Dáil debates

Tuesday, 30 June 2020

3:40 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I move:

That a sum not exceeding €19,897,700,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 2020, for the salaries and expenses of the Office of the Minister for Health and certain other services administered by that Office, including grants to the Health Service Executive and miscellaneous grants and that a sum not exceeding €30,000,000 be granted by way of the application for capital supply services of unspent appropriations, the surrender of which may be deferred under Section 91 of the Finance Act 2004.

As I stand in the House for the first time as Minister for Health, I am deeply conscious of the impact of Covid-19 on the people living in our country. We have seen our safe, well-ordered worlds of routine turned upside down. We have lost beloved friends, family members and neighbours and have been unable to mourn them as we want to. We have asked more and more of the people working on the front lines and behind the scenes in our health service. We have asked them to work relentlessly in the face of what must have seemed like endless days and nights. I thank every one of them from the bottom of my heart for all they have done. I know that the people they have worked so hard to care for do too. I thank our radiographers, porters, healthcare assistants, midwives, doctors, ambulance personnel, receptionists, nurses, and those in the hundred other professions that have cared for patients and kept our hospitals and other health facilities running so well in the face of this awful disease.

We need to repay their hard work, and that of many others outside the health service, by continuing to listen to the public health advice. This disease has not gone away. It is highly infectious and many people in our society are especially vulnerable to it. As we heard last night from Siobhán Killeen of the Dublin GAA team, even people who are fit and healthy can become very ill. We know that, even after people have recovered from infection, they can face weeks or months of after-effects. We have to keep up the good work or we risk losing the ground so many have fought so hard to gain.

It is, of course, very important that we reopen society and our economy but we cannot do so at the risk of another wave of infection around the country. I ask people to follow the advice of the experts, who have guided us very well so far. We still need everyone to wash their hands well and often, to maintain their physical distance from others, to try to limit their contacts with others, to observe cough and sneeze hygiene, and to wear a face covering where physical distancing is not possible. We need everyone to remember the symptoms of Covid-19 and to contact a GP immediately if they feel sick.

Covid-19 has affected every part of society, including our finances and previously agreed budgets. This afternoon, I seek the House's approval for this Revised Estimate for the 2020 Vote for my Department, Vote 38, to ensure the health service continues to be funded in 2020 to meet the significant and unprecedented challenges of Covid-19 and to ensure the funding of much-needed health and social care services for our people.

The original Revised Estimates for Public Services for 2020 were published in December of last year and included a total of €17.9 billion in Exchequer expenditure for Vote 38. Following this, the national service plan for 2020 set out the totality of planned services for the year, based on the December allocation. This included additional provision to advance Sláintecare objectives in 2020 and other key development priorities.

The delivery of the plan for 2020 has been severely affected by Covid-19, as the health services responded in an unprecedented fashion to the pandemic and incurred substantial additional costs in so doing. As a result, the Revised Estimate presented today provides an additional €2 billion to health in 2020. This brings the new adjusted total for the health Vote to €19.9 billion.

Today's debate has a very specific purpose. Approval of these Estimates provides the legal basis for the increased expenditure being incurred by the health Vote and will ensure that the health service is funded in the months ahead. The scale of expenditure to date and measures taken in response to Covid-19 and the overall impact of Covid-19 on the finances of the health system means that the passing of this Revised Estimate is essential to ensure compliance with the four-fifths expenditure rule.

The figures presented to the House represent the expenditure approved by the previous Government for Covid-19 measures to date. It does not represent the totality of the costs of Covid-19 for this year, nor an estimate of same. Significant further investment will be required this year in areas such as personal protective equipment, PPE, acute bed capacity and planning for winter 2020. We will also have to continue to assess the impact of factors such as the potential increase in those qualifying for medical cards due to economic developments and a potential reduction in private charge income to hospitals.

Today's debate is also an opportunity to begin a new conversation about our health service and its funding. The pandemic response has highlighted many strengths and positives in the health service. However, we know that our health service is challenged in normal times and was not best positioned to deal with the pandemic. Poor access to primary and community services, capacity deficits in acute hospitals in areas such as critical care and weaknesses in the governance and integration of services were handicaps that the health service has moved rapidly to deal with as best as it could.

We need to build on this work and in doing so ensure the health system has the capacity and capability to meet future demand. We know for sure that future demand will be influenced by a growing and ageing population, but as recent months have proven, we must also be ready for unexpected public health threats. A stronger more resilient health service is a national priority. The pandemic response has required the implementation of many of the key principles in Sláintecare, a single-tier health system for Covid-19 patients, care provided at home or in the community instead of in hospital, and telemedicine, virtual consultations, e-prescribing and other e-health initiatives. The benefits of these principles have now been demonstrated and we must apply these lessons across the system.

In recent months there has been significant investment and enhancements in capacity and staffing across the health system. This too needs to be sustained, as major additional investment will continue to be required to increase the capacity of the public system to better meet the health needs of citizens. As the reopening of the economy and society progresses, the many challenges that the health system faced before the pandemic still exist, but now must be tackled in a new and at times more challenging context. One of the most pressing tasks is to resume the operation of health and social care services in the face of a, thankfully, much reduced rate of Covid-19 infection. This will involve on-the-ground assessment and changes in clinical practice to prevent and control infection. It will take some time to clarify what level of activity will be possible to achieve in each of these settings. While the HSE is working on a clinical roadmap for the delivery of non-Covid services in a Covid environment, it will be necessary to reassess the targets set out in the national service plan. Capacity in many services will remain reduced and demand is likely to be higher than normal, both because elective activity was postponed during the crisis and because demand for many services may be higher than pre-Covid levels. Meanwhile, we will need to be vigilant in implementing the public health surveillance controls to avoid further spikes of Covid infections, while being prepared to deal with any upsurge in healthcare requirements if, as a country, we are not successful.

The programme for Government sets out the Government's vision to address both the long-standing and new challenges. Building on the Sláintecare vision and reflecting on the Covid-19 pandemic response, this Government has set as its mission the introduction of universal healthcare. The key building blocks to achieve this include the delivery of more care in the community, increasing capacity in the community and in acute hospitals, with an immediate focus on critical-care capacity, supporting the healthcare workforce and implementing e-health.

The programme also makes specific provision for enhanced care for older people and provides for the establishment of a commission on care and supports for older people. The delivery of this programme will require major investment in the public health service through both current and capital expenditure. However, it will also require major reform. This reform will not just be about how we deliver health services but also how we fund and invest in them. The programme for Government identifies the need for generally improved budgeting for demographic-related costs, which is particularly relevant to health services. Ministers will be required to produce service improvement and reform plans. As set out in the programme, spending on health will be prioritised for improved budgeting.

Returning to the Revised Estimates and the measures contained within, in support of the national action plan on Covid-19, €2 billion in additional gross expenditure has been approved to date for specific measures. This funding is incorporated in the Revised Estimate. Approximately €1.2 billion in additional cash has been advanced to the HSE to the end of June to meet the ongoing costs of managing the pandemic. As a result, my Department estimates that, based on current trends, the health Vote will reach the ceiling under the four-fifths rule for expenditure by August. Hence, this request to the House to endorse the Revised Estimate so as to resource measures to tackle Covid-19 and continue to deliver a broad range of health and social care services.

I will now outline the key health measures delivered to date under the national action plan on Covid-19. Further detail has been provided to Deputies in the briefing pack prepared by my Department. The first measure relates to testing and tracing. At the core of Ireland's Covid-19 response is a commitment to robust and continuing public health actions, including testing levels, contact tracing, modelling and surveillance to estimate the potential impact, communicating evolving public health messages and maintaining public awareness so that we can adapt our public health response as flexibly as we need to.

The national public health emergency team, NPHET, has recommended that the health service needs to have a testing capacity of 100,000 tests per week for the remainder of 2020. The HSE has put this capacity in place with 90% of all tests complete from end-to-end in three days or fewer.

The plan includes support for nursing homes and home support. The Revised Estimate makes provision for the temporary assistance payments scheme, which provides support to private and voluntary nursing homes to ensure that they can continue their role in the overall public health response to Covid-19. The nursing home sector cares for one of the most precious and vulnerable groups in society, and our goal is to protect older people wherever they are living. Priority actions include heightened infection control measures, supporting staff working in nursing homes, and ensuring their safety and health as we continue to deal with this pandemic.

In addition to financial support, the HSE is also providing substantial non-financial support in the form of PPE supplies, temporary accommodation for nursing home staff and through the crisis response teams, including deployment of HSE staff. There is also considerable support in the form of telephone support, infection prevention and control, IPC, support and public health support provided to nursing homes.

Revised arrangements with GPs were established to ensure that the people had access to triage services for Covid-19. I compliment GPs and everyone who works in general practice on how they have responded. Dedicated Covid-related respiratory clinics were set up in GP practices, and telephone triage was set up to facilitate remote access to services in line with public health advice. The clinical management of patients with mild symptoms of Covid-19 was shifted from hospitals to home and community settings. These arrangements were for an initial period of three months. However, key measures have been extended until 10 August 2020.

With regard to caring for people in acute services, the initial focus for acute hospital preparedness was on building up surge capacity to ensure the maximum number of critical care and general acute beds were available to cope with the potential number of cases requiring hospitalisation.

Baseline permanent adult critical care capacity in Ireland was 255 beds. Funding for a further 40 adult critical care beds, and two paediatric critical care beds, was provided as part of the response. In addition to the funding for increased critical care capacity, the response to Covid ensured funding for an additional 324 general acute beds.

The acute hospital system and critical care service have coped during this crisis.

While bed occupancy reached 280 critical care beds at the peak, the additional demand for critical care was met by surge ICU capacity. Thank God we did not see the scenes that some of our neighbours in Europe did with people needing serious acute care in hospital car parks.

The HSE secured 100% of the capacity of the private hospitals for an initial period of three months. As of Monday 22 June, 11,531 public patients have been treated as inpatients, 46,298 as day cases, 44,865 as outpatients while 71,967 public patients have been provided with diagnostics in private hospitals under these arrangements. This agreement concludes today, 30 June, and work is ongoing about future arrangements with the private hospitals.

The national action plan provided for a significant expansion of the health workforce. The HSE pay budget has increased by €490 million in these Revised Estimates due to the projected increased salary, agency, overtime and absenteeism costs associated with the response to the Covid emergency. The number of whole-time equivalent staff in the HSE has grown by 3,271 this year to the end of May. My officials are engaging with the HSE on staffing requirements for the remainder of the year to meet Covid-19 and non-Covid-19 demand.

As part of the response to Covid, there has been investment in the expansion of community care places, including those for persons with a disability, across the country. This includes advancement of projects planned in line with the disability de-congregation programme, as well as upgrade and refurbishment work on suitable facilities. In addition, arrangements were made for healthcare staff needing to self-isolate. These have largely been managed locally by the community healthcare offices of the HSE. Centrally, the main isolation facility established was Citywest. The HSE has decided to step down this arrangement and has triggered the break clause. The agreement will conclude on 22 October.

A key focus throughout the pandemic has been in the area of infection, prevention and control. In a time of global shortages and intense competition for personal protective equipment, PPE, the HSE, with the support of my Department, IDA Ireland, the Department of Foreign Affairs and Defence and others, managed to rapidly develop global and domestic supply of PPE. PPE will represent one of the single biggest items of expenditure associated with the Covid-19 response. My Department advises that HSE modelling has identified that the overall cost of PPE in 2020 could be as high as €1 billion. My Department and the HSE are engaging on this matter.

The additional funding allocated to the health Vote has allowed for a rapid and targeted response to implement the measures outlined in the national action plan. We remain in a pandemic and the scale of the challenge for the health services is unprecedented. Further investment will be needed, such as additional PPE, an enhanced 'flu vaccination programme for next winter, increased capacity and alternative arrangements with private hospitals. Such measures are under review by my Department in collaboration with the Department of Public Expenditure and Reform. The Government will be asked to determine additional funding allocations where necessary. Also subject to further review and deliberation are the achievability of national service plan savings, the loss of hospital income as a result of Covid-19, additional costs associated with recommencing non-Covid healthcare in an environment of physical distancing and heightened infection control and additional initiatives for the winter.

The health system responded quickly and efficiently to the Covid-19 emergency. Additional spending has facilitated necessary and rapid introduction of testing, provision of essential PPE, enhanced support to critical health services and introduction of additional hospital capacity and community services.

Existing oversight structures between the Department of Health, the Department of Public Expenditure and Reform and the HSE, including the health budget oversight group, along with new structures and processes, have facilitated timely decision-making during the pandemic while also ensuring high standards of governance are maintained. These structures ensure this significant investment is approved, monitored and reported in line with agreed sanctioning processes and financial procedures.

I commend the Revised Estimates for the health Vote to the House. It represents a significant but essential investment in Ireland’s pandemic response. Ireland has been successful in flattening the curve of coronavirus transmission. This pandemic has been an unprecedented challenge, met with great solidarity and fortitude by the people. We are going to need that continuing sense of community and responsibility as we take our first steps into a reopened country, travel around Ireland and learn to live with Covid-19. We all need to use our own judgment and take personal responsibility for protecting, not just ourselves, but those around us. I am asking everyone to be aware of the risks, keep informed about the disease and where it is in our community. People should check our online Covid-19 data hub before they leave the house, like they do with the weather. One should keep a log of the people one meets so that public health officials can contact them if they need to. We are not out of the woods yet. If we stay the course together, however, there will be a day when we are.

3:55 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Thank you, Minister. We congratulate you on your appointment and acknowledge that it is very much in the nation's interest that you succeed in the challenges that lie ahead.

I call Deputy James Browne.

Photo of James BrowneJames Browne (Wexford, Fianna Fail)
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I am sharing time with Deputies Robert Troy and Jennifer Murnane O'Connor.

I wish Deputy Stephen Donnelly the best of luck in his new ministerial role. He is a highly capable Deputy. I have been glad to serve beside him for the past number of years. I look forward to significant reform and delivery that I have no doubt he will deliver under his stewardship.

I express my sympathies to the families of those who have passed away since I last spoke on this issue in the House. It is deeply difficult to lose any loved one. What some families have had to go through with Covid and burying loved ones without being able to do it in the manner that would befit those who passed away is extremely difficult. I acknowledge the will and the strength of the people for the past several months, as well as those who continue to do their very best for our communities.

I acknowledge last night's "RTÉ Investigates" programme. We owe a huge debt of gratitude to our front-line workers. The selfless and life-saving determination of those health workers we witnessed in that programme is phenomenal. I acknowledge their compassion, dedication and the sensitivity with which they handled extremely difficult circumstances. What we saw last night in St. James's Hospital is reflected across our healthcare services. Our doctors, nurses, healthcare workers, paramedics, porters, catering staff and security staff in hospitals and healthcare centres deserve phenomenal respect and thanks. Covid is an ongoing situation. If there is anything we can do to acknowledge the determination and effort healthcare staff have made, it is that we follow the Government's advice in terms of continuing to use alcohol-based sanitisers on our hands when going in and out of supermarkets and so forth, to use face masks where advised and continue to remember the sacrifices that our front-line workers have made during the lockdown. It is not just our healthcare workers but our postal workers, public and civil servants, gardaí, volunteers, and staff throughout the public and civil service have done phenomenal work. They deserve a huge acknowledgement.

Covid-19 has led to an unprecedented interruption in healthcare delivery across the world. It has affected services across all of our hospitals and community care settings. The programme for Government pledges that the resumption of services will lead to the delivery of services in a planned, appropriate and considered manner.

I want to focus on how this pledge will impact on our mental health services and drugs services. The outbreak of Covid-19 has created significant anxiety, stress and fear among many people, reinforcing the need for a range of mental health supports and services. Sharing the Vision - a Mental Health Policy for Everyone is a new national health policy focusing on a stepped care approach to enable individuals to access a range of services that best meet their needs and circumstances as close to home as possible. It retains multidisciplinary staff teams as the cornerstone of support to individuals with mental health concerns attending primary care services. By providing more assistant psychologists, occupational therapists and other key workers, we will create a flexible approach and encourage more collaboration with acute services in the voluntary and community sectors. We will ensure that any new services, such as Outreach, are supported by community cafes and intensive rehabilitation units. Care will be provided to vulnerable people in a variety of inpatient and community settings.

The outbreak of Covid-19 advanced the development of online training, counselling and crisis texting in our health services. This is very much welcome. Through the promotion of digital health interventions, such as online training, safeTALK training and a new pilot telepsychiatry services, including in emergency departments, we will significantly improve access to mental health services.

A Vision for Change, the predecessor document to the new national policy, set a high standard for the development of mental health policy, but it did not have an implementation plan effected to ensure that outcomes were being measured. Sharing the Vision includes an implementation roadmap, with outcome indicators, and allocates ownership of the recommendations to lead agencies, with time-bound implementation targets against each action.

In further developing our mental health services we will work to end the admission of children to adult psychiatric units by increasing inpatient beds, as well as by examining the model of assigning these beds. We will open the new National Forensic Mental Service hospital in Portrane. The programme for Government also commits to examining the need for the appointment of a chief psychiatrist in the Department of Health and a national director for mental health in the HSE to help co-ordinate and make more efficient the delivery of mental health services throughout the State.

A health-led approach to drugs misuse will be key in drugs policy. Substance abuse and addiction affects people from all walks of life. By treating the use of substances as a public health issue, rather than solely as a criminal issue, we can better help individuals, their families and the communities in which we all live. I am glad to see that the refresh of A Vision for Change will correct a most egregious anomaly whereby those who had addiction issues were treated separately from those who had mental health issues. I am glad to see this finally being addressed. The national drug strategy, Reducing Harm, Supporting Recovery 2017-2025, provides a roadmap to achieving these aims by promoting a more compassionate approach to people who use drugs, with addiction treated first as a health issue. We will also see the committee for Reducing Harm, Supporting Recovery linked to the Sharing the Vision implementation committee. It is critical that there are cross voices on those two committees, to reassure and reconnect the connections between mental health and drugs issues. There is huge hope here but the key issue will be in the implementation of our mental health policy and our drugs policies.

4:05 pm

Photo of Robert TroyRobert Troy (Longford-Westmeath, Fianna Fail)
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I add my voice to the congratulations to the Minister, Deputy Donnelly. He comes into the role with a wealth of experience. It is very important that the new Minister can hit the ground running. Of all the Departments within the new Government, this Department perhaps has the most challenges. It is welcome the Minister, Deputy Donnelly, knows what needs to be done straight away.

I also add my voice to the thanks to the people who work on the front line. If anyone was in any doubt, last night's programme hit home the level of compassion, care, volunteerism and of going over and beyond what is necessary. The programme was a testament to them. We salute all our heroes across the many aspects of our health service and all the people who have worked on the front line in the past weeks.

I have a number of specific questions on which I hope the Minister, Deputy Donnelly, can come back to me today or later on. With regard to public health consultants within the area of community infection prevention and control, I understand there is an issue around their contracts and the threat of a strike. The area of infection control is important and I wanted to bring this to the Minister's attention as something he needs to look at very early in his tenure.

As we discuss supplementary budgets, will the capital budgets announced at the beginning of the year be ring-fenced? Is there a guarantee that projects committed to, for instance, a particular hospital or service, will proceed? I am thinking, for example, of the MRI scanner for the Midland Regional Hospital, Mullingar. It was part of the 2020 service plan. Some €2 million was allocated to the building of the hospital wing that would accommodate this scanner, for which local community groups fundraised. The funding is now in place and I want to ensure the money ring-fenced for this will be there, and that the scheme can advance during this year.

I turn to the advice by NPHET around places of worship. Last week a decision was taken that one size does not fit all. Comparing a small rural church to a big cathedral that may hold 2,000 people, then regardless of the size of a church, restricting numbers to 50 people does not work. The church authorities have made a lot of effort to try to bring about proper protocols so they could commence holding confirmations and Holy Communions. I have been contacted by many families in my constituency who are worried that these sacraments cannot proceed for their families. I am quite conscious that not everyone will be worried about this as an issue but there is a sizeable number of people in our constituencies who are worried. The original guidelines were reversed and then the reversal was further reversed. I ask the Minister to bring clarity to the matter so that people will know, depending on the size of the church, whether or not the 2 m rule will be adequate to ensure the protection is in place. Nobody is talking about compromising public health.

We should never waste a crisis. Covid-19 has identified an opportunity to bring about the necessary reforms within the HSE so that the people for whom the HSE was established to serve are best served. We need to ensure there is no longer a situation where the delivery of a treatment or service depends on the region of the State a person lives in or how deep his or her pockets are. Treatment and service should be universally available to everybody depending on medical need. If the Minister, Deputy Donnelly, can ensure this happens during his tenure, then it will be a job well done.

Photo of Jennifer Murnane O'ConnorJennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I too wish our new Minister well in his role. There are many challenges there and healthcare is so important to all of us. It does not matter whether a person has private health insurance, a medical card or whatever, everybody is entitled to the same treatment. We have to go forward like that, all working together. I pay tribute to the healthcare front-line workers and to everyone who worked so hard over the past months. It has been very hard. We should appreciate everyone who worked so hard.

With regard to the schools vaccination programme and the students who would ordinarily receive their vaccines but due to Covid-19 restrictions have not, will these students receive all their vaccines this year? Will they be accommodated in the autumn roll-out of vaccinations countrywide? Will dental patients on medical cards be able to access the National Treatment Purchase Fund, NTPF, to have pressing procedures undertaken? This is one of the biggest issues given the number of telephone calls I have had on it. Perhaps the Minister will provide clarification on this in writing, because it is important to get it sorted so everybody can get his or her dental treatment. Does the Minister know the waiting list times in the HSE schools programme for children under 16 years of age awaiting approved braces, or HSE dental procedures? Is there a breakdown of procedures available? Does the Minister know if there is a timeline for these procedures to take place, given the Covid-19 restrictions? I know the Minister will come back to me with these details.

I am aware of another serious issue that needs to be addressed, and on which I have had several telephone calls over the past months. If a medical card holder is charged for blood tests, can he or she be refunded by the HSE? People from Carlow town, Tullow, Bagenalstown and all over the constituency have telephoned me about this. Some of them are being charged for their blood tests even though they are medical card holders. Can one get a refund? Is there a system where the money can be claimed back from the HSE? There has been so much confusion over this. I have been on to the HSE but I find that I need to get the matter clarified. Can one actually receive a refund? If a person holds a medical card then he or she should not be charged for getting bloods done.

People have come to my office and told me that they could not afford to have blood tests done even though they had medical cards. Can we have clarification and will the Minister revert?

I wish him well. There are many challenges. He might be able to revert with answers now, given that we have a few minutes left.

4:15 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Does the Minister wish to respond? I am afraid that there are only seconds left.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes. On the Deputy's various points, I will get her a detailed briefing and offer her a meeting with the officials, given that different officials will handle the various questions. We could then go into the detail of the school vaccination programme.

As to using the NTPF for dental procedures, a part of the programme for Government is the expansion of dental services. That is definitely an issue that has to be examined.

Establishing a timeline for orthodontic services will be an important part of the HSE's resumption of services plan, which is being put together right now. I will ensure that the Deputy gets a note on its status. I will also pose the question, and be happy to discuss the issue with her later, relating to medical card holders and blood tests. I will ensure that she gets a detailed note on same.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Now we move to the Deputy O'Reilly of Sinn Féin, who is proposing to share time with Deputy Paul Donnelly.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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We will share our time ten minutes with five minutes apiece. Within the confines of my ten minutes, I wish to allow a minute or two for the Minister to respond, if that is okay.

Like others, I will take the opportunity to wish him the very best in his new role. It is a great honour not just for him, but for his family and friends, to serve as the head of the health services for the coming years. Having sat on the Opposition benches and the health committee with him, I know that he has an understanding of the issues and the crises facing the health services. While we might disagree on the required solutions, he is aware of the level of work that is needed to rectify the many strands of the health services that have been forced to struggle due to the actions of his predecessors and previous Governments.

The new Minister can be sure that, as I did with his predecessor on repeal, Covid and other significant healthcare matters, I will work constructively with him and offer solutions. Although I will be constructive, I take my role as the lead Opposition spokesperson seriously. I will work and engage constructively with those on the Opposition benches as well as the Government benches for the improvement of health services for patients and healthcare workers alike. I say this notwithstanding any signal that came from others on the Opposition benches at the weekend. The Minister can be sure that, while I will be constructive, I will also hold him to account. It is no more than he would expect.

With those formalities out of the way, I will turn to the Revised Estimate. I welcome the questions and answers format. It is a new departure and a good idea, and I will divide my segment into seven minutes and three minutes.

I have to be critical of the presentation of the Revised Estimate. This is not intended in any way to be critical of the Minister or how he will run the Department in future, given that this Estimate came to us last week when the Department was still the responsibility of the previous Minister, Deputy Harris. It was only a few hours before we came to the Chamber to review an estimated spend of €20 billion on the health services that we received a briefing document. That document did not offer much in the way of clarity or definitive detail as to where exactly the additional Covid-19 spending would go and how it would be spent. I thank the Minister and his office for the briefing, but it was scant on detail. I hope that this is not a sign of what is to come and that we can expect more detail in future. I also hope that he will ensure that, under his stewardship, the presentation of Estimates will change substantially, incorporate greater detail and be open to scrutiny by the health committee.

I remind the Minister that it was only last year that he called on the then Minister and the departmental officials to read the Parliamentary Budget Office's report on the Revised Estimates. He stated that it was "impossible to conduct decent scrutiny because the numbers are not comparable" and "there are a number of challenges in undertaking effective scrutiny of this money ... [because we are not able] to compare the figures from today to the figures from December ... because the [figures] are not like for like." Unfortunately, the same applies today, but we have the added complication of additional figures being inserted because of Covid-19. In this Estimate, we have subheads such as Primary Care Reimbursement Services Covid 19 Actions at €110 million, HSE - Covid 19 Actions at €1.6 billion and Capital Covid 19 Actions, including ICT, at €220 million. The briefing document that we received a few hours ago tries to give additional information, but it falls short of presenting a detailed breakdown of where and how the money will be spent beyond the inclusion of micro-subheadings. I will cover this matter more in my questions at the end.

There are many questions that we have to ask of the Minister and the Estimate is an opportunity to do so. Will this money be used to retain the bed capacity that was secured to prepare for a surge in the pandemic? Hundreds of beds were reopened, yet we hear today that there are 192 people on trolleys. For years, I pleaded with the then Minister to open closed beds only to be told that there was none available in the system. The Government magicked up 1,000 beds, though. We need to keep them open.

While we are on the subject of trolleys, will the Minister continue to refer, as he did in opposition, to the INMO trolley figures, which are taken every day? It is ridiculous that successive Ministers get into a row with the organisation that compiles these figures. Can we settle on using the INMO figures from here on out?

How is it possible that some parts of this Revised Estimate have not changed since the Revised Estimate in December? It is unbelievable that the Department would produce this Estimate and maintain that some areas of spending outside of Covid-19 will not increase or decrease by virtue of the new dynamic facing the health service. It is also probable that there will be a slower than usual provision of treatments and procedures due to the new ICPs. Such a situation may result in changed figures from those included in the Estimate. Consequently, I do not know how the parts of today's Estimate that are outside of Covid-19 changes can show the same spending as December's Estimate. Deputies and the general public take into account that the deferral of treatments may result in increased costs when treatment is ultimately delivered. An analysis of basic health economics shows us that delayed care can mean an increase in costs, as diagnostic tests may need to be retaken and illnesses might become more advanced, necessitating more intensive treatments and longer inpatient stays. Depending on the scale of the effective reduction in the use of the public health service, there may be increased waiting times for inpatient and outpatient procedures post the pandemic. All of these effects are likely to result in a significant knock-on effect on non-pandemic public healthcare spending late in 2020 and into 2021. This has not been factored into the Revised Estimate. I am also cognisant of the fact that, unless and until an effective Covid-19 vaccine is developed, increased costs for PPE, contact tracing and so on will continue to put spending pressures on Vote 38. This means that we may well be back debating Supplementary Estimates later in the year.

My questions relate to areas where there should be more detail from the Department. For example, beyond stating that sanction for the €110 million under the Primary Care Reimbursement Services Covid 19 Actions subhead was provided to the HSE on 16 March in respect of GP services and is included in the funding approved by the Government, we have no further breakdown of how that amount was distributed, who received it and for what. Other procurement accounts for €89 million, which is the estimated cost to date. What does that incorporate exactly? Similarly, will the Minister clarify whether the planned €62 million relating to absenteeism relates to sickness due to Covid-19? There is a planned cost of €74 million on ventilators, with €18 million already spent. Can we get additional details on the number of ventilators procured and do we now have a sufficient quantity, including to cope with a potential second wave?

Some €9 million has been spent on the Citywest isolation facility to date. I understand that the contract has been cancelled. Is the State liable for the remaining €16 million outlined in the planned costs section of the departmental briefing?

Approximately €320 million has been spent on PPE, as outlined in the report of the Parliamentary Budget Office. Despite that, we have consistently been told that the HSE has spent €1 billion on PPE. Which is it? Who is correct and how much has been spent?

The private hospital deal is estimated to cost €258 million by 12 July. Will the total spend equal the planned gross cost of €426 million? Will the Minister provide some clarity on this matter? We do not have additional information on what we have got so far for the €258 million. What use has been made of the capacity? How many procedures have been carried out? Does it represent value for money? Has the Department considered these matters?

It is disappointing that we do not have a further breakdown of the information. The Minister would share my disappointment were he sitting over here on the Opposition benches. He has promised a new departure in the Department of Health.

Will the Minister examine, where the capacity exists, the purchase not of services from the private sector but actually the purchase of the facilities themselves, if they come up for sale? It has been done in other jurisdictions, it makes a lot of sense and it represents good value for money. Rather than paying in to the private sector which has to take a profit off the top, if the opportunity arose would the Minister consider purchasing those facilities from the private sector?

4:25 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Maybe we will hear Deputy Paul Donnelly because there is just a minute left.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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That is fair enough.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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The Minister may correspond with Deputy O'Reilly.

Paul Donnelly (Dublin West, Sinn Fein)
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I also congratulate Deputy Stephen Donnelly on his new role as Minister for Health. I wish him well and commit to working with him in a positive and outcome-focused way that ensures that we deliver for and with our communities. As Deputy O'Reilly said we will also do our best to hold the Minister to account, as is our role.

Covid-19 has shown once again the true spirit of community that when needed, they are ready to help in whatever way they can. We must ensure that we harness, nurture and cherish the skills and expertise in the community. I have been involved in working and supporting communities in Blanchardstown for nearly 25 years. I have seen the highs and lows of community-led action to tackle problematic drug use. I was a founding member of the local drugs task force and several drug and youth and community projects. To be honest, we have gone back about 25 years when it comes to our voice being heard. Unfortunately our voice is being ignored by HSE management in particular. I have read in detail the programme for Government and the promises made on drug and alcohol services. In the future I would like to come back to the Minister on some of those concerns but for now I have a couple of questions.

I recently asked the previous Minister for Health, Deputy Harris, about supports for community drug projects and for funding for PPE and I note that the Minister mentioned earlier that there was a potential cost of over €1 billion for PPE for the HSE. Unfortunately, the answer I got back was that community drug projects across the State are not getting any funding whatsoever for PPE or for any adjustments that they need to make to their facilities. This shows a complete lack of understanding of funding of community drug projects.

As someone who is currently a board member of the Dublin 15 Community Drugs Team, every cent is spent and accounted for every year. There is no capacity for PPE and no capacity for us to be able to change the way our building operates to enable us to operate the service in the best way we possibly can. There is no leeway in funding and there is no magic tree there we can go to. Our funding comes primarily from the HSE and unfortunately that has been rejected.

We provide a programme called the Arising Stabilisation Programme and I invite the Minister out to see it in the future when we do get back up and running. It is a huge support for older, more vulnerable participants in our project and we have real concerns about how we are going to get that back up and running again. The feedback we have gotten over the last number of weeks and months when the project has been closed and we have been dealing with people through Zoom and one-to-one phone calls etc. is that these are deeply vulnerable people who need real one-to-one support. How we are going to do that given the costs that are going to be incurred by us? Renting other rooms is another additional cost that we cannot meet and that community drugs teams and other community services just do not have funding for into the future. Looking at funding it is really important, now especially. Will the Minister look at funding for community drug teams and how that is supported from now until the end of the year? Most likely it would need to be into the new year because as I said we do not have the funding to be able to do the work that is needed.

Drugs affect all communities and none is immune to their devastating effects. However, some are more affected than others and we work in very disadvantaged areas. Will the Minister give a commitment that disadvantaged communities be given a real voice at the table, from the top, on the national strategy and then on the ground with the local drug task forces? CityWide Drugs Crisis Campaign has looked at the programme for Government and at many other programmes for Government and national drugs strategies. They have said: "We have consistently argued for the strengthening of the role of the DATFs and for resourcing of the DATF projects and we need to see this Programme finally delivering on the resources required." That is really critical as we move forward because that community has been really affected during the Covid crisis.

I have one other question around vaccines. Are there any plans to make the flu vaccine free for all citizens to take pressure off the services if a second wave materialises? I was talking to a health official last night and one of the official's big concerns is around Covid-19 combined with the flu coming into the winter and how we are going to cope with that.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Deputy Griffin is sharing with Deputy Durkan. They have 15 minutes.

Photo of Brendan GriffinBrendan Griffin (Kerry, Fine Gael)
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I thank the Ceann Comhairle. Deputy Feighan would like some time as well if that is okay.

I congratulate the Minister, Deputy Stephen Donnelly, on his appointment, I wish him the very best of good fortune into the future. I want to echo the Ceann Comhairle's words earlier as well - when the Minister is successful in his job and is doing a good job it will impact on the lives of many people. I wish the Minister every success and offer him every support as well. I hope everybody in this House will do likewise because he is in what is ultimately a life and death Department. It is a very serious position, one of huge responsibility. I have no doubt it is a daunting task for any Minister for Health to step up to the mark and take on the job and I wish him the very best in the time ahead.

I also want to take this opportunity to acknowledge the role of the former Minister for Health, Deputy Simon Harris, and acknowledge all of the work that he did. It was a very difficult task indeed and particularly in the context of Covid-19 it was a hugely challenging role. I also want to acknowledge the former Ministers of State who served with him, Mr. Jim Daly, Mr. Finian McGrath and Ms Catherine Byrne for their work. They are no longer Members of this House but I want to acknowledge the years of work that they put in as well in the service of the people of the State.

I welcome the opportunity to speak on the Revised Estimates. It is very important that the necessary and required investment be made and approved by this House. I want to acknowledge the outstanding response that there has been to date to the Covid-19 crisis by everybody involved in our health services. When I talk about everybody I mean everybody who is at the front line in our communities throughout the country, everybody who has been working behind the scenes in all of our health facilities, everybody who is working in the Department of Health and the HSE and all of the team who have undoubtedly played a huge part in saving many lives all over this country. We will perhaps never know the people whose lives were saved. We can however be quite certain looking at other countries and the huge devastation felt there that thankfully we have not had the types of numbers that some countries have experienced. We can be pretty sure that there were many lives saved here.

I also acknowledge the huge suffering that is still ongoing and the huge loss that is being felt by people. Many families throughout this country are grieving loved ones right now and have not even come to terms with what is happening yet. One person I spoke to recently who lost a family member was saying that it is all like a blur; we are still in the middle of this crisis and maybe it will hit us sometime soon, or perhaps later. I want to acknowledge those people. In my thoughts today are the thousands of people around the country who are mourning a loved one and who perhaps did not get the opportunity to say goodbye to them in the way that we would normally do and in the way that is customary, something that has been very painful for people.

It is very important, as the Minister said, that we continue to remind everybody that this crisis is not over.

One of the biggest risks this country faces at present is complacency that we are over the worst of Covid-19. We know it has not gone away and we know there is a risk of further new cases and, unfortunately, further deaths. The soundings that have been coming from people such as Professor Holohan and many others in recent days need to be amplified. This is why I was glad to hear the Minister's comments today. It is very important that we continue to remind people they need to be careful and look after themselves and others in the time ahead. I commend "RTÉ Investigates" for the programme aired last night. It was timely given that we moved to phase 3 of the roadmap yesterday. The programme showed people just how serious this is and how important it is that we continue to be vigilant and look after ourselves and each other.

I hope the Minister's tenure in the Department will be successful and I wish him and all the people working in the health service the very best in the continued fight against Covid-19.

4:35 pm

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I am glad to have an opportunity to contribute on this very important issue. I congratulate the Minister on his appointment and wish him well. We were colleagues on the health committee in the past and I assure him that I will be constructive, innovative and progressive as required. There is no doubt that the challenges ahead are numerous and no more difficult than the challenges of recent years. The Department has received a great deal of criticism in recent years. It was alleged that it did not have the ability, personnel or commitment to deal with the crisis or the commitment of the Government. The list goes on. The fact remains, and it is blatantly obvious now, that the Department, the HSE in general and every member of the health services on the front line, middle lines and back line committed themselves, in the past six months in particular, to dealing with the crisis and they did it extremely well. We owe them a huge debt of gratitude for the work they did and undertook. They succeeded not in bringing the virus to a halt but certainly in containing it and I hope that will continue.

I hope the Minister will be able to continue the work of his predecessor. I acknowledge the role played by his predecessor, who was in a very difficult situation at a sad time for the country, the services and everybody. He continued stoically to deliver and stayed with the system, keeping in mind the central role that had to be played and he did so successfully.

In the past, I have strongly supported the democracy of the health services, in the sense that much can be learned from those at the coalface and those at ground level throughout the regions and in every aspect of the delivery of the services. They are the people who know first hand what is required. They know it earlier than most others. The important thing, particularly with regard to Sláintecare, is that as it develops barbs may well appear from time to time to hold up the system and slow down the smoothness of the evolution of the health service that is now envisaged. This will need to be monitored and the Minister knows this better than most. There will arise occasions that perhaps were not anticipated and they will need particular treatment and this is important. I know he has the nature to deal with this type of situation as it arises.

Another aspect of the system we need to look at now is the degree to which community care is developed in future, including home care for patients who have the option of being cared for at home. As I have said previously, this costs money. It is not free and it requires good organisation. We also have the ongoing demands with regard to children with special needs. We need to try to ensure the health services extend to those children everything that is possible as and when required.

We also need to look at the medical card system and how it operates. Something that is quite annoying is when, for example, a person making an application might not be familiar with the bureaucratic system and may not supply all of the information required. It is particularly irritating that such people are informed the file is closed and that a new application must be made. It may well be that many of these people are in poor health or are in fear of their emerging health situation. They may have many demanding issues on their minds at the time and cognisance needs to be taken of the fact that they need to be listened to carefully and accommodated in so far as possible in every which way.

I wish the Minister well and I hope that he can rise to the occasion and deal with the long list of issues ahead of him. We will help him in every way possible. He might not think it is helpful at the time but we will do our best.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I wish the Minister every success in the coming months and years. He will have my full support in everything he does because the health service is so important to us. We have seen during the Covid crisis just how important it has been. I pay tribute to the front-line staff who have delivered huge resources and have worked extremely hard. My sympathies go out to the families of the more than 1,700 people who have passed away.

I am from the constituency comprising Sligo, Leitrim, north Roscommon and south Donegal. Nine years ago, we had an issue in Roscommon University Hospital with the downgrading of the emergency department. It generated a lot of media coverage locally, nationally and probably internationally. I invite the Minister to Roscommon University Hospital to see what a great hospital it is now. It is a state-of-the-art hospital. It is a shining light of the small hospitals throughout the country. Management, the HSE, the Department of Health and staff are working together. It is a safe hospital. It is twice as busy and, with the air ambulance and advanced paramedics, it has saved hundreds of lives. I invite the Minister to see the great news that has happened in the past nine years. The endoscopy unit is up and running and the Mayo and Roscommon hospice is being built beside it. I want the rehabilitation unit for the west of Ireland, which will be a step down facility from the facility in Dún Laoghaire, progressed as quickly as possible. The Minister is very welcome to come and see the hospital. The only problem with it now is that it is so busy there is no car parking. Perhaps some could be built.

There is another issue in Sligo University Hospital. One year ago, we had the national cardiac review and we are expecting an update. When is it coming? We need to see the new cardiac cath lab in the north-west placed in the hospital. I would also like updates on the issue of the north west hospice and the new medical block at Sligo University Hospital. When the Minister comes to the north west, after the Covid crisis is over, I want him to visit the hospital and meet the management and staff. It is vital that he does a tour of these two hospitals.

Last week, I raised with the former Minister, Deputy Harris, the issue of adopting a common sense approach to allow churches to reopen. They have worked extremely hard and brought out advice and proposed new measures. I understand there will be meetings with the Minister and church leaders in the coming days, although some may have already taken place. I would like an update on this. We need a common sense approach to the bigger churches in the larger towns that can accommodate 1,500 to 2,000 people. They are prepared to work with the Minister. They understand the implications of the Covid health crisis. We need a common sense approach.

4:45 pm

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Does the Minister want to respond to any of those questions? There is a little over a minute remaining. The Minister might correspond with the Deputies on some of those matters.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I can do so. The main questions in that section were raised by Deputy Feighan and I acknowledge the offers of support from the various Deputies. We are in this together, we need to fix it together and I look forward to working with everybody on it. As we have Deputies living all over the country, that local intelligence will be important, be it on local primary care centres, hospitals, cardiac units or ambulance services. Having that information feeding into the Government from all over the country is an essential part of one of the many roles the Oireachtas can play in making sure every part of the country is heard.

I acknowledge the invite to the hospitals from Deputy Feighan and will take him up on that. I will get the Deputy a detailed briefing on the hospitals in the north west and provide him with an answer on when the national cardiac review will be published. If the Deputy would like to meet me and the officials, or both, for more detail afterwards, we will set that up quickly.

Ossian Smyth (Dún Laoghaire, Green Party)
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I would like to sincerely welcome Deputy Donnelly to his new role as Minister for Health. In opposition, he was both insightful and constructive. I hope and expect that the Minister will bring that insight and expertise to the continuing reform of our health services. I would also like to take this opportunity to thank the former Minister for Health, Deputy Harris, for his service. The real character of a man is sometimes revealed when he is under stress and the stress was unique during the pandemic.

We are here today to assess the additional budgetary requirements for the health service for the remainder of 2020. We recognise that apart from the pandemic, there continues to be underlying pressure on health service costs arising from inflation in a variety of areas, including the areas of drugs, salaries, high-tech diagnostics and treatment options. We are clearly examining a large incremental budget from the health service today. We recognise that the structure of the budget and the way it is reported make it difficult to scrutinise this ask in great detail. Paul Reid has said on the record on multiple occasions that he expects to be in front of subcommittees in this House explaining and defending the additional HSE funding and we look forward to having an opportunity to investigate that further. Can the Minister confirm that it continues to be our intention to engage with the HSE on the detail of the incremental Covid-19 spending, while recognising the reality that much of the expenditure was battlefield spending with decisions rightly made at great speed and sometimes without the level of scrutiny we would have applied in normal times?

Clearly, the additional expenditure on PPE will represent a major line item for the HSE for the foreseeable future. It is right and appropriate that we seek to protect our front-line healthcare personnel. We have all stood at our front doors and clapped for our front-line workers but sufficient investment in PPE is the first and most practicable way we can demonstrate that support. What is the Minister's view on the likely long-term trajectory and strategy on PPE? Does he expect it to be a permanently substantial budget line item? Assuming he expects it to be permanent, does he have a view on how we should optimise the long-term supply chain for such PPE? Specifically, should we negotiate longer-term arrangements or options for international supply or should we seek to build national capacity, a national stockpile of PPE, or both? We do this with our oil reserves so should we do the same thing with PPE? We all watched with bated breath as aeroplanes took off from China carrying emergency supplies that we did not have time to check through and not all of it suited. It is important to have a long-term strategy about how our PPE supplies should be kept in reserve and delivered and to examine the question of whether they should be manufactured in Ireland.

Another major item in the budget reflects the costs that were incurred in securing private hospital capacity as an insurance policy against a large surge in acute hospital or ICU capacity during the pandemic. I note the Green Party's support in government for this initiative, as we voiced our support when we were in opposition. The open book accounting arrangement was a reasonable way to conduct the transactions at short notice. It should be no surprise to anyone who has read these budgets that the costs of owning and running a major acute hospital are substantial. Having this kind of surge capacity access going into the future will be a major asset in our strategic pandemic planning. What is the Minister's view on whether and how we should continue to hold an option over exercising a similar, fair and fairly compensated takeover of private hospital capacity during any future pandemic?

The original 2020 operating metrics, targets and service level agreements have not been updated in this Estimate to reflect the impact of the pandemic, which is completely understandable. The Parliamentary Budget Office considers the failure to estimate the impact of the pandemic on existing metrics, context and impact indicators to be a matter of serious concern. I can understand this sentiment but not in the short term. That normal business, including most medical business, was suspended for four months clearly means some targets will inevitably be missed by a wide margin. It is not fair or reasonable to expect that the Department of Health and the HSE should have fully updated their metrics by now. There are two reasons for this. First, we are still in a pandemic and it is fair to say that all our healthcare professionals, including administrative staff, continue to be focused on saving lives rather than updating metrics. Second, if they were to attempt a short-term update, the huge uncertainties would render such updates completely meaningless. We do not know how outpatient and inpatient diagnostic rates will be affected as we emerge from the pandemic. Guesswork in the guise of diligence is not helpful. That said, we want to ensure that over time meaningful metrics in the light of the steady-state post-Covid situation are defined, and that the structure of the health budget and Vote is changed so that it is amenable to meaningful and transparent scrutiny in this House. Will the Minister commit to updating the performance metrics for the different programme areas for the 2020-21 financial year? Will he investigate how we might be able to restructure the reporting of the budget in future so that we can more meaningfully scrutinise it?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for his contribution and questions and I look forward to working with him. I agree that the structure of the Estimates is difficult to interpret. I have expressed myself on the record for many years on this. We need to find better ways of providing this information to the Oireachtas. One of the most important roles of the Oireachtas is to hold the Government to account on the money it spends on behalf of the Irish people. I struggled for years in opposition with interpreting this information. I commit to working with the officials and the HSE to improve that. The establishment of the Parliamentary Budget Office is useful but a lot more can and should be done. The programme for Government provides that this will be looked at.

The Deputy asked if the Oireachtas will have the opportunity to engage in more detail on the extra spending. It absolutely will. I will make myself available for that and I have no doubt the officials within the Department and the HSE will do so too. If the Oireachtas wants to engage in that through the Dáil or the relevant committees, there will be no issue. As I said earlier, I will be back before the House seeking additional funding. This €2 billion is for measures that have been taken to date to deal with Covid-19 and a lot more will have to be done.

The Deputy spoke about long-term spending on personal protective equipment. He asked whether we need to build a national stockpile or increase domestic production. At this point I would say that all options need to be examined. If there is a second wave or a different public health outbreak in the future, we do not want to be scrambling to get planes in from China. Given where the health system was, the HSE deserves enormous credit for what it did and how quickly it responded but we do not want it to be in that situation again. All options have to be on the table in that respect.

A question was asked about private hospital capacity and if we continue to hold an option on using such hospitals during the pandemic. The private hospital contract ends today. It was understandable why it came in, although issues with it were raised by me and by others in the House during the contract negotiations.

The reduction in capacity in the public system caused by Covid-19 is immense. We may need to leave 20% of beds vacant. People involved in scopes say capacity could be down by 50%. I heard one figure of 80%. Surgeons say that in some cases they can do half the number of surgeries. GPs can see fewer people. Our public health system therefore faces an unprecedented crisis triggered by having to respond to Covid. I think a challenge at the same scale is having now to provide non-Covid care in a Covid world. Again, I think we will have to look at an awful lot of options. The goal is not to have dependency on private providers; the goal is universal healthcare provided through the public system. In the short term, however, the public system has just lost a vast amount of capacity. Our obligation is to make sure people can get access to healthcare. The medium-term goal, not even the long-term goal, is that we transition as quickly as we can to full capacity within the public system.

4:55 pm

Photo of Alan KellyAlan Kelly (Tipperary, Labour)
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I congratulate the Minister. It is pretty rare that a spokesperson moves straight into being a Minister, particularly one taking over from his neighbour, so there is an additional dimension there. I wish him the best. We in the Labour Party will support him during the pandemic and when we agree with him. When we disagree with him we will oppose him. I very much welcome the fact that he will do questions and answers. That is a good change. I also welcome the precedent he has set here with various Deputies, starting with Deputy Murnane O'Connor, of offering briefings from officials on specific issues. I presume this offer applies to each and every one of us. I have a number of observations and questions. The Minister might answer the questions in whatever time he has.

What we are doing today we are doing a bit blind because, due to the way in which the Estimates are put forward, there is no linear capability or way for us to see where money will be spent. That is partly understandable but obviously not acceptable, and the Minister would be the first to say so if he were standing here, so that cannot happen again. He said when he was in opposition - and he will hear that quite a lot over the next few months and years - that he would set up an office for budgetary management. He also said he would hire quite a number of forensic accountants across the Department. I presume both of these things are happening. He might verify firstly that he will do these things because he was very strong on them, to be fair to him.

We need a plan for reopening the health service. The HSE has published a kind of strategic framework for delivery, but it has not published a full clinical roadmap. When will we get that? We have been waiting a seriously long time for it. The Minister said on 11 June that screening was not being restored quickly enough, so I presume he has now put in place plans to accelerate screening. Will he give us some details on changed dates or quicker dates? Given my track record, I am certainly not happy with where screening is at the moment and how it will be rolled out.

Today's motion will add €2 billion to the budget. We will support that but we also need to see, first, what the percentage is of services that are not being utilised and, second, what budgetary saving there has been. We know there are mental health services, disability services, community services, etc. We cannot see what percentage of the budget has not been used on all of these and where it has not been used. Could we have a breakdown on that?

Could we have statistics on what private hospitals provided during their period under State control - the numbers of procedures, the costs, etc., by location? Post Covid, what will the Minister change in regard to information provision from private hospitals into the national statistics? When he was in opposition the Minister complained quite rigidly about the lack of conformity in that regard.

I totally disagree with the Minister on the NTPF. What is his plan for its use? Does he envisage that during his tenure as Minister over the coming years, we will not use the NTPF? How does he believe we will use the NTPF over the next year in particular?

We all know there is a huge issue with bed capacity. The Minister felt 2,600 beds needed to be put into our public health system. Obviously, he has not even been in the job a week, but will he provide an initial analysis of how he will make that provision and over what timelines?

Will the Minister undertake to conduct a cost-benefit analysis on nationalising existing private hospitals versus new build? We need to do new build as well, but would it not make more sense to nationalise one of the larger private hospitals in order to create public capacity? Has a cost-benefit analysis been done on that? We are spending 20% more than the EU average on healthcare, but our public healthcare system is still underfunded. This is clearly down to duplication between public and private healthcare, and this is a huge inefficiency. The Minister comes from a management consultancy background. We all supposedly agree on a one-tier health system and Sláintecare. How does he intend to address that?

What are his plans and what outcomes will he deliver in his first 100 days as Minister?

What is the Minister's position on the de Buitléir report? The former Minister for Heath, Deputy Harris, who is Deputy Donnelly's predecessor and neighbour, on numerous occasions asked him this question. Many of my colleagues and I were very clear in our support of the report. What is Deputy Donnelly's position now as Minister?

We are very dependent on overseas medical staff, as the Minister knows. I think 3,000 non-Irish staff, who do fantastic work, registered in 2017 alone. We will have challenges in this area. What plans does the Minister have in this regard? While I am at it, I compliment the makers of last night's fantastic documentary. It was amazing. The Minister has committed to providing 5,000 more doctors and nurses in the public health system. Where will he source them? Will he undertake to bring a report to the House on the labour force implications of Covid-19 along with a plan for the future staffing of the health service? This could be done in conjunction with his predecessor, who in his new role would be able to help him with that. The Minister has made very public commitments on ending the different pay grades of consultants. He very publicly said when in opposition that he would do this immediately if he became Minister. When in 2020 will this difference end?

What is the latest status of the children's hospital and the finances surrounding it? I do not expect the Minister to have the figures off the top of his head but I would like to know. Has anything in the service delivery plan been affected from a capital point of view because of Covid? I have already asked the Minister's Department about this and it could not provide answers, so perhaps he could.

Will the Minister consider rolling out a full flu vaccine for everybody? I believe, and my party has put this forward numerous times, that this would be the most appropriate thing to do over the coming years.

The Minister said quite publicly that he would find €20 million extra for disability services. When will that be put in place?

Disability services are completely and utterly underfunded. We have a situation in Carrick-on-Suir in relation to St. Brigid's District Hospital, which is an amazing place that provides respite and palliative care services. It was taken over as a stepdown facility for Covid services. This is an example of another service that was taken over but is at this moment no longer used or needed for Covid care. When will it be released to do the work it did fantastically beforehand? I would like a specific answer on that service and similar services across the country.

5:05 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Kelly for his offer of support. We worked together well on the health committee and I hope we will continue to do so. I wrote down many questions but I missed some because I was still writing. I will get the Deputy detailed responses in writing and I am happy to meet him to discuss them.

I agree with the Deputy on the presentation of financial data and we have covered it. It needs to be done well. In defence of the officials, they have been trying to put this together in a time of extraordinary volatility and that is why the performance measures have not been changed. They should be commended on putting it together given the volatility, but I think we all agree that we want data presented in a way that is easier to absorb and easier to hold to account.

On the office of budgetary management, or whatever we call it, it is in the programme for Government that we need investment in financial resources within the Department. It is very important. I agree on the question of forensic accountants. I am going from the top but I am happy to get the Deputy notes on the rest of his questions.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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I congratulate the Minister, Deputy Donnelly, and wish him well in his work. As the Ceann Comhairle said earlier, we all need him to do well. I am sure there will be a high level of co-operation as there was in the production of the Sláintecare plan. If we are on track and if we are serious about accelerating Sláintecare, he will have support across the board in doing that.

The purpose of this session is to look at the Revised Estimate. To a large extent, this is looking at it after the event because much of the money has been spent. I want to reiterate comments made by others on the manner in which the Estimate was produced. It is easy to excuse many things given the Covid crisis but the people responsible for producing the Estimate were not, in the main, involved in Covid. Lessons should have been learned from the criticisms the Parliamentary Budget Office, PBO, made on the presentation of the Estimates. Those messages should have been heard and we should not be in this position yet again. This is not just a criticism of the Department but it means the rest of us in the Dáil cannot do our job properly in terms of scrutinising a huge spend. We cannot establish whether we are getting value for money in the way the money is spent. The extraordinary thing is that with the additional €2 billion allocated, the performance metrics have not changed at all. It is ridiculous that there has been no change in the structure of the Estimates. That has to be taken on board as it will not be tolerated for another year.

I want to ask some questions on where we are at the moment in respect of Covid. There are concerns about the lack of detail provided on expenditure on testing and tracing and on PPE and on the deal done with the private hospitals and with Citywest. The private hospitals deal is looking like costing somewhere between €400 million and €500 million. My understanding is the beds in Citywest are largely empty, and have been for most of the time, at a cost of €25 million. It was absolutely right to prepare for a surge and ensure that we had capacity for that. However, it is important to point out at this point that we had rapid exponential growth in cases of Covid for a six-week period but we reached the peak around 9 April and the numbers have been rapidly reducing since then, thank goodness. We are down to very small numbers at this point. I cannot see why we have not had the roadmap for restoring non-Covid healthcare long ago. This is about the sixth week that the roadmap has been promised. I do not blame the Minister for that, but his predecessor promised week on week that it would be agreed the following week by the HSE board. We still have not seen it and there is a huge amount of capacity there that seems to be unused and that we are all paying for. That does not make any sense. When will that roadmap finally be produced?

My next question relates to foreign travel. We should listen very carefully to what the CMO said. He has been ringing alarm bells, especially over the past week. We must take note of that. We have been told about the green list, land bridges and all of that, and that is right. The data should drive that. If we are to introduce, as I think we have to do, measures to potentially ban flights coming here from some countries or ensure there is legally based supervision of people coming in from badly affected countries, is legislation required for that and is it the intention of Government to introduce that legislation? Otherwise we are on a hiding to nothing in terms of the risks that are being run.

The Minister often talks about data and data should be driving all decision-making around this. There is now quite a body of data built up and we have many people involved in that. The problem is that most of it has been kept secret. I spent five or six weeks chasing the Department of Health to get data on the prevalence figures. It had it but it just did not produce it. There is no reason all the data associated with Covid should not be open source. Will the Minister give a commitment to ensure that happens so he brings the public with him and there is a clear rationale for decisions that are being taken?

My next question relates to strategy. What is the strategy on the containment or the elimination of Covid? I heard about an outbreak in a nursing home. We are being told about potential clusters. What happens if many people come in from abroad? What is the strategy in terms of a rapid response to a threat like that? Is there a plan to target people in a specific locality or setting, such as a nursing home? What is the plan for testing and tracing? Is there a strategy to ensure we respond rapidly to any new outbreak or upsurge?

My final question relates to overall healthcare and the health service. We will have other opportunities to talk about the Minister's intentions in relation to Sláintecare. However, I am concerned about the over-concentration of the Minister and his party on the NTPF. Yesterday morning, the Minister said in an interview that he wanted to see strategic partnerships with private healthcare. What exactly does he mean by that? It really concerns me, given what many of us feel arose out of the Sláintecare committee and also what the Irish Medical Organisation, IMO, is saying. If money is put into the NTPF, it is being taken directly out of the public healthcare system and it is delaying reform.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Shortall for her kind words and look forward to working with her and everybody else. The Deputy said quite fairly that if we are serious about accelerating Sláintecare, then we will work together. To be unambiguous, we are deadly serious about and committed to Sláintecare.

It is the pathway to universal healthcare, the introduction of which is ultimately our mission. We are not only committed to it but we want to accelerate it. We cannot accelerate it all at the same time but we want to go faster where we can. If the Covid crisis has taught us anything, it is that we need to modernise, move to the regional structures and move towards an area-based deployment of assets in healthcare as quickly as possible. I give the Deputy that commitment unambiguously.

I agree with the Deputy's point regarding the presentation of the financial data. That the performance metrics have not changed is, I think, because people have been so focused on responding to Covid. We all know that the target number of procedures for the given amount of money will be difficult to meet in an awful lot of cases. Many of the performance measures will, unfortunately, have to come down. One of the challenges we have is that a lot of the cost is still incurred, which means there is a lot of fixed cost versus variable cost. We hope there will be an acceleration that will mean the procedures which were missed earlier can happen. The other thing that happened is that many healthcare professionals who were working in paused care moved to do other things. For example, dentists were-----

5:15 pm

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Given the time constraints, will the Minister move on to answering my other questions?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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Yes, absolutely. The Deputy's question about the roadmap for the resumption of services is one that I have also asked. My understanding is that it will not be ready next week and may take several more weeks. It is something I will be looking into with urgency. I will get back to the Deputy when I know more.

On the question of whether legislation is required in respect of foreign travel, my understanding is that there is an ongoing debate on exactly that question.

The Deputy asked whether we can make Covid-related data open source. My preference is that transparency is generally good. We need to ensure privacy where there are issues about protecting individuals but my preference would always be that transparency should be the default unless there are things that need to be closed down.

The testing and tracing plan needs to be looked at. NPHET said that for the rest of this calendar year, we need to be able to do 100,000 tests per week. My understanding is that significantly fewer than that are happening at the moment. There are some good things happening. For example, the second wave of testing is taking place in nursing homes - the Chief Medical Officer has been talking about this - and is beginning to identify cases of asymptomatic staff and multisymptomatic staff.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Social Democrats)
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Will the system be in a position to respond to a second surge or wave of infections?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I was asking the same question last week and I will get back to the Deputy on it. It is something that needs to be looked at in a lot more detail.

Photo of Gino KennyGino Kenny (Dublin Mid West, People Before Profit Alliance)
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I will get the niceties out of the way first by wishing the Minister well in his role. I expressed the same wish to his predecessor, Deputy Harris, four years ago. Once that is done, we can go ahead with not being nice to each other.

I want to raise a number of issues, the first of which is the effect of Covid-19 on the nursing homes sector. I welcome the additional provision in the Revised Estimates to deal with the crisis. However, the level of death in nursing homes during the Covid pandemic is a national scandal. There is a lot of speculation as to why it happened. That question probably cannot be answered here and will have to be dealt with in a different venue. The relatives of those who passed away will want to know why their loved ones passed away in such a manner.

Over the past 20 years, we have, in effect, privatised care of the elderly. The statistic that stands out is that 20 years ago, 80% of nursing homes were public and 20% were private. Today, the opposite is the case. I am not being ideological in raising this issue. Many studies have shown that where there is privatisation of healthcare - we have seen it during the Covid crisis - the outcomes are much poorer than is the case when there is public provision of healthcare services. That has to be taken on board. The Minister's predecessor said that we need a new process and a change of direction in dealing with the question of private versus public provision. I draw the Minister's attention to St. Mary's nursing home, also called the Telford Centre, which is located off the Merrion Road, not too far from here, and is due to close down at the end of the year. This facility has been completely free of Covid infection and the staff are devastated that it is to be closed down. Will the Minister examine how this nursing home might be brought into public ownership? We need to give the residents and staff hope that it will remain open into the future.

My last question concerns an issue I have raised ad nauseamin the House and still has not been resolved in any way, namely, the lack of progress around the medical cannabis access programme. One year ago to the day, the previous Minister, Deputy Harris, introduced legislation which, for the first time in Irish medical history, legalised medicinal cannabis and allowed doctors to legally prescribe it under a new access programme. However, as of now, not one person has been prescribed medical cannabis products under the scheme. There is not a week that goes by when I do not have parents ringing me to ask for help on this issue. Sometimes I do not know what to say to them other than to acknowledge that the matter was legislated for last year. There are extremely vulnerable children who need access to these products to give them a chance. I hope the Minister can give some notice of progress on this issue.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Kenny for his comments. I am sure we will agree on many things because we are all committed to universal healthcare. That is the goal. We all want to stabilise the system, get through Covid, deal with the reduction in capacity and make sure people can get healthcare when they need it. I am sure we will disagree on plenty of the details but I think we probably agree on the mission.

I do not have details regarding the specific nursing home to which the Deputy has referred. If he wants to talk to me or write to me about it, I certainly can ask somebody to take a look at it. I agree with the Deputy that the nursing home sector needs a serious review. One of the things we are committing to in the programme for Government is a very broad strategy looking at elderly living in this country and acknowledging that things need to be done in the nursing home sector and other areas.

With regard to medicinal cannabis, I recognise the work the Deputy has done in this area. He has been working on the issue for many years and has been one of the most progressive and strongest voices in the Dáil in this regard. I have supported much of what he has brought forward. Like the Deputy, I have spoken to parents all over the country who are saying that this product seems like a very good thing for their children. I was very glad to see the legislation that introduced the access scheme and I will undertake to get a briefing done for the Deputy that sets out where we are at and what the various blockages are, so that we can move the programme out as it was intended.

Photo of Mick BarryMick Barry (Cork North Central, Solidarity)
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I have a question for the Minister on the issue of mental health services. Before I deal with that, I want to make a couple of points about the deal between the State and the Private Hospitals Association. There have been various criticisms of that deal, some of which are valid and others not. One criticism is that it was bad value for money because there was only a 36% bed occupancy rate during the crisis. I do not think it would have been possible to foresee in advance that the occupancy rate would be at that level. The State had to err on the side of caution by booking a large number of hospitals and a large number of beds. As such, this particular criticism is not a valid one. However, what is a valid criticism is the question of value for money around the expense of hiring beds compared with the cost of doing so in other jurisdictions. In the UK, where there is a Tory Government, the deal between the state and the private hospitals worked out at €10,332 per bed. In this State, the cost worked out at €44,213 per bed.

That is four times the rate that was paid in the UK. The beneficiaries of this were largely people who were not exactly in need of huge extra funding, such as Larry Goodman, owner of the Blackrock and Hermitage clinics; Denis O'Brien of the Beacon Hospital; the University of Pittsburgh Medical Centre, UPMC; the Bon Secours order, and so on. I have said it before and I will say it again: the deal should be published in full. We did not get that commitment from the previous Minister. What is the current Minister's position on it?

On the question of mental health, it is generally accepted that demand for mental health services will increase in the wake of lockdown. The only question is to what extent. Some 6% of the spend in our health service goes on mental health, which is half or less than half of the equivalent spend in other European states. We have relied heavily on charities whose fundraising sources have been hit very hard over the course of the lockdown. Doubling the spend on mental health services is a modest demand and it should be done within the framework of an Irish national health service. Sharing the Vision makes 100 recommendations for changes in mental health service but contains no costings. When will the costings be published?

The point is often made in this Chamber, or in the other Chamber across the way, that there was unanimous cross-party support for Sláintecare. That is not correct. I was a member of the Sláintecare committee for a year. I listened to all the evidence and supported many of the reforms in the report but did not vote for it because it fell short of what all the evidence indicated was needed, which is an Irish national health service involving the nationalisation of the private hospital sector in this State. The parties involved pulled back from making such a bold recommendation. The Covid crisis meant that healthcare was provided not on the basis of the size of one's wallet but on the basis of one's health needs. That should be the case for cancer services, heart disease, depression, and all other illnesses. Unfortunately, Professor John Crown was correct when he said in the Sunday Business Post on 21 June that the new programme for Government plans to copper-fasten the two-tier health service and instead of taking a step forward towards an Irish national health service, it is actually a step back. That is my observation. My questions relate to the mental health services and the publication of the deal with the private hospitals.

5:25 pm

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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Unfortunately, the Minister will have to communicate his answers to the Deputy because the time is expired. I call Deputy Lowry.

Photo of Michael LowryMichael Lowry (Tipperary, Independent)
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I congratulate the Minister on his elevation to high office. As Opposition spokesman, he showed a command and a deep understanding of the health brief. He has the ability to be a reforming and performing Minister for Health. In his political transfer, he showed political shrewdness and awareness and I am glad his courage and political agility has been rewarded with ministerial office. I look forward to supporting his best endeavours in his Department.

The country was riveted to the television last night as "RTÉ Investigates" took us inside the intensive care unit at St. James's Hospital at the height of the Covid-19 crisis. The scenes were heartbreaking. We saw the suffering of patients, the anguish of relatives unable to visit or be with loved ones in their final hours and the sheer loneliness at the graveside of a patient who sadly passed away. It was a difficult programme to watch. It was human pain at its most raw and people at their most vulnerable. Seldom has a programme given such an insight into what love and dedication truly means. The staff in this busy unit in St. James's went way beyond the call of duty in caring for their patients and the stress this call of duty caused them was etched on their faces. They gave haunting accounts of putting people they had cared for into double body bags and hearing the sounds of the zips being closed. They recounted calling families with the last news they ever wanted to hear and described the effort of going to work knowing that the events of the previous day could recur. The scenes we saw from St. James's Hospital last night were replicated in hospitals throughout the country. Although many patients died without their families at their bedsides, they did not leave this world without love and care in their final moments.

Throughout this Covid-19 crisis, Irish hospitals have provided exemplary care to the patients struck by the virus and our response to this epic health crisis is the envy of other countries. We have set a high standard and continue to do so. Ireland can be justifiably proud of the performance of our health service in handling the virus since it swept across our country. I pay heartfelt tribute to our doctors, nurses and all the front-line staff for everything they have done. However, just a few short months ago, before we ever heard of Covid-19, every Member of this House was getting complaint after complaint about the health service. There were issues with trolleys, waiting lists, cancer procedures, long delays in getting test results and early discharges from hospitals. The health service was one of the top two major concerns in the run-up to the general election. Could this be the same health service that rose above and beyond all expectations during the pandemic? What lessons can we learn from our handling of the crisis that we can apply to the health service as we move forward? As we enter a new era in politics, with the lessons learned from the pandemic and knowing where the cracks are in the system, it is now over to the Minister. The direction he is going to lead us in is at his discretion. What is the roadmap? What is the strategy and what is the main objective and timeframe for delivery of that strategy?

While the proper and adequate funding of our health service is vital, I do not share the view of many that lack of funding is the sole reason it is rated so badly. We have a serious problem with the management of facilities and personnel in our healthcare system. We are also not utilising our acute hospitals to their maximum potential. We have made major investments in world-class theatres and diagnostic and laboratory units around the country and it does not make sense for those facilities to be closed or curtailed at weekends. Our first-class delivery care units should function on a 24-7 basis, thereby increasing the throughput and reducing the waiting lists.

The successful handling of the Covid-19 crisis in our health system required substantial money. Additional staff were brought on board quickly. It took money to do that, but it also took expert management of the situation. The driving force behind our excellent handling of the crisis was the way we managed it. The speed and urgency of the required response to the crisis demanded that it be managed with almost military precision. Even before the first case occurred, our hospitals were ready and intensive care beds, critical care beds and step-down beds were made available at rapid pace. Testing centres were also quickly established. The one major glitch in the system was the failure of the HSE to support the nursing home sector in a timely fashion, and we were also slow to roll out testing and contact tracing. That needs continuous upgrading as it is the principal strategy for coping with a virus that is going to remain with us.

If we are to take any lesson from our handling of the Covid-19 crisis, it has to be that strong management is the key to both implementing efficiency and maintaining high standards. The health service we aspire to provide to our people through the introduction of Sláintecare will not be delivered to its full potential unless it is run like a high precision machine or a top performing business. The overall management of the health service must be the very first thing that is examined, and examined rigorously. Areas that are fragmented and sections that are top-heavy with administration or where there is duplicity of tasks should be eliminated. When direction from the top is strong and provided by a single expert group of advisers, the rest will flow with much greater ease. It has never been more clear that a strong management core will be the key to the success of Sláintecare.

Indeed, without it the best of plans can rapidly spiral out of control. Our health service can be greatly improved. However, with all we have learned over the past number of months and all we have proven ourselves to be capable of, we know now with certainty that we can get it right if we do it right. Covid-19 has changed our lives irrevocably in many negative ways, but it has also shown us the path that could change our health service for the better for every man, woman and child in the country. We must build on the lessons we have learned.

I also wish to raise the non-payment of subsistence for theatre nurses who were deployed from Nenagh and Ennis to University Hospital Limerick. This is more a matter of principle than of money. Some 16 theatre nurses answered the emergency call for deployment from Nenagh to Limerick to assist in the fight against Covid-19. They did so, without hesitation, for the public good. Their work schedule expanded to working 12-hour days, weekends and night duty, where previously they had worked eight hours a day, Monday to Friday. The redeployment involved longer travel and an earlier starting time. Many of these nurses left home at 5 a.m. and did not return until 10 p.m. This involved a major change to their daily routine, massive inconvenience, additional childcare expenses and the onset of undue stress and anxiety. It is astounding to learn that these nurses were refused a subsistence allowance. This refusal is mean-spirited and harsh. While nurses welcome the public clapping of approval, it should not be too much to expect the HSE to give practical recognition to their heroic efforts. I ask the Minister to seek clarification of why these nurses were refused a meal subsistence allowance.

Finally, Our Lady's Hospital in Cashel is a long-standing saga in the underutilisation of accommodation. It is shameful to see so much high-standard accommodation not availed of and not in use. The Minister's predecessor, Deputy Harris, visited the hospital two years ago. He was surprised and disappointed that the facility was not put into service. He undertook to instruct the HSE to examine the obvious potential for step-down beds. Recently, as a consequence of the coronavirus, patients from St. Patrick's Hospital in Cashel were relocated down the road to Our Lady's Hospital. This was understandable on health and safety grounds. It was the first tangible acknowledgement by the HSE that Our Lady's Hospital was suitable to accept patients. I hope this temporary arrangement does not become permanent. St. Patrick's Hospital in Cashel is included in the capital programme for a new 50-bed unit. I hope this new unit continues to advance and I urge the Minister to ensure a long-term plan is put in place by the HSE to provide step-down and convalescent beds in Our Lady's Hospital in Cashel for use by the local community of Cashel and the district.

I have not given the Minister time to respond so I ask him to communicate with me in writing.

5:35 pm

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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The Minister will do his best to correspond, as usual. I call Deputy Mattie McGrath.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I am sharing time with Deputy Michael Healy-Rae. Ar an gcéad dul síos, I pay tribute to all the front-line staff and the workers in all areas who did Trojan work. I sympathise with each and every family that lost loved ones. I thank RTÉ for the "RTÉ Investigates" programme last night. It was just shocking. What happened in nursing homes was unforgivable.

I wish the Minister well in his office. We are asked today to increase his budget from €18.3 billion to €20.3 billion with very little explanation or breakdown of the costs. We are going to do it with goodwill, but it is an enormous amount of money. We need to see value for money. Many questions must be asked. As I said previously, things had to be done. I supported the takeover of the private hospitals, but when I saw it costing €115 million per month I was shocked. When I saw that being extended to keep them for June, when there was clearly no need for them, it was just incomprehensible. The cost of Citywest Hotel at €12,000 per bed is four times what the cost is in England. It is costing €21 million in total. It is unbelievable money.

On mental health, I received a reply to a parliamentary question today after months of trying to get information about the costs. St. Michael's in Clonmel, a short-stay mental health facility, was closed down under the so-called A Vision for Change. Despite numerous meetings, suicides and mental health issues, we have failed to get a single bed in south Tipperary. The HSE has accepted there is a deficit of 25. Now we find that €700,000 has been spent on St. Michael's to get it ready for Covid-19, with bathrooms en suite. I salute the building contractors, O'Gorman Construction (Ardfinnan) Limited, and all the builders who worked on it. They did Trojan work. I am not criticising them but I am criticising the fact that we could not get the facility open for mental health beds. I want it to be kept open when this is finished to provide mental health beds. We need mental health services. The Covid-19 crisis has made the need enormous.

On top of that there is the cervical smear programme, BreastCheck and the men's prostate screening. The backlogs are going to be astonishing. We seem to have money. The €2 billion today is just unbelievable.

On daily mass and NPHET, the previous Minister, Deputy Harris, told me in the Dáil last week that he agreed with me that one size does not fit all with regard to churches. Fifty in every church is ridiculous. He said he would bring it up with the Cabinet. It was brought up in the Cabinet, there was a meeting and I understand today that the Minister, Deputy Harris, informed other Deputies that it had been changed to 100, which is a welcome step. However, a telephone call was made from the Taoiseach's office - not the Taoiseach - to the archbishop in Dublin last Friday night to say it was changed back again. Who is pulling strings here or what reasons have they for trying to deny the people? Never did people need spiritual nourishment more than they need it now. We should allow the people to go to prayer. Since I was privileged to be elected to the Dáil 13 years ago I have been listening day in and day out to the naysayers on separating church and State, yet now we want to control the church. Are we going to be communist Russia? That is what I see.

I cannot stand here on this tragic evening with such tragic loss of life due to Covid-19, which we are all so concerned about, without reading out a figure that I received today from the Department of Health. There were 6,666 babies aborted in 2019. My God, we have Covid-19 and with this slaughter in 2019 is it any wonder? Where is the money coming from that? It is to become an industry. It is a shocking indictment of our country. We were told it would be safe, legal and rare. How rare is 6,666? It is an appalling vista in our system. Then we have crocodile tears about people injured and dying due to Covid-19. Let us compare the figures. One death anywhere is one too many. I support life from the cradle to the grave, from the womb to the tomb, and I am shocked by what has happened. It beggars belief.

I have gone over time so I will let Deputy Michael Healy-Rae make his contribution.

Photo of Michael Healy-RaeMichael Healy-Rae (Kerry, Independent)
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First, I personally wish the new Minister for Health every good luck. As I said in my first address on his nomination, he made a massive transformation. He certainly played his political cards in a very special way and I compliment him very much. I hope he will be able to represent not just his constituency but the people of the country, who are looking forward to better healthcare, in a special and hard-working way. My office is near his old office and I know he was extremely focused and hard working. When one is near another person's office one gets to know the person's modus operandiand his was second to none in my humble opinion. I wish him well.

I will again remind him of an awful special case, as it would be neglectful of me not to do so. People always say one should not pick particular cases but our job is to represent everybody. I remind the Minister again today of a young boy who has a 90° curve in his spine. He is Ronan Foley from Dungeel in Killorglin. I ask the Minister to take that case under his wing and ensure he gets urgent care. He has been waiting for 20 months and has been in agony for every hour. He should not be enduring agony.

With regard to Covid-19 and the people we have lost, every one of us has known personally people who have died during this crisis and their families. We sympathise with them. I have heard the previous Minister for Health and others praising our nurses and healthcare workers.

What drives me mad is to see ads being put up praising them. I say we should stop praising them and pay them. Pay the nurses the money. There is money owed to our nurses, so pay them. There are people working on the catering side of our hospitals who have not received an increase in 13 years - that is, 13 years ago they were getting a wage and they are getting the same wage today. That is not right and it should not be the case. Stop the praise and start the pay.

We have people waiting to have operations who are in pain. There has been a doubling of the number of people on inpatient and day care waiting lists for operations in University Hospital Kerry. I want to thank the Bon Secours Hospital in Tralee and Kerry University Hospital for working in tandem during this crisis. The model will be of great interest to the Minister. The model in Kerry is unique in that we have a private hospital and a public hospital within sight of each other in the town of Tralee. I brought one of the hospital managers to meet with the previous Minister for Health and very good suggestions were made as to how the hospitals could work better together. Very unusually, it came to pass during the crisis, when the State took over the hospital and they worked very well together. I am sure there are lessons we could learn from that to improve the healthcare we are able to offer the people of Kerry.

The figures I gave the Minister with regard to the doubling of the number of patients show there are 12,000 people on inpatient and outpatient waiting lists in University Hospital Kerry. Those 12,000 people are not living in comfort and they are not living pain-free. Many of those people who are waiting to have operations are in pain. One of the worst things any society can do is leave citizens in pain, whether they are waiting for knee operations, hip operations or to have cataracts removed from their eyes.

I have been very glad over a number of years to facilitate the passage of people from here to the North for operations, which should not have to happen. This has now expanded, not just for cataracts but for hip and knee operations and other procedures. We should not have to do that. Older people should not have to get on a bus. We try to make it as pleasant an experience as we can, but it should not have to be that way. If people need an operation to have cataracts removed, my goodness, it is a simple procedure and it should be happening here in a timely way. The number waiting for operations in Kerry has increased by 1,041 persons. I do not want that to continue.

With regard to mental health, I know the Minister will take particular care of this part of his brief. There are young people who fall between the cracks in our healthcare system because of their age. When they are going from teenage years to young adulthood, they fall between the stools and the services that should be there for them when they need them are not there. I deal with parents who have children and young adults with difficulties, including mental health difficulties. It is an awful thing to witness and an awful thing for the young people, and it can lead to addiction problems and other personal difficulties. As politicians, we should be doing anything and everything to take care of people with mental health problems, whether they are younger, middle-aged or older. Unfortunately, and it is an indictment of the society we live in, these problems are becoming more common.

I look forward to working with the Minister in a workperson-like way, not in a critical way. When I see the Minister for Health doing good, I will be the first person on my feet thanking him and complimenting him and his Department. If I see ways in which he can be encouraged to do things differently, I will be the first on my feet in a positive way, encouraging him to do things differently.

5:45 pm

Photo of Bernard DurkanBernard Durkan (Kildare North, Fine Gael)
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I call Deputy Connolly, who is sharing time with Deputies Harkin and Fitzmaurice.

Photo of Catherine ConnollyCatherine Connolly (Galway West, Independent)
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Guím gach rath ar an Aire agus déanaim comhghairdeas leis ina ról nua. Táim ag tnúth le bheith ag obair as lámh a chéile ó thaobh córas sláinte aonleibhéil a chur chun cinn de.

I congratulate the Minister and look forward to working with him and I welcome his commitment to a one-tier system. However, his commitment is somewhat undermined by the programme for Government, which is committed to the promotion of private medicine and the National Treatment Purchase Fund, which I believe is contradictory and internally inconsistent.

I fully support the revised budget. However, I draw the Minister's attention to the Parliamentary Budget Office document, which he did not refer to in his speech. That might be a good place to start because the Parliamentary Budget Office was set up to advise us all in an independent manner. The one thing I disagree with is that it was said the document was a short read of ten minutes, but it certainly was not as it took longer than that. I draw attention to the fact that for the figure of approximately €2 billion, other than three headings, there is no detail or breakdown whatsoever. Many other concerns were raised in terms of performance metrics and so on. I do not agree with Deputy Ossian Smyth, who said it is not possible. Of course, it is possible. This was flagged ages ago by the Parliamentary Budget Office, not just in regard to Covid. I ask the Minister to look at that and perhaps the next time he is making a speech, he might refer to it and say what he is going to do about it.

I wish to raise a number of issues but I do not expect the Minister to answer them within the five minutes we have left. I want to thank the Minister's predecessor, Deputy Harris, who did his best in terms of answering in the Dáil as honestly as he could, and when he could not, he answered us afterwards. However, I did not get a reply on the issue of service level agreements with the private hospitals. I am on record as saying it was the right thing to do at the time. As time progressed, however, I seriously questioned the wisdom of the arrangement. We never saw the contract, which showed absolute contempt for the democratic process. We were given heads of agreement but we were never told how many hospitals were involved, and whether it was 17, 18 or 19. Most unacceptably, there was no service level agreement. When I posed this to the Minister last week, he told me they were in the process of finalising the service level agreement.

Let me give the Minister one example of someone in Galway who was due to have an angiogram today in a private hospital in Galway but was told she would not be called because there was something wrong with the machine, which I can understand. When she asked when she would be called, she was told she would have to go back to the HSE. Surely a service level agreement would foresee that things happen, and if there was a commitment to see her within the time of the contract, then provision should be made for the future. Instead, however, that person is going to be seen by the public health system and she was simply told the contract is up tomorrow - end of story.

Can the Minister confirm to me in writing whether the service level agreements have been reached with all the individual hospitals? Have the private hospitals finally come under HIQA? Who is monitoring the private hospitals? I understood HIQA was to do that, so has it happened yet?

With regard to the roadmap for recovery, while the Minister said it will take a few weeks, there is an urgency to that. For example, there is the situation of people with Alzheimer’s attending day centres run by charities and by the HSE, as well as adults with Down’s syndrome and disabilities, but there is no clarity as to when they can go back.

With regard to contradictions, figures were given for protective equipment of €300 million and €500 million, and the media are talking about €1 billion. This is simply not acceptable.

The Minister said that Covid stretched the health services but they were at creaking point before Covid. In fact, I have repeatedly referred to a letter the Minister and all of us got from Fórsa highlighting the complete inadequacy of our primary care services and the crisis that existed prior to Covid, but which Covid brought into sharp relief.

I fundamentally disagree that we looked after the residents in nursing homes. We did not. I have taken every opportunity to say that because we did not, although we had ample time to do that. While I appreciate how difficult it is for the HSE, we did not put our nursing homes and residential centres at No. 1 on the list. We failed to do that and we failed to be honest about the testing regime from day one. We manipulated and we twisted and we spun.

I ask for openness and accountability so that we can all work together.

5:55 pm

Marian Harkin (Sligo-Leitrim, Independent)
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I am sharing time with Deputy Fitzmaurice. I congratulate our new Minister. We soldiered together in another life and I know how committed he is to what he does. I wish him well in his new role.

I want to raise three points, the first of which I raised with the previous Minister for Health. The HSE's framework for the resumption of adult disability day services baldly states that the quantum of services supports will be cut back. We are talking to families, including adults who have disabilities ranging from mild and moderate to extreme, who have been largely abandoned in their homes since 16 March. Many of these people are at their wits' end. They see this new framework telling them about increased use of technology but many of the adults who have disabilities will not be able to use such technology for one reason or another. Will the Minister speak to the HSE and ask officials to look at this from the perspective of the family carers and the service users, to consult family carers and to make sure that the services put in place are adequate? The new normal should not involve cutting back services but should work towards full resumption of services.

My second point relates to residential care places for persons with intellectual disabilities. Many families are at their wits' end and I know of homes that are unsafe. There is a chronic shortage in that regard, about which I will speak to the Minister personally.

To move to my final point, we hear a lot about balanced regional development. I have heard the Minister himself mentioning it when speaking about broadband. It applies equally to his own Department, however. Investment in healthcare infrastructure in the northern and western region is 42% of that in the east and midlands. I know there are specialised hospitals in those regions but this investment does not even come close to what is required. In that context, I will refer to something which Deputy Feighan mentioned. What progress has been made in respect of the plans to construct a 46-bed medical unit at Sligo University Hospital? That would simply bring bed capacity in the region to the point at which it was ten years ago.

Photo of Michael FitzmauriceMichael Fitzmaurice (Roscommon-Galway, Independent)
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I wish the Minister the very best of luck. He has a tough job ahead of him but working together we can do a lot. I have a few quick questions. With regard to foreign travel and the Erasmus programme, colleges are telling people to travel. What is the Minister's view in that regard? Second, when is the deal with the private hospitals over? Third, Roscommon University Hospital has a shell in which more day case procedures could be done to take pressure off University Hospital Galway. It is looking for funding. Will the Minister commit to providing it? With regard to section 39 organisations, 1% was taken off their budgets. Will the Minister restore it? I would be grateful if he could answer those questions.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Fitzmaurice for his kind words. The private hospital deal ends today. As of tomorrow, there is no deal in place but we are looking at a new arrangement with private providers as a short-term measure to ensure we can replace lost capacity in the public system while dealing with the pandemic. With regard to Roscommon, I will have to undertake to get back to the Deputy on the situation with regard to funding.

On the issue of Erasmus students, I do not actually have an answer but it is a great question. The Chief Medical Officer is very concerned about foreign travel but the situation with the Erasmus programme is different. It does not involve people coming in and out of the country in high volumes but rather students spending a number of months or a year somewhere else. It is a great question but I am probably not qualified to answer it. It is a question for the public health officials. I imagine they would probably ask which countries and cities we are talking about. If the Deputy wishes, I will undertake to get some public health advice on the issue for him. It is an excellent question.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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We now move to an dara babhta. The names I have for Fianna Fáil, who will share 15 minutes between them, are Deputies Flaherty and Murnane O'Connor.

Joe Flaherty (Longford-Westmeath, Fianna Fail)
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I thank the Acting Chairman but there has been one change to the line-up; I will be sharing with my colleagues, Deputies Devlin and McAuliffe. I commend our new Minister for Health and wish him the very best in his new role. I would be remiss if I did not single out the immense personal contribution of his predecessor, Deputy Harris, in the battle against Covid-19.

The challenges in the area of health are many, deeply pressing, and all the more pronounced as a result of the budget challenges outlined here today. There is probably not one aspect of the health service that is not challenged. What is more frustrating for us as new Deputies is the level of tolerance for this. It seems that it is expected and accepted that there will be an inordinate waiting list and delays for everything. In the case of home help, one is expected to be grateful for the minuscule offering for which one may qualify.

I believe in the new Minister's enthusiasm and energy for the challenges ahead, which include Covid, cancer, Sláintecare, consultants' contracts, the disability sector, and the mental health crisis. All of these challenges will loom large for him.

I welcome the commitment he made earlier to the area of orthodontics. In recent weeks, I submitted a parliamentary question about a young teenage boy from County Longford. After waiting one year for a referral from his local health clinic in Longford town, which incidentally no longer treats or assesses young children for dental care, he was seen by a HSE orthodontist who confirmed that he was eligible for orthodontic work under category 4D. He was duly referred to the orthodontic services in Tullamore more than three years ago. There are still children on that waiting list who have been on it since January 2013. At this rate, it will be another four years before this young boy receives treatment. If it continues at this pace, it will have been almost eight years since he first engaged with the service when he receives the necessary treatment. That is eight years of waiting for a young boy who is in pain, who is suffering discomfort and who is deeply self-conscious about his teeth. That is not the health service we want and deserve. In the HSE's response to my parliamentary question, I was told that, as he was in category 4D, this young boy did not have a high clinical need and would have a long wait for services due to the long-standing deficit in availability of trained staff.

Throughout the Covid pandemic, we have seen that there is no shortage of Irish medics ready to return home and fight the fight. They include a paramedic who left all behind him in Papua New Guinea to come home to Longford and fight the fight against Covid. He has, however, spent the past few months sitting at home on the couch twiddling his thumbs because only a handful of those who volunteered have been mobilised to fight the good fight for the health of the Irish people.

The Minister will be in no doubt that he has a tough task ahead but he will have the absolute and fervent support of all in this House in his endeavours. I appeal to him to ensure that the success stories of his tenure in office will include a successful outcome for that 15 year old boy in Longford and the many others who are desperately waiting for orthodontic treatment.

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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I congratulate the Minister on his recent appointment. I know it is one of the most challenging roles in Government. I look forward to working closely with him during the term ahead.

The additional expenditure of €2 billion for the health services illustrates the severe impact of the Covid-19 pandemic on our health services. Clearly, the additional resources are welcome and necessary, as we heard in the Minister's speech earlier. During the first few months of the pandemic, the previous Government introduced a range of precautionary measures such as the takeover of private hospitals. This was welcome and necessary. It is clear that it is no longer necessary and I welcome the ending of the HSE's contract with the private providers today. This will allow private hospitals to return to providing services.

As we begin the reopening of the health system, I ask the Minister to prioritise supports for people with disabilities who are on waiting lists and for their families. Obviously, we need to reduce those lists. As the Minister and all other Members will be aware, we have all been contacted by, for example, elderly parents who are gravely concerned about their children or adult family members with intellectual or physical disabilities, whether in regard to respite or accommodation needs.

I ask the Minister to respond to me, perhaps after this session, about the current plans for funding of these vital services for the remainder of 2020.

The Minister will be aware that I spoke to him previously about section 39 funding, in particular for convalescence and step-down services for elderly people. I ask the Minister and the Department to respond again to me about the planned funding for the remainder of this year for that very important area.

Covid-19 has resulted in soaring waiting lists for inpatient and outpatient services. The latest figures show outpatient waiting lists increasing to 575,863 during May alone, while the inpatient day case waiting list now stands at 86,946. I know the Minister spoke about that himself many times, but this underlines the necessity of getting services in hospitals back up and running. I would welcome clarity from the Minister on those issues.

6:05 pm

Paul McAuliffe (Dublin North West, Fianna Fail)
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Like previous speakers, I congratulate the Minister on his appointment as Minister for Health. I say that, not out of some sense of party loyalty, but because I have seen in a very real way the ability and skill he has applied to the health portfolio as an Opposition spokesperson. I saw it here in the Chamber but more important, I saw it when the Minister came to visit my constituency with a number of other spokespeople from the Fianna Fáil Front Bench. The Minister listened with real integrity to people from that community speak about how they were in the grip of the drugs industry. I very much welcome the commitment in the programme for Government to deal with addiction as a matter of health rather than a criminal matter. I hope to play a part in leading the debate on how we treat addiction differently. I very much look forward to an opportunity to have the Minister and perhaps other Ministers who attended that meeting return to the constituency to speak again to the people there. Unfortunately, yet again over the weekend there was a shooting in my community. The family resource centre which operates in the area had to reduce the services it can provide due to the level of intimidation. We cannot leave any community in the grip of the drugs industry. I hope to work with both the Minister for Health and the Minister for Justice, Deputy McEntee, on that.

I wish to raise with the Minister the commitment in the programme for Government on primary care centres. I have spoken to him many times about the primary care centre in Finglas. We have been campaigning for it for more than eight years. The HSE has done much work on it and a site has been selected in conjunction with Dublin City Council. I ask the Minister to do everything he can in his time in the Department to ensure the primary care centre in Finglas is delivered. It is something that will have major benefits for the ageing population in this area that has real needs but insufficient GP services, as well as for the children who require access to mental health services. I look forward to working with the Minister and to pushing his officials to ensure the primary care centre is delivered.

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I am not sure that there were so many specific questions. In response to what Deputy Flaherty said about orthodontics, it is a major issue that any child would have to wait eight years for orthodontic services. It is a failure on all our parts. Consultant surgeons and dentists tell us it is far cheaper to intervene early because in dentistry in particular early detection and treatment is critical. My view is that we are failing the unfortunate young men like the one Deputy Flaherty mentioned, as well as young women. Those waiting lists are not acceptable. One of the big opportunities we have is the public health school intervention teams, which work very well where they operate. One of the commitments in the programme for Government is to look at activating a DEIS-style health intervention team along the model that was previously rolled out very successfully. That is something we need to spend serious time on.

I thank all my colleagues for their good wishes. I really do appreciate them. As I stated earlier, no one Deputy in this House is going to be able to solve healthcare. It requires us all, and I really look forward to working with everybody on it. Different Members of the House specialise in different areas. For example, Deputy Butler puts significant emphasis on older people. I was honoured to be in Deputy McAuliffe's constituency. I recognise the amazing work he does on addiction. I agree with him that it is genuinely transformative that we will move from it being a justice and policing issue to a health issue. Obviously, as regards the situation he raised in his constituency, the community Garda force, the drugs task force and the Garda drugs teams need the resources on the sharp end, but it is very relevant that for people in addiction we will begin to move to treating this as a healthcare issue, as we should.

I assure Deputy Devlin that we will prioritise disability. It has taken a very sizeable portion of the programme for Government. It will be front and centre. It is now under the remit of a member of Cabinet and I hope in the very near future we will be work out exactly how it will work. We need a whole-of-Government approach to disability. It is a health issue, a transport issue, a justice issue, and an equality issue. I fully agree with what Deputy Devlin said. My commitment to him is from the health portfolio. We will not be found wanting.

I would be delighted to go back to Deputy McAuliffe's constituency. If he is okay with it, I will ask the HSE for a report on what is happening with the development of the primary care centre in Finglas and we will get back to him.

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail)
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I congratulate the Minister, Deputy Stephen Donnelly, on his elevation to the Cabinet last Saturday. I have worked closely with him for the past two and a half years on the health portfolio and I look forward to working with him again.

I wish to briefly raise one issue with the Minister that I know he is very familiar with. In Waterford and the south east, cardiac care is time-sensitive. It is now 6.15 p.m. in the Convention Centre in Dublin and if any of us were to suffer a cardiac attack or cardiac arrest we would be able to go to any number of hospitals in the surrounding area to have treatment. However, we are not as fortunate in the south east. The cath lab in Waterford closed at 5 p.m. It is open for 39 hours a week, Monday to Friday, from 9 a.m. to 5 p.m. There is a clear commitment in the programme for Government to provide a second cath lab. My Oireachtas colleagues in Waterford and I have worked very closely together for the past four years and we have finally made progress. A second permanent cath lab has been agreed, it is written into the programme for Government and it must be delivered sooner rather than later. That is the most important element of progressing the situation in Waterford.

Currently, we are also recruiting for a fourth consultant cardiologist. To deliver 24-7 cardiac care in University Hospital Waterford, UHW, seven consultant cardiologists are required, in addition to a second permanent cath lab. It has taken so long to get to this stage and we are moving very slowly. People in Waterford and the south east are so frustrated. We feel there is an inequality of access to healthcare. There can be great outcomes for something as simple as a heart attack with stenting and the various procedures consultant cardiologists can do. I will be in the Minister's ear on a constant basis to get this over the line. I am sure my colleague to my left will raise the issue as well in the next few minutes. It is so important for us that we finally get movement on the issue. I ask the Minister to contact the relevant person in the Department to find out exactly where we are on the timeline. I accept that it cannot be helped that we have lost four months because of Covid.

We were at the planning stage and hoping to start construction in the summer. We need a clear timeline and outcome regarding this build. Once again, I offer my congratulations to the Minister.

6:15 pm

Photo of Niamh SmythNiamh Smyth (Cavan-Monaghan, Fianna Fail)
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I too congratulate the new Minister for Health, who was a very able and capable spokesperson for our party for the past four years. I am thrilled to see him in this ministerial position.

I was also thrilled to have him in Cavan and Monaghan not that long ago. Then he got the full guided tour of Cavan General Hospital and of the minor injuries unit in Monaghan hospital. As he will be aware, there were concerns about the midwifery led unit in Cavan hospital recently. I am delighted the Minister's predecessor, Deputy Harris, allayed those fears and concerns around the future of that unit. It is a significantly important facility, as there are only two in the Republic of Ireland whereas there are eight in the North of Ireland. We know it is an ambition of the national maternity plan that there would be a rolling out of more midwifery led units across the country. Rather than any clouds of doubt hanging over Cavan General Hospital's unit, we need to nurture, harness, support and put resources into such facilities.

The midwifery led unit in Drogheda is thriving and growing. More and more women are opting and choosing that as their maternity pathway. The one in Cavan General Hospital has massive potential to serve not just Cavan and Monaghan but the Border and midlands region with a little bit of support, emphasis and promotion put into that important facility.

I again congratulate the Minister in his new role. I invite him to Cavan General Hospital as well as to Monaghan. At Monaghan hospital there are real opportunities. It has a wonderful minor injuries unit, which relieves the pressure on the emergency department in Cavan General Hospital. There is an enthusiasm among the staff not to just have it as a nine to five, Monday to Friday, operation but to expand it to a 24-7 operation. I hope the Minister might be able to help make that happen.

Violet Wynne (Clare, Sinn Fein)
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I am sharing time with Deputies Ward and Cullinane.

I want to raise the ongoing issue of capacity in our health service. Time and time again, we listened to the Minister's predecessor saying that we were investing in our health service. However, this funding never alleviated the pressures on our health services. We in the mid-west are constantly faced with overcrowding, long waiting lists for our elderly and lack of provision for our younger people.

Last night, I watched the RTÉ programme, which highlighted the Trojan work our front-line care workers do each day and how well they adapted to the pressures of Covid-19. For that I sincerely thank them.

Now that we are faced, however, with more backlogs of procedures and tests, many who were on a waiting lists to start treatment over the past 18 months are facing yet another delay due to Covid-19. Like everyone, I accept that this was unprecedented and unforeseen. I would like to tell the Minister, however, about the case of a family from Clare I had the absolute pleasure of meeting yesterday. The lovely family in question are waiting painfully and reluctantly since June of last year on the much-needed Spinraza treatment for spinal muscular atrophy, SMA. I met Jordan Perez, who is 12, and his brothers and sisters - Ryan, Zoe, Faith and Ezra. I can tell the Minister that their story is heartbreaking. The Department approved access for treatment on 12 June 2019 on an exceptional and individualised basis for people under 18 years of age with SMA type 1, 2 and 3. This was a huge moment for the families of these children. Now it is overshadowed by angst and despair as children like Jordan are still waiting with no confirmation of a date for the treatment to begin.

Jordan has been let down by this failure and he deserves much better. It is not right and it is not good enough. Jordan Perez has SMA type 2. Being deprived of this treatment is negatively impacting on his quality of life and, ultimately, his hopes for the future. Jordan waits patiently because he is so good natured and is a huge credit to his family. Unfortunately, his abilities are deteriorating right before his family's eyes. This must be addressed with the utmost urgency.

The HSE quotes capacity issues as one of the main reasons this treatment has not taken place thus far. We have been constantly calling for ICU bed capacity in particular to be increased. As we navigated through the Covid-19 pandemic that need was apparent. ICU bed capacity has a knock-on effect for being able to conduct this treatment. I am calling for ICU bed capacity to be prioritised properly but more specifically for the Spinraza treatment that is life-changing for these children with SMA such as Jordan.

With these Revised Estimates, how will the Government ensure the knock-on effects of the Covid pandemic will be minimal on the health service? How will the Department ensure there is no further delay for children like Jordan who so desperately need access to the care and the treatment they require?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank the Deputy for raising this issue. I share her views on Spinraza. It is a matter that I and my colleagues in the previous Dáil campaigned hard for. As the Deputy spoke about a specific family, if she provides some more details, we can then get a briefing to her.

How we avoid knock-on impacts on our health system because of Covid is a profound and seminal question for healthcare this year. The impact of Covid in terms of waiting lists, the additional money that has to be spent and reduced capacity is unlike anything we have ever seen. It will have a knock-on effect. There is nothing anybody could do to prevent such an effect. We have to move very quickly. Much work is being done by the Department and the HSE on resumption of services and finding new capacity. We are going to have to innovate like we have never innovated before. Everything has to be on the table. We are going to have to bring everyone together.

If there is one thing that Covid showed us, even with a system already stretched beyond capacity, it is that our clinicians, our managers, departmental officials and everybody who works in the system reacted as one in a spectacular way. We need to keep that spirit of co-operation going to address the question the Deputy raised, which is the most significant question for healthcare now.

Photo of Mark WardMark Ward (Dublin Mid West, Sinn Fein)
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After constantly calling for the previous Minister for Health to release Sharing the Vision: A Mental Health Policy for Everyone, I cautiously welcomed the fact that it was finally published just before the previous Government ended. A Vision for Change was a bold document and one of its time. Due to lack of proper investment from previous Governments, however, it was never even close to being fully implemented.

We can have no half measures when it comes to mental health services provision. We need a fully integrated mental health service that provides patients with the care they need when they need it. I challenge the Minister and whoever else will have responsibility for mental health in the new Government to put into effect comprehensive, person-centred, holistic and community-based mental health services. This is a challenge the previous Government failed. That Government was responsible for acute waiting lists. In December, 2,327 children were waiting for an appointment from CAMHS. More than 100 of these kids were waiting over 18 months with more kids waiting for more than two years. One recommendation of Sharing the Vision, with which I agree, is to increase the age range of those eligible to attend CAMHS from 18 to 25.

Currently, young people make the transition to adult services at the age of 18. This can be an age when change, uncertainty and vulnerability prevail. Failure to secure a safe transition can lead to disengagement and ultimately to poorer mental health outcomes. Unless there is adequate investment in these structures and in CAMHS staff, I am afraid that this could just lead to an increase in waiting lists and a lack of services for those who need them.

Over the years, many people have fallen through the cracks of mental health services, but I will welcome stuff when it is good. I welcome the desire in Sharing the Vision to provide a service for those who have a dual diagnosis. There needs to be a vision, and I have not seen it in this Revised Estimate, for local addiction services to be fully resourced. The existing services are bursting at the seams. They need long-term investment so they can budget for and provide services for emerging needs and not just current needs, and so they can be proactive instead of reactive to problems as they arise. The 14 local drug and alcohol task forces need an increase of funding to allow them to plan strategically for the long-term services they need to provide comprehensively, and for which the sector is crying out.

There has been an over-reliance, and I hope it does not continue, on non-governmental organisations to provide the mental health services the Government should provide. We need to move away from this model. We need to fund addiction and mental health services directly and publicly. We need parity of esteem between mental health and physical health. As mentioned earlier, we are on the verge of a mental health tsunami post Covid-19. Existing mental health services are already inundated with cries for help. Covid-19, by its very nature, has increased people's worry and their anxiety levels. Young people were left in limbo for too long with regard to their leaving certificate examinations. They are missing their friends, missing school and missing their social supports and structures such as Gaelic football and whatever other clubs they are involved in. People have witnessed and experienced increased levels of domestic violence. People have lost loved ones and were not able to attend funerals due to restrictions. Some people have experienced financial uncertainty and job insecurity. People have lost businesses, are behind on rent and mortgage repayments and are worried about childcare. There are many issues across the spectrum. Front-line workers have provided essential services right through this pandemic. I include also the retail staff, delivery drivers and everybody else at the forefront. They may need our help in the future. I call on the Government to meet the mental health experts and service providers to get feedback on Sharing the Vision, and to have a robust, open and honest conversation to improve the mental health and addiction services in areas where gaps exist. Time will tell if this Government has the political will to implement real changes in how mental health services are provided. Unless there is an increased budget for mental health and addiction services, I am afraid documents such as Sharing the Vision will not be worth the paper they are written on.

In my area of Dublin Mid-West I congratulate those who took part in the "Itsoknottobeok100k" initiative in June. It is a bit of a mouthful but that is its name. A group of people got together and decided to raise awareness around mental health services in our area, and to raise funds. As we speak they are on their last lap in Collinstown Park in Neilstown. I was hoping to be there too because I took part in it, but I am here. I congratulate each and every single one of the participants. I commend them for the community approach to an issue where they saw gaps in services, and they are looking for those gaps to be plugged.

6:25 pm

Photo of David CullinaneDavid Cullinane (Waterford, Sinn Fein)
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I commend the new Minister and wish him well. I send him my best wishes. Obviously, we want anyone who takes up high office and a Ministry as important as health to succeed.

In 2009, I was a member of Waterford City and County Council when a presentation was given to the council by a group of healthcare professionals who were based in University Hospital Waterford, a number of whom were cardiologists. At that time - 11 years ago - they said we needed to expand cardiac services in Waterford for the entire south east. Alarm bells went off in the council chamber when the group said that if someone had a heart attack in Waterford or the south east outside the normal hours of 9 a.m. to 5 p.m. Monday to Friday, he or she would have to go in an ambulance to Dublin or Cork for emergency cardiac care. There has been an ongoing campaign since then. I have a very straightforward question for the Minister. I raised this matter right through my period in the Seanad when I was elected in 2011, and when I was elected to the Dáil in 2016, as others have also done, and yet we have not had delivery of 24-7 cardiac care. The Minister's party leader and now Taoiseach, Deputy Micheál Martin, stood behind a banner and said that if Fianna Fáil was in government it would deliver on this issue. Fianna Fáil is now in government, Deputy Stephen Donnelly is the Minister for Health and Deputy Micheál Martin is the Taoiseach. Deputy Butler spoke earlier about the good work that has been done by all of us in the region on this matter. That work resulted in the last Minister for Health committing to funding a second cath lab. That is now delivered and is there. I have a direct question for the Minister. Can the Minister give me and the people of Waterford and the south east a categorical commitment that 24-7 emergency cardiac care for the south east will be delivered by him, as the Minister for Health, given the commitment made by the Taoiseach, Deputy Martin, as his party leader, and by others on this issue? It is a very clear question that deserves an honest answer for the people who live in the south east. Will the Minister for Health, Deputy Stephen Donnelly, be the Minister for Health who delivers 24-7 emergency cardiac care for the south east?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I acknowledge the work that has been done by Deputy Cullinane on this matter. The Deputy and I have been in the Dáil together for many years. I have heard him advocate consistently for this. I appreciate his reference also to Deputy Butler who has advocated and fought very hard on the matter too, as have all the Waterford Deputies. Indeed, we have a new Deputy in this Dáil who has also fought hard on this issue. When I was made health spokesperson for Fianna Fáil, one of the first things I was asked to do by Deputy Butler was to meet our new Deputy from Waterford, Deputy Shanahan, and the cardiologists. The cardiologists came to Leinster House to meet us and to lay out the case. They made a very strong case. They said to me at the time that the focus was on 24-7 care, which is incredibly important and is the goal. To do that, they said they needed a second cath lab. They asked that this was where we put our focus. They said that without the second cath lab it could not be done. They pointed out that in the absence of 24-7 care and a second lab, scheduled cardiology appointments were being cancelled due to other emergencies such as heart attacks. It was causing consternation because the scheduled work could not be achieved. They asked first and foremost to please get them the second cath lab. That is a commitment in the programme for Government. It is being committed to. I am happy to commit to it. It is a commitment of the Government. Now we need to figure out exactly what else is required - how many cardiologists are required, how many technicians are required, what other support staff are needed, and what linkages are needed between the various hospitals. The goal is 24-7 care. The first and critical big step is the cath lab. If the Deputy does not mind - this is literally my second day in the job - I want to sit down with the HSE to understand the steps that are required. I would very much like to meet the Deputy and the other Waterford Deputies to discuss how we progress it. It is a really important issue for the region.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Are any Deputies wanting to come in from Fine Gael, the Green Party or Páirtí an Lucht Oibre? Goodness, they are all gone to the hills. My list is exhausted here. After that it must be the Social Democrats. No one is offering from the Social Democrats or from People Before Profit. I will call the Deputy from the regional party.

6:35 pm

Verona Murphy (Wexford, Fine Gael)
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Deputy Verona Murphy-----

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Go raibh maith agat, and sorry.

Verona Murphy (Wexford, Fine Gael)
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-----of the Regional Independent Group as opposed to party.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Sorry.

Verona Murphy (Wexford, Fine Gael)
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Not at all.

I congratulate the Minister on his job, which I am sure he is looking forward to doing. He certainly has the necessary ability and insight, which he displayed as spokesperson over the past number of years. I wish him well and I hope we will work well together.

There are some issues that need addressing, particularly in Wexford, and I will get straight to them. The Minister has heard from other Deputies that, unfortunately, mental health services are in crisis, a situation that is being reported as a tsunami. If we do not halt that tsunami, the ensuing devastation will be with us for generations. More and more people's mental health is being compromised due to poor domestic situations exacerbated by staying at home, the Covid crisis, life pressures, and no jobs but bills to pay. There are also those who are already within the mental health system.

Some frightening statistics were published lately. The national spinal injuries clinic's latest report states that it had seen an increase from 1% last year to 17% in March and April 2020 in the number of patients with injuries sustained through suicide attempts. This figure seems to reflect a trend that has been seen elsewhere. In a survey conducted of 615 consultants by the College of Psychiatrists of Ireland, one third said that new onset and relapsed patient cases were on the increase.

Of particular concern in this regard are the younger and older generations. In March and April, the Mental Health Commission reported an increase of 7% in involuntary admissions by the Garda of mentally ill people since last year, most of whom were under 30 years of age. Last November, the Oireachtas committee on mental health heard that there were 2,600 fewer staff in mental health services than was recommended by the Government's A Vision for Change. The recently published ten-year roadmap, entitled Sharing the Vision, which follows 14 years on from the previous roadmap, A Vision for Change, contains no costings or details of staffing levels for the next ten years.

In Wexford, our CAMHS unit does not have a child psychologist or a dietitian for a child or otherwise and its occupational therapist is only part time. We are letting our children down. The CAMHS unit recently moved into Arden House. Although a new and fresh building and everyone is thrilled with it, it will not provide services unless a dietitian is appointed. Believe it or not, I know of a child psychologist who submitted a CV to the HSE three months ago applying for the job in Wexford. I have persistently been told by the HSE that money is not an issue but that finding an applicant is. In the three months since she applied, she has not even got a response to say that her application has been received. There is something very wrong with this. For three years, the Minister has understood these issues. He stated in many interviews during his election campaign that he would invest €200 million in our mental health services. However, if this is not and has not been a money issue, why has that child psychologist not received a response regarding a job that is so badly needed?

I get calls every day from the parents of children who need these services. The one point they keep repeating to me is that words on paper are no good and that what is needed is action. I am delivering that message to the Minister and asking him to take action. I would have no difficulty sitting down with him to discuss the CAMHS unit and the wider mental health services in Wexford. I would welcome his intervention to ensure progress by the HSE on this matter.

The next matter I will raise is of grave concern, and not just because of last night's "RTÉ Investigates" programme. Rather, it has been brought to my attention by a local day care centre, which has received little funding, but funding nonetheless, for bereavement counselling for our elderly citizens. Unfortunately, Tusla will stop making that bereavement grant available. It has instead been transferred to the HSE where an arduous process is involved. We know from last night's programme, the wider Covid crisis and the fact that we all have parents and we know what they have been through that it is imperative that the bereavement grant be made available as a matter of course. We do not need to continue showing disregard for our senior citizens. We must take the actions that are required. Many of the citizens in question are in their later years and need bereavement counselling to give them peace of mind. I call on the Minister to oversee this matter or write to me to let me know what can be done about the procedure. If a care centre has already been in receipt of bereavement funding, it should just be a matter of making a simple application to receive that funding again.

I will turn to the Hew Houghton Hospital in New Ross. A former Minister of State in the Department, the then Deputy Jim Daly, visited New Ross with me. Funding was granted. Unfortunately, however, the situation has not been furthered. The facility mainly cares for dementia patients and has been invaluable to our community, including throughout the Covid pandemic. The staff are wonderful. There has been no Covid case in the hospital, but it needs that funding and maintenance work needs to be carried out. Will the Minister give an update on the matter? Doing so in writing would not be an issue.

Many families have contacted me in recent weeks. Some nursing homes - more private ones than otherwise - have reinstituted visiting, albeit outside for 15 minutes or so per patient in some cases. People are not necessarily being denied access, and I understand the plight of the nursing homes in having to keep their patients and residents secure, but will there be guidelines for visitations, when will there be a safe period and what kind of direction and help can the Minister give private and public nursing homes? They may need more assistance, be it due to financial requirements or a lack of capacity to deal with outsiders visiting due to the social distancing requirements. Many people are now asking to see their loved ones, who are in an age bracket where they need to interact.

We will have a large number of issues to discuss in future, but I hope that we can give many of them immediate attention, in particular the CAMHS unit in Wexford. All that I request is a short meeting so that, if it is not a funding issue, we can sit down and work out what we can do to further this cause for the young people of Wexford.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Next is Deputy Nolan of the Rural Independent Group.

Photo of Carol NolanCarol Nolan (Laois-Offally, Independent)
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I wish the Minister well in his role and every success. It is a challenging portfolio, but I do not doubt that he will be successful and effective. I look forward to engaging with him in a constructive manner and, I hope, finding solutions for some of our ongoing problems.

The Revised Estimate being presented to us indicates the staggering levels of funding that are going into the Department of Health and the management of the HSE. This is of major concern to many, including me. Can this issue be examined? We must take responsibility and ensure that adequate funding is being directed to where it needs to be. For example, I constantly hear that disability services are being left short and that the services themselves are inadequate. The same applies in the case of mental health services, which have been mentioned a number of times in this debate, and home care. Elderly people are being failed and are left languishing on long waiting lists for home help.

In terms of speech and language therapy and occupational therapy, children with special needs are waiting unacceptable lengths of time, which affects their well-being and educational attainment. I attended a meeting of the Laois Offaly Families for Autism organisation before the election.

I gave a pledge to those people that I would continue to raise this issue on the floor of the Dáil as a Deputy for Laois-Offaly. It is distressing to hear what many parents have to go through and the fight they have with the system in terms of getting basic services for their children. We have a serious ongoing problem in Laois-Offaly. Perhaps therapists could be brought from areas or regions where there is not a problem to areas or regions where there is a backlog. There should be ongoing recruitment of therapists to make sure we are ready for when there is an urgent need. At present, I can assure the Minister there is a long waiting list in Laois-Offaly that badly needs to be tackled. I have no doubt he will try to do that.

Since its post-crisis low in 2015, gross Voted spending on healthcare has risen by almost €5 billion. The concern of many people is that we are not seeing value for money and we are not seeing the services. A change of approach is needed to ensure we see value for money and adequate services in all those areas I mentioned.

Will there be room in today's Estimate for the appointment of an independent external facilitator in respect of Midland Regional Hospital, Portlaoise? This hospital has been left in limbo for so long and the issue has been raised on the floor of the House many times. I have raised it since I became a Deputy for Laois-Offaly. The hospital is unable, because of the uncertainty, to develop and expand other services to the extent that it would like and the recruitment of specialist staff is difficult. I appeal to the Minister in this regard, and I would be grateful if he could bring a final resolution to this ongoing issue. The future of the facility has been in doubt for too long.

With regard to the Estimate, we know that primary care and mental health services have been receiving comparably smaller shares of additional funding. However, mental health services receive a small share in overall terms. As I understand it from the Parliamentary Budget Office, PBO, analysis, this is the result of a €46.5 million fall in capital budgets, which offset current spending that is expected to rise by €51.3 million. I hope this increased budget can be maintained. There is simply no point in rolling out mental health strategies if the funding is not there to make the ambitions a reality, because people have been let down for so long and the gap in our services in terms of mental health has been filled by many voluntary organisations that have done fantastic work. We have men's sheds, Jigsaw, and many GAA clubs that are embracing this issue and helping in every way they can, but we urgently need more.

With regard to attendance at masses and other church services, I appeal to the Minister to make sure a common sense approach is adopted. I have been contacted about this issue often over the past few weeks, and I agree it is unfair that restrictions are imposed that we do not see in any other sector. I ask the Minister to make sure a common sense approach is adopted and parishes are allowed to make the decisions for themselves.

6:45 pm

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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I call an Teachta Danny Healy-Rae, más é do thoil é.

Photo of Danny Healy-RaeDanny Healy-Rae (Kerry, Independent)
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I too wish the Minister, Deputy Donnelly, all the best in his new job. I look forward to working with him and we will certainly have a lot of things to sort out.

I thank the health workers all around the country, but especially in Kerry, the people who worked in the hospitals in Tralee, Cahersiveen, Dingle, Kenmare, Killarney, and indeed, Bantry, which is very close to us and deals with many patients in our general district.

I ask the Minister, as I have asked several times before, to deal with the need for expanding or reopening the beds in Kenmare and Dingle and the new promised hospital for Killarney. I want to highlight problems in the emergency department in University Hospital Kerry, Tralee, where people over 80 and 90 years of age are waiting up to 24 hours or more. There seems to be a problem with doctors in the emergency department, in that there is not enough of them or of radiologists to read X-rays and scans. People are being sent home without this happening and that is not good enough.

I want to raise the issue of home help. People would like to stay much longer in their homes if they had a bit of extra home help, for which I am calling.

We know about the sanitary requirements and such being followed up by HIQA. Who is monitoring the protein and nutritional value of what patients are getting in hospitals, care homes, and places where elderly people are being fed to ensure they are receiving the proper nutrition, especially where outside caterers are employed to bring in the food? We need to ensure they are getting the right type of food with the proper nutrition and protein in it.

We are all here today to support the extra funding that has been allocated. We wish that it was more, because so much more is needed. I would like to ask the Minister and the Government what investigations have been done internationally into who caused this virus. It is said it was the Chinese. I ask that we follow up on that, even though people are dead and families have suffered severe pain. I think of the Cagney family in the Black Valley beyond Kenmare who have suffered so much. No money will ever compensate them, but if the Chinese are responsible for this virus, I ask the Minister and the Government to follow up on that and to ensure the people of Ireland get some compensation for what has happened here. We all know what it is costing. We do not have mines, gold, diamonds or oil. The ordinary working person will have to pay the price. If there is to be retribution, we should go after it, because what has happened to our country is not fair. Our lives and the lives of everyone we represent have been destroyed and upset.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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Go raibh maith agat. With the agreement of the House, Deputy Paul Murphy-----

Photo of Joan CollinsJoan Collins (Dublin South Central, Independents 4 Change)
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I am due to speak next. The Independent Group has eight minutes.

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
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Put me after the Deputy.

Photo of Mattie McGrathMattie McGrath (Tipperary, Independent)
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With the agreement of the House, I will allow Deputy Murphy, who missed his slot earlier, to speak. Is that agreed? Agreed.

Photo of Joan CollinsJoan Collins (Dublin South Central, Independents 4 Change)
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I watched "Prime Time Investigates" last night and it was harrowing and sad. I wish to express my solidarity with the families of the patients who died and the staff who were with them, who became their carers, who took care of their medical needs, who became their communicators and who literally became their undertakers. That is the role they played over that period and that must be recognised, not with a clap and with people standing in the street. They have to be looked after now. Those workers were distraught. They need care now, and they need follow-up care. They need better terms and conditions in terms of their pay. They need those beds to be kept open. They need the extra staff who came home to stay in our health service and they need us to start moving to a Sláintecare situation and an NHS for Ireland. They were amazing staff. That was not just happening in St. James's Hospital but it was happening all over the country.

I agree with Deputy Connolly about the nursing homes. They were not prioritised and, to a certain degree, I understand that because the HSE and NPHET were scared of its lives about what could have happened in the public hospitals because of the crisis in healthcare. That is where things went wrong, because they were focused mainly on the public hospitals and the public in general and they dropped the ball from the point of view of our nursing homes and our older people.

We saw what happened as a consequence.

We are discussing Vote 38, which is the additional funding of almost €2 billion required to ensure the health service could respond to the Covid crisis. It is a retrospective go-ahead. The committee has not had an opportunity to scrutinise the Estimate, which is understandable but regrettable. The format it has been issued in makes it very difficult to read. We are really voting on the macro moneys and the broad figures of €115 million per month for taking over the private hospitals, paying the rent, testing and tracking and personal protective equipment critical to respond to Covid-19. I want to try to bring in a micro aspect of our health service whereby workers have been very much let down and I would like the Minister to look into it if he can. I will ask a few questions at the end.

At the start of the crisis we were asked to stand and clap for the heroes who are the front-line workers in our health service but the reality of the treatment of these workers in many cases is nothing short of disgraceful. Recently, I was contacted by a worker in the health service with 20 years service in an administrative role. At the start of the crisis, this woman and her colleagues were told by management that they were considered front-line workers and that they could not work from home. She has two children, both with underlying health issues, and could not use her parents for childcare for obvious reasons as they were aged over 70. In effect, she was forced to use her annual leave to take time off to mind her children. Her annual leave year begins on 1 April and people have 26 to 28 days, depending on their service. All of this person's annual leave was used by the end of May because she had no one else to look after her children. All of her annual leave until 1 April 2021 is gone. Her option now is unpaid parental leave. I am sure it is not just this person in this situation.

The crèche facilities available to this person pre-Covid were 7.30 a.m. to 6.15 p.m. These were the same as her working hours and she could work around them. Now what is available is 8.45 a.m. to 5 p.m. because the childcare facility cannot do more than this. She has an hour commute to work in the morning and the same in the evening. This means she could only be at work at 10 a.m. and would have to leave at 3.30 p.m. to collect her children. This is not an option for her. The cost of the crèche now available for 22 hours a week for two children is €294, leaving her with approximately €100 a week for everything else, including diesel, travel, lunch, household outgoings and mortgage. Her partner is also a front-line worker. He has to go in as he is a subcontractor and would lose the contract if he was not available.

My understanding is that it is against the law to force workers to use annual leave in this situation but effectively this is what has happened. The problem is widespread for front-line health workers and it was raised recently by the INMO. The Government promised to make special arrangements to provide crèche facilities for health workers but completely failed to deliver. I find the situation absolutely incredible. Surely there is somebody in charge, either at ministerial level or among the officials in the Department or managers in the HSE who could have used their imagination and wit to provide a solution. These workers should have been allowed to stay at home with full pay. That is the bottom line. They had no other choice. They had to stay at home and they should have been told to stay at home on full pay.

This worker is now looking at the possibility of seeking alternative employment with suitable hours, which is going to be very difficult for her but she does not really have much choice. This is the choice she has been given. She was really let down, as were many of her fellow health workers. She has said staff are in despair and stressed and some are depressed. These workers should be given back the annual leave they had to take. They should be given the flexible hours to be able to look after their children. This worker should be able to work around the childcare hours that she has.

Will the Minister investigate this? Will he give a commitment to front-line workers that he will find out how many of them were affected? I am speaking about ambulance workers, nurses, administration staff and workers across the board. Will the Minister find out how many of these workers were affected and write to them to tell them they will get their annual leave back, they do not have to take unpaid parental leave and they will be paid in the meantime and given flexible hours? I hope the Minister will respond to this.

6:55 pm

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Collins for raising these issues. Deputy Collins and I were in the Chamber, along with others, discussing this very issue with the INMO during the past ten days. The situation our front-line workers were in was incredibly difficult, and not just front-line workers but also a lot of the management staff and non-clinical staff who were just as essential at keeping everything going and found themselves in impossible situations. The reality is there are many people in the healthcare system who have not had a day off since March, whose personal lives have suffered and who are exhausted. They have gone above and beyond to keep the show on the road and make sure people got treated. I agree with Deputy Collins that they deserve huge credit and huge recognition throughout the country.

Specifically with regard to childcare, there was a big issue and I say this as a father of three young children. I spent the past few months involved in home schooling my children. The schools were closed as were the crèches and childminding options were not available. Obviously, in many cases grandparents could not come in. A childcare scheme was launched but it did not work. I would like to look into this further. From what I have read, one of the issues was there was an understandable reluctance for childcare professionals to come into the homes of the healthcare professionals because, as the healthcare professionals said themselves, they were at risk. A genuine effort was made but it did not work. I will seek a briefing and I will ask that the Deputy is provided with a briefing.

I agree with her that the first thing we have to do is understand what the scale of this is, how many people were affected by it and what has been the cost on them. Do we have a situation whereby many of our front-line workers, whom we applauded quite rightly, have been suddenly left without any leave for the rest of the year? Even if we were not thinking about them, which we must, even if we were selfishly just thinking in terms of the healthcare system, our healthcare workers are exhausted. They are burnt out and the stark reality is that come September, October and November we will ask them to step right back up again. We do need to find ways to support them. I will revert to the Deputy and I thank her.

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
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We are here to discuss the question of extra funding. I do not think anyone in the country could dispute the need for extra funding for our health service. That is probably a general truth but it is particularly true at this moment. There are legitimate questions about where the money is going and conditions in our health service. If possible, I want to do back and forth question and answers.

I will start with an issue the Minister also raised when he was in opposition, only a number of days ago. On at least five occasions, he raised the question of the deal with the private hospitals. In his words, €115 million was a large sum of money, which obviously it is, and he was concerned that it did not represent value for money. Now that he is getting his feet under the table as a Minister, will he be any different from the previous Minister? Concretely, I repeatedly asked the previous Minister to publish a breakdown of those costs, and the cost estimates the Department or the HSE gets on a monthly basis from the private hospitals, so that we can see where that money is going and, in particular, why it is the case that we appear to be paying more than five times as much per bed compared to what looks like a similar deal with the NHS. Instead of providing this information, and I had many exchanges with the former Minister, he simply spoke at length about how important it was to use the private hospitals and about how we needed the capacity, about which there was no question whatsoever. It was a question of what the nature of the deal was and how to get that capacity. Will the Minister publish these details? Will he publish the breakdown of costs so people can see for themselves why it is costing so much?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank Deputy Murphy. My preference is to start from a position of transparency.

We must also be mindful of issues of commercial sensitivity and of protecting individual identities in cases. We all know information has to be withheld in those cases.

I am puzzled by the comparisons I have heard and I would need to see the underlying reports. It was alleged earlier on that the cost, presumably per bed night, was multiples here of what the NHS procured from private hospitals. I would need to see the detail on it. It sounds puzzling. I understand that the contract was done on a cost basis. I have no reason to believe that is not true and, therefore, it would have to be the case that it costs several times more here per bed night. It is something I will certainly be looking at.

I appreciate the Deputy's comments on the deal and I had made similar remarks. While I was critical of aspects of the deal, I fully accepted that it had to be done. To some extent, the empty beds told a story of success because they were not needed. The Deputy and I, along with everybody else, would have loved to have seen them deployed to non-Covid-19 and elective care instead. We have to be clear that if we are to enter into new arrangements with the private hospitals due to the extent of Covid-19 and the depletion of resources it is causing in terms of our capacity, which we would be well advised to do if we want patients to get care, we need to make sure that whatever agreement is put in place, that first and foremost it delivers high quality care for the patients who need it. Second, I agree that it also has to represent value for money. We will be looking at that, particularly in the context of the best way to engage for however long we want to put an arrangement in place.

7:05 pm

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
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I strongly urge the Minister to publish those figures so people can see for themselves to better investigate the situation and to compare it with Britain.

I have another question on the pay and treatment of nurses, who have been on the front line over the past while, along with other workers, in the struggle against Covid-19. We know that more than 8,000 healthcare workers have been infected, making up a huge percentage of our total infections, which is the highest rate in the world according to the Irish Nurses and Midwives Organisation. However, they have not received any hazard pay. Too often, particularly in the earlier days, they were left without adequate PPE and still Covid-19 is not being treated as a workplace injury for those workers. Over the weekend, a clip was circulated from 2008, which the Minister probably saw, of the then Minister for Health complaining that nurses were well paid as new entrants. In fact, our nurses have been overworked and underpaid, not just during the crisis but well before it. That was why they had to fight for pay increases and for parity with other healthcare professionals, including in their strike last year. Does the Minister agree that at the very least, our nurses should get hazard pay during this crisis and that they deserve a raise into the future?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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In the first instance, the issue being raised with me by nurses and midwives is the full implementation of what was agreed after the strike last year. I joined them on the picket lines and I have no doubt the Deputy joined them on the picket lines as well. We need to look at that first and foremost. I want to be careful about how I say this. I was going to say the primary concern of the nurses and midwives I spoke to on the picket lines was not pay. I do not mean to say they were not interested in their pay but I mean that their real passion was the quality of care. On the picket lines they talked to me about safe staffing levels. I do not mean to diminish the pay aspect in any way but it is to their great credit that they were not going out on strike primarily looking for pay increases. Rather, they were talking about patient care. We have to address both of those issues in the first instance. Both of those issues have been agreed to. We agreed to implement the safe staffing levels and to fully implement the agreement that was put in place.

Further to that, it is definitely worth taking a look at what options are there. The Deputy has raised the issue of hazard pay and other Deputies have raised the issue of returning leave that had to be taken to mind children. Other Deputies have raised other issues and the INMO and nurses and midwives themselves have raised other issues. We need to recognise the work that has been done. Over the coming weeks, we will think about how we will equip the system and support our healthcare professionals for the rest of the year. We have a group of people who have stood up and served to an extraordinary level, many of whom are very tired and we need to take a look at that in the coming weeks, along with many of the issues that were raised here today.

Photo of Paul MurphyPaul Murphy (Dublin South West, RISE)
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Most of the healthcare professionals hired during the crisis have been hired on short-term contracts with CPL, a recruitment agency. The former Minister, Deputy Harris, refused to publish the details of that arrangement. Will the Minister publish the details of the arrangement between the State and CPL?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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If the Deputy does not mind, what I will do is ask for a briefing on why it may or may not be possible to do so. It may be that there are issues of commercial sensitivity involved but I will ask the question.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Ceann Comhairle; Kildare South, Ceann Comhairle)
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Does the Minister have anything else to say in conclusion before we bring the matter to finality?

Photo of Stephen DonnellyStephen Donnelly (Wicklow, Fianna Fail)
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I thank all of the Deputies. It has been a long, detailed and good session and we have touched on many of the issues that have been raised. We have discussed our extraordinary healthcare professionals on the clinical side, the administrative side and the support side in the HSE, the Department and right across the system. There has been wide and deep recognition of the role everybody has played.

I understand that the Vote is being accepted and if that is the case, I want to thank the House for that and for the recognition that this money is essential and has been put to good use by our healthcare professionals and workers in the national response. I repeat that I will be back seeking further support from the House because this additional €2 billion is for measures that have been agreed by the Government to date and it is not a full-year Estimate. The reality is that as we continue to pay for costs directly related to Covid-19 and as we figure out the resumption of non-Covid-19 services, which are so important, we will think hard and hopefully we will be clever and come up with good ideas but it will cost money, and probably a reasonable chunk of money.

I want to finish with some good news. One of the items in the Estimate and that was part of the Covid-19 response was the temporary assistance payment scheme for the nursing homes. The original scheme, which was for three months, runs out today. The nursing homes and the residents and their families are quite understandably concerned about that. Nursing homes, like many of our essential health and social care services, are facing a range of challenges in the wake of Covid-19 and they all need to do things differently. Great strides have been made, including in the further suppression of the virus in the community. We must continue to provide support to nursing homes and to contribute towards their continued planning, preparedness and response to Covid-19. I am pleased to announce, therefore, that following a review, I will be extending the temporary assistance payment scheme for a final three months. The scheme will continue to be open for nursing homes for the months of July, August and September. It is an important contribution to supporting the sector in its ongoing preparedness for managing and mitigating the impacts of Covid-19, as well as supporting and protecting residents, which is at the core of everything they need to be doing. The extension of the scheme allows these preparedness and management measures to continue to roll out and also provides certainty on the conclusion of the temporary scheme. I must also recognise that significant systems and structures to facilitate the support of private and voluntary nursing homes have been put in place and have developed considerably in recent months. These non-financial supports come in the form of PPE supplies, temporary accommodation for nursing home staff and through the HSE's crisis response teams, including through the deployment of HSE staff.

A considerable amount of support, in the form of telephone support, infection prevention and control support and public health support, is being provided to the nursing homes in parallel to the scheme that was put in place. The extension of the scheme also recognises that these other supports have been deployed as well. The extended scheme, therefore, will operate with some amendments. The new standard assistance monthly payment rates will be €600 per resident per month up to 40 residents, €300 per resident per month up to 80 residents, and €150 per month per resident thereafter, to an overall ceiling of €60,000 per month. The outbreak assistance payment component of the scheme will also continue.

The HSE continues to provide significant supplies of PPE to nursing homes, with well over €20 million worth of PPE provided to date. This must be recognised in the extension of the scheme. It no longer makes sense to have in place two separate funding supports for PPE. Therefore, for the remaining life of the scheme, the HSE will continue to provide PPE to nursing homes and the scheme will no longer need to cover this cost. The scheme administration is also being simplified with the removal of the form A process. This process made sense at the commencement of the scheme to ensure early flow of funding. However, it has served its primary purpose and may now be counterproductive to good administration and user-friendliness on behalf of the nursing homes, so we are discontinuing it. A small number of other amendments are being made, and I will announce details of this later.

I wanted to finish on some good news, some recognition of the need to continue to support primarily the residents of our nursing homes but also the amazing staff, who have worked so hard over the past few months. I thank the House again for supporting the Vote.

Vote put and agreed to.