this and that there is no funding for them. We have seen HSE workers employed through agencies who are willing to help being given zero hours, but they do not qualify for the Covid payment as they are under contract to the agencies. This also needs clarity.
Our sympathies must go out to the families who have lost their loved ones, and our thoughts and support must go out to them in these shocking times. The support of all, including the State, must also go to our health and front-line workers and the people in the community and voluntary sector who deliver meals on wheels. All this is hugely important to the people in their homes at this time. The postmen and postwomen are working tirelessly.
PPE is vital in the fight to prevent people from contracting Covid-19. Health workers in many areas, whether in nursing homes or home help, still have little or no PPE. I have been contacted time and time again by home help workers who have no PPE whatsoever. They are going door to door and are on the front line. They deserve more respect than to be left without PPE and we need clarity as to why that has happened. It leaves them wide open and very upset. Why are the health workers left without this equipment?
Many Deputies have mentioned delayed results. I have had numerous calls from people who have been waiting two or three weeks for results, even the other day someone with stage 4 cancer pleading for his results. He will not be allowed get his treatment until he gets his results. It is not good enough that he is waiting for them. I was even told the other day by someone who left the country on essential business that our airports are carrying out no restrictions whatsoever. He sat on the aeroplane as he would sit at any other time in recent years. There are no restrictions whatsoever on people flying out of our country. Surely the airports and airlines must have the same restrictions as everywhere else.
Concerns in the community must be looked into. I respect that the Taoiseach has no magic wand to resolve all, but there is upset, especially among people over 66 years of age who are working. They feel badly done by. They are not asking for €350 in Covid money but are asking for the difference between their pension and the Covid payment to be given to them. They paid their taxes and continue to do so but have now been forgotten, just like rural social workers. These are part-time farmers or fishermen, many on the front line, delivering meals on wheels daily to people who need them urgently. They have lost their farming and inshore fisheries income and are left with €220 a week to raise their families. They surely deserve to have the difference made up to them, just like those aged 66 and on a pension. The only relief many of those over 66 have got in the past few weeks, after adhering to strict stay-at-home guidelines, is a grant of up to €500 from the Irish Red Cross and Age Action Ireland, two great organisations. This was to help with the comfort of our elderly. Applications were meant to be in by the end of August. Yesterday, unfortunately, it was announced that that application date had been brought ahead to tomorrow at 5 p.m., leaving tens of thousands of people who were looking for a few quid's worth of comfort unable to get their applications across the line on time. I urge the Taoiseach that the State step in to help these people at this time. As I said, they are staying at home, they are adhering to the rules and they need help. I ask the State to consider stepping in and helping the Irish Red Cross and Age Action Ireland on this issue.
Another issue affecting the elderly in Cork is the mail delivery service. The mail delivery centre in Cork was closed and moved up to Portlaoise. Now elderly people and many other people trying to conduct business tell me their mail has not come for four or five days. Elderly people are ringing me saying they cannot get their Southern Starnewspaper. Delivery is taking a week. These are small bits of communication these people need. In fairness to the Minister, he did give extra capacity to the broadband and mobile phone companies. This is very important at this time because many people are trying to work from home and in rural settings. However, is that being fed down into the rural areas where these people have returned to work? At the moment it has not in Bandon, Clonakilty, Skibbereen and Bantry. People living in such places have been on to me continuously.
The islands' economies are dependent on tourism. Due to the fact that islands are now closed to everyone but residents, that summer events have been cancelled and that ferries are running basic services, the islanders are worried. The populations of the islands had stabilised but they are now in a position whereby they might lose some of their people to the cities. What thought has been given to this? Again, I understand that a significant number of issues are at play but these are people's concerns. Tourism is the backbone of so many communities throughout the country. The hotel sector, cafes, restaurants and publicans are all in need of direction from the State because they are not sure where we are going. Will they be able to open their doors this year? If not, is something in place for them so that they can at least survive this crisis? We must look beyond this crisis. I need to talk about the farming and fishing sectors but I will do so at a later stage.
Tá dhá cheist agam, ceann amháin i nGaeilge agus ceann amháin i mBéarla. Baineann an ceann i nGaeilge leis na coláistí samhraidh. Thug mé fógra don Taoiseach go raibh mé chun an cheist seo a ardú. Tá a fhios aige go bhfuil cinneadh déanta ag an Roinn Cultúir, Oidhreachta agus Gaeltachta nach mbeidh na coláistí samhraidh ag dul ar aghaidh an samhradh seo. Tuigeann na mná tí agus na coláistí samhraidh é sin agus ar a laghad tá cinnteacht ann anois.
Is é an rud a chuir isteach ar an earnáil agus ar na mná tí seo go raibh an fógra lom agus gan aon tuiscint ar cé chomh tábhachtach is atá an earnáil seo do na Gaeltachtaí ar fud na tíre nó ar na freagrachtaí atá ag an Rialtas don Straitéis 20 Bliain don Ghaeilge agus faoin bplean gníomhaíochta a eascraíonn as an straitéis sin.
Fiafraím den Taoiseach an mbeidh sé sásta a rá go dtiocfaidh sé ar ais le sonraí ó thaobh pacáiste tarrthála don earnáil seo agus an fód a sheasamh i ndáiríre ar son na ndaoine seo mar tá rud difriúil i gceist anseo. Is é seo an chéad uair riamh a bheidh na coláistí samhraidh ar ceal. Níor tharla sé sin riamh roimhe laistigh de chéad bliain.
Sa bhreis air sin, tagann an earnáil seo faoi rialacha an Rialtais agus is é an rud is tábhachtaí an méid daoine agus gnóthaí atá ag brath ar an earnáil seo. Is croílár na nGaeltachtaí iad na coláistí samhraidh. Tá a fhios againn i bhfianaise a leochailí is atá an teanga agus na Gaeltachtaí, mar go háirithe bhí clár ar TG4 aréir - beidh an dara clár ar siúl an tseachtain seo chugainn - a chuir in iúl a leochailí is atá stádas na nGaeltachtaí. An féidir leis an Taoiseach mar sin teacht ar ais le sonraí ar phacáiste tarrthála atá práinneach?
I will zone in on nursing homes. The Taoiseach said that the real enemy is complacency. For me, the real enemy is us, as Deputies, thinking that we could rely on the narrative coming from this institution and other institutions. If experience has taught us anything, it is that we should never rely on the formal narrative. The real danger is that we would fail to learn - as has been stated previously by my colleague to my left - and that we simply cannot go back to where we were. We must learn.
On one level, this virus knows no bounds but, on another, there has been no equality in the way people have been treated. I had a quick look at the position relating to nursing homes with the help of the people who work with me and to whom I must pay tribute. This pandemic was declared on 11 March. When it was declared, it was accompanied by the comment that the virus was spreading so rapidly, the WHO had no choice but to declare a pandemic. The delay on the part of various governments in taking action was commented on. That was on 11 March. On 17 March, the Taoiseach travelled to the US. Less than five days later, there were four clusters in nursing homes but there was no action plan. On 24 March, there were clusters in nursing homes but there was no action plan. On 27 March, there were clusters in nursing homes but there was no action plan. I forgot to mention 26 March and other dates.
Finally, the Minister for Health, Deputy Harris, met representatives of nursing homes. It seems to me that nursing homes were utterly forgotten. To my horror, an expert from Trinity College Dublin told me that the issue in nursing homes had crept up on us. That captures my horror and upset. The real danger is that of losing the ability to feel upset at the level of deaths in nursing homes and residential centres, not to mention direct provision. Why were nursing homes not top of the list from day one? Why was action not taken and why is it not being taken in respect of direct provision centres, given that official briefing papers indicated an analysis was being carried out by the various local health organisations?
On private hospitals, as I drove to Leinster House today I heard that 75% of capacity in the two private hospitals in Galway is not being used. The State is paying €150 million a month to private hospitals. I ask that Deputies be given a copy of the contract with those hospitals.
The Taoiseach is a doctor but I am not. That said, I understand that in medicine one does not put an emergency plan in place unless there is an accompanying medical recovery plan to come out of the emergency. Do we have a recovery plan? Does it set out criteria for when restrictions can be eased, such as in terms of transmission levels or ICU capacity? If there are such criteria, what are they? Have we already reached them? Undoubtedly, restrictions will be eased somewhat. Although we do not know what level of easing there will be, we will need testing. What level of testing and contact tracing capacity are needed in order to ease restrictions? Will an app form part of the contact tracing capacity? Is such an app being developed? If so, by whom? Will it use open-source coding such that one can see exactly what is being developed, what the app can do, to whom it can give information and what information about people it is processing? I have many other questions which I assume will be replied to by way of written answers.
Absolutely. On being pressed for time, I must represent the country at the European Council which starts at 2 p.m. I would not like the country to be unrepresented at it. In addition, as Members are aware, there is a two-hour public health rule which states that we will become close contacts if we are in the same space for more than two hours.
I will first answer the questions asked by Deputy McNamara as he kindly left me time to so do. A recovery plan is in development. It is the plan to allow us to unwind the restrictions that have been imposed on people. We expect to receive it and to be able to share it with the public before 5 May. We very much welcome consultation with Opposition parties which wish to make submissions on the plan. There is engagement with unions, employers and other sectors of society on how the unwinding of restrictions can best be achieved.
An app is being developed by the HSE. I do not know whether it will be ready before 5 May, although the Government would like it to be ready by then. I do not know enough about the area to be able to comment on whether it is open-source data content but I will find out and revert to the Deputy.
On the criteria for when restrictions can be eased, they are essentially the criteria set out by the World Health Organization. There are epidemiological criteria such as whether the number of cases and other data are going in the right direction, which is important. Second, there is the question of how are we doing in terms of ICU, bed capacity and overall health service capacity. In addition, there is the criteria of whether we have testing and contact tracing in place to respond to a second peak or a return of the virus, if that were to occur. Those are the kinds of criteria that come in.
Deputy Kelly raised-----
What are the criteria in terms of transmission rates and ICU capacity?
On the app, the Department of Health stated it will not be open source. My fear is that it will lead to a similar fiasco to that created by the public services card which Philip Alston, the UN special rapporteur on extreme poverty and human rights, stated had no lawful basis and, obviously, did not have buy-in from the public.
We need to have buy-in for any app that will be developed.
On the open source issue, I do not know but I will check that out and come back to the Deputy. It is not an area I have particular expertise in.
We do not have exact numbers for the criteria yet. If there are to be magic numbers, they have not been set yet and we do not have any advice on that from NPHET yet. The criteria are the instance of transmission, including in relation to outbreaks in residential and other healthcare settings, ICU occupancy, which is an indicator of transmission in the community, and public health capacity, that is, having adequate testing and contact tracing in place. Those are the criteria.
In the time allowed, I will try to touch on some of the other matters Deputies mentioned. On the Government's response to Covid-19, and it is not just the Government but it is the wider Government, including the HSE, healthcare staff and all of us who are fighting this virus, I have always felt we are fighting it on six fronts, namely: PPE to make sure our staff are protected; testing and tracing; ICU capacity; ventilators and bed capacity; the economic and welfare package to protect businesses and livelihoods; societal actions such as social distancing and lockdown; and protecting vulnerable groups, including those in care homes, prisoners, Travellers, Roma, the homeless and those in asylum seeker accommodation centres. People often ask which one of those has been prioritised over the other but it has never been a case of prioritising one over the other. We have always tried to fight this battle on all six fronts. I never attended a meeting where anyone ever said we should prioritise nursing homes over PPE or testing over social distancing, for example. That is not how it works. There are six fronts with six battles and we are trying to fight on every front every day in order to give each one equal attention and as much attention as possible. We have been running into problems every day, whether that is with PPE, testing, vulnerable groups or the economic and welfare questions but we are trying to do our best on each of those every day. It is a misunderstanding of how this pandemic is happening and of the challenges we are facing to think we would ever somehow set out a ranking order and say that PPE was less important than nursing homes or that testing was less important than the homeless. That is not how it works on the six front lines I am fighting on and it misunderstands the challenges we are facing.
On transparency, I accept the points Deputies are making about the need for greater transparency but I ask for their understanding. People are busy and they are swamped. They are struggling to read their emails and to read the interesting and important documents being sent to them every day from people all over the country who want to help and make good suggestions. This is a rapidly changing situation. Facts and data change by the day. Things we thought were true a few days ago may not be true today. Even our understanding of what the symptoms of the virus are has changed in recent weeks. The data changes on a daily basis and is very often out of date.
On testing, I am advised by the HSE that there is capacity to ramp up testing to 10,000 people per day in the testing centres and ideally the testing centres will provide an appointment time 24 hours from referral. Hospitals are doing testing for patients and healthcare workers in the hospitals at a rate of about 1,500 tests per day. The National Ambulance Service has ramped up testing to an average of 1,500 tests per day. The testing criteria have changed over the course of the pandemic and they will change several times. Initially anyone with symptoms was eligible for testing. That had to be changed in line with the World Healthcare Organization guidance when we had a particular backlog to only include those who had fever as well as respiratory symptoms and also healthcare workers. NPHET intends to widen the criteria again. We have more capacity than demand at the moment, as was mentioned, so it will be possible to widen the criteria and NPHET will advise on that, perhaps as soon as tomorrow, with a view to widening the criteria next week so we can test more people. However, I need to be frank and honest with people. When the criteria are widened, it is done so on the basis that it is thought there will be extra demand but that is not known for sure. Therefore, there is an inherent risk in widening the testing criteria that we may find ourselves overwhelmed and running into problems with backlogs and so on all over again. That is not a mistake or a failure on behalf of anyone. It is just that one can only guess how much a change in criteria will impact demand. Everyone is doing their best on that front.
Deputies mentioned testing asymptomatic patients. Until a few weeks ago, the scientific advice around the world was that it was not useful to test asymptomatic patients because the viral load would be so low that the test would be negative even if the patient had coronavirus. That has changed and it now appears that SARS-CoV-2 can be picked up in patients who are asymptomatic.
People will be aware now that for the first time we are probably one of the few countries in the world, if not the only one, testing asymptomatic patients in nursing homes where there has been an outbreak. Two or three weeks ago, the science was that those tests would not be valuable and we did not have the capacity to do them anyway. However, we were always testing symptomatic patients in the community and in nursing homes.
On nursing homes more generally, the funding package is live and applications have been made to it. I believe that, so far, they have been small, but money, it has not been issued, will be soon. Personal protection equipment, PPE, deliveries are regular. As I said, testing is under way. I absolutely would have preferred that it would have been sooner if it had been possible. It was not possible because of the backlog and the prioritisation advice.
On staffing, there is an agreement with the unions to allow HSE staff to work in the nursing homes. It is voluntary and we are now asking people to volunteer to take up posts in nursing homes to help out there. In some cases, local hospitals have taken over governance. Dealgan House Nursing Home is example of that and there may be more. For the record, there are different types of nursing homes in this country: public, private, and voluntary. I have seen no evidence yet that shows that any one sector has performed better than the others in terms of cases, deaths or infection control. Those which have made the news have largely been public ones, but some of those are excellent institutions. Even in really good institutions where there are great staff, where there has been PPE available and there are single or double rooms, and where everyone has done everything right, we have still seen the virus get in just as flu does in the winter season. It is important to bear that in mind.
For the record, the Business Committee agreed to requests for questions and statements. If people consume all the time of the ten minutes making statements and including questions, it leaves no time for the answers. Deputy Martin's suggestion is best that the Taoiseach can respond in writing to points that he has not managed to cover.