Thursday, 15 October 2020
Ceisteanna ó Cheannairí - Leaders' Questions
This morning, the people of Cavan, Monaghan and my own county, Donegal, woke up to the news that level-4 restrictions would be introduced to stem the rising number of Covid-19 infections. I am aware of the great lengths people have gone to in recent weeks since the additional restrictions were imposed on those counties. People have made sacrifices to protect themselves, their families and the wider community. There is no doubt it has been difficult for people but I believe we can get through this together. In Donegal, we have seen that the numbers will start to reduce over the coming days. This provides us with a wee glimmer of hope but it is far too early to suggest this is in any way a trend. What we all need to do now is dig deeper, work together, follow the public health advice and get the better of this virus.
I am aware the restrictions imposed on households will cause alarm for many people. We need to remind people that there are exemptions on compassionate grounds.
While it is clear that we do not want anybody breaching these restrictions, common sense must prevail. I am mindful that there are people across the State, young and old alike, who feel isolated and alone, who are very vulnerable, and they should not suffer that. No one should be left isolated or cut-off from his or her communities. This needs to be clear. Further guidance on the compassionate grounds would be welcome. Caithfidh an Rialtas cinntiú go dtabharfar tacaíocht do na daoine sin.
The impact on incomes for workers and families also needs to be considered as level 4 restrictions are severe. Ten days ago, the Minister for Finance said that the impact of these restrictions would result in hundreds of thousands of job losses. That is, unfortunately, the reality. The public health restrictions create huge difficulties for our people. We can get through this, but only if the support is in place to help people through it. On 17 September, the Government cut the pandemic unemployment payment, removing vital income support at a time when it was most needed. On Tuesday, the Government confirmed its commitment to make these cuts permanent, to reduce income support at a time of heightened restrictions and of income loss. That was a mistake. Thousands of workers in the three counties that have entered level 4 restrictions will lose their jobs this week. They will fall back on income supports that have been cut, but they still have to pay rent and to pay mortgages to the banks. They still have to cover the cost of childcare and to put bread on the table for their families. For them, this is a time of worry, stress and anxiety and they need support.
While we hope this does not come to pass, there is a possibility that other counties may enter level 4 restrictions in the time ahead with further job losses inevitable as a result. Sinn Féin warned last month that cuts to the pandemic unemployment payment were premature and short-sighted. Last night's announcement by Government is proof of that. We know that the average person in receipt of the upper limit of the pandemic unemployment payment, PUP, of €300 per week had a pre-Covid income of well above €500 per week. Level 4 restrictions will result in significant income loss. Government is determined to cut the PUP by another €50 at the end of January and again by €50 at the beginning of April.
The Tánaiste will know that the virus has not gone away and that it will, unfortunately, remain with us for a while. It will be with us at the end of January and in April. For as long as that is the case the threat to job losses remains. It is crucial that workers and families have certainty that their incomes will not fall off a cliff and that they will be supported. I am calling on the Government to change direction. I am asking that it put in place an adequate income support for those people who will lose their job and those who have lost their jobs as a result of this pandemic, not least in Donegal, Cavan and Monaghan. I am asking the Government to reverse the cuts to the pandemic unemployment payment and to bring the top level back to €350.
The decision to move Donegal, Cavan and Monaghan to level 4 will come as a bitter blow to the hundreds of thousands of people who live in those counties, although from my contacts with them I think the vast majority understand why it was necessary and that the decision had to be made given the very high instance of the virus in those counties relative to the rest of the State. People living in any other county should not get the wrong impression. When people hear that three of the Border counties have been moved to level 4 they may get the wrong impression that this is a problem up North or a problem along the Border. It is not. People in any part of Ireland should not take any comfort from the fact that the rules are stricter in these three counties. The virus is circulating in the community in every county in Ireland and we need to understand that that is the case and make sure that we comply with public health advice and change our behaviours. In all 32 counties, we need to embrace the public health advice. Whether we are at level 1, 2, 3, 4, 5 or 26 if people are not doing what they need to do it is not going to work. We know what we need to do. People need to keep apart, wash their hands regularly, cough and sneeze into their elbows or a tissue and, if they feel unwell, they need to stay at home, stay away from other people, including other people in their own household, contact their GP seeking a test and, if told to restrict their movements or to self-isolate, they should do exactly that. It is those behaviours that will get this virus under control because that is what got the virus under control in the spring when we all worked together as a nation to do so.
In terms of the financial assistance that is being provided to businesses and to individuals in the three counties, the Covid restriction subsidy scheme, CRSS, will kick-in next week. This will provide a weekly payment for any business that is closed as a result of Government regulations. We have instructed that the three counties be prioritised in terms of the applications that are made. Also companies will qualify for the employment wage subsidy scheme. It applies to any company that has seen its turnover fall by more than 30%. By virtue of these restrictions, more companies will qualify for that scheme in Donegal, Cavan and Monaghan than would have otherwise and commercial rates have been waived across Ireland for the remainder of the year.
In terms of the pandemic unemployment payment, it is now based on a person's income prior to losing his or her job. People who previously earned less than €200 per week will have full income replacement in that they will receive €203 per week. Those who earned between €200 and €300 per week will receive €250 per week, which, for many, is full income replacement and for others up to 86% and those who earned more than €300 per week will receive €300 per week. I acknowledge that there are people who were full-time workers and earning more than €300 per week who will see a significant reduction in their income but it is a scheme that has to be affordable and one that compares very favourably, I am sure Deputy Doherty will acknowledge, with the schemes that exist in the UK and in Northern Ireland.
In terms of any further reductions that may occur in January, that is a matter that will be kept under review by Government. We have set aside contingency funds in the budget announced this week to allow us to extend that January deadline if we are still in the teeth of the pandemic. The flexibility to extend that deadline is available to us and we will give that consideration.
I agree that we need to follow the public health advice, look at how we can limit our social contacts, maintain distance from each other and dig deep at this time but it is very difficult. There is also a role for the State here in terms of the restrictions that have been introduced. When Donegal was moved to level 3, there was a surge there in claims for the pandemic unemployment payment. The number of claimants in that county increased by one third. Level 4 restrictions will result in other people losing their jobs, not only in Donegal but in Cavan and Monaghan. As the Tánaiste said, this virus is not unique to those counties and others may follow the course of action taken in those three counties. The average wage for people who are now availing of the pandemic unemployment payment at a rate of €300 per week was €560 per week. The Government has cut that support. At a time when restrictions that are being introduced by Government are resulting in people losing their jobs there is a responsibility on Government to support that income. I accept it cannot support all of it but €350 per week was the appropriate amount in April, May and June and it is the appropriate amount now. People are facing into winter and Christmas and they do not know how they will get by because the Government has cut their payments by €50, it being a significant amount for many of those who have to, as I said, pay bills, mortgage or rent and put food on the table. I am asking the Government to do the right thing. Given the increased level of restrictions Government needs to reverse the cut to the pandemic unemployment payment and to return the top rate to €350 per week.
When the pandemic unemployment payment was introduced by the previous Government it was only supposed to last for 12 weeks. Obviously, we have learned since then that this pandemic is going to be with us for much longer than we thought. To make sure that we could extend it well into next year, if we have to, we had to link it to wages. That was done so that we could continue to support people's incomes. These are the types of choices Governments must make and they are not easy choices at times. When I hear the Deputy speak I often feel he speaks as though his party has no experience of government on this island. There is a Sinn Féin Minister for Finance North of the Border in the Six Counties, as the Deputy describes it. There is also a Sinn Féin Minister with responsibility for welfare. It is a devolved matter. The income support being provided to people north of the Border is about £100 sterling per week under universal credit, which is much less than it is here. Part-time workers, rather than getting full income replacement, get only two thirds of their income. I appreciate Sinn Féin does not control the chequebook, but it has autonomy and it could take money from other areas and put it into an increase in the universal credit.
However, taking everything into account and operating in the limitations that exist, Sinn Féin decided not to.
Five months ago, I stood in the House and asked the Minister at the time for a roadmap on testing. My understanding was that in June, as we began to open up the country, the system of testing, tracing and isolating would begin in earnest and every person who needed to be tested for Covid-19 would be tested. I understood that was how Government was going to contain the virus while being able to keep the country open.
To me, test, trace and isolate means that positive test cases would and should be isolated. Then, their contacts would be traced immediately, tested and isolated and so on. Where that system is operated effectively, we can contain the virus. We test, trace and isolate. Yet, the information I have today is that in three and a half months the Government system has failed miserably. The virus has spiralled out of control. If we are to be truthful about the real reason it has spiralled out of control, it is that the Government failed to put a system in place to do contact tracing when the numbers were low. When we had cases of 70 and 80 per day, there was no effective contact tracing. As a result, we have seen the numbers spiral to multiples of that in every county. It has spiralled out of control. That is why we have a resurgence. It is a total systems failure in contact tracing.
The Government's inability to put in place the most basic elementary and logistical solution in contact tracing is the real reason that we are moving to level 4. Maybe not as many people would need the pandemic unemployment payment if we had an effective contact tracing system in place. Why has the Government system failed us with regard to contact tracing?
I understand the argument Deputy Murphy is making. I can even understand, on occasion, the desire to seek to wish to blame someone for the fact that we are now experiencing a second wave of the virus. However, I do not believe the argument Deputy Murphy is making - that it is down to failures in testing and tracing - really stacks up. Let us consider Denmark, for example, a country that is doing three times as much testing as us. Guess what Denmark is experiencing? A second wave with a similar incidence of the virus to what we have. Let us take, for example, somewhere like Germany, which handled the first wave really well. Germany was extraordinarily impressive in terms of its ability to test, trace and isolate people. It has just recorded a record number of cases, the highest ever. The number is higher than even during the first wave. This is something that is happening all across Europe. All across Europe we are experiencing a second wave and pretty much every country in Europe is now recording record case numbers despite the best efforts of their Governments, populations and health authorities.
We should avoid the temptation to make it so simplistic that if only X, Y or Z had been done by someone else it would all have been grand, because that is not really what the facts tell us. I will explain why I believe that is not the case.
I want to pay tribute in particular to all the people who are involved in testing and tracing across Ireland currently. We talk a good deal about our hospitals being overwhelmed. Thankfully, so far, they are not. We have approximately 30 people in intensive care units and we have capacity for 350 beds. We have approximately 200 patients out of 11,000 beds. However, the people who are really overwhelmed at the moment are the wonderful people working in our laboratories who are processing 15,000 tests per day, the medical scientists, the wonderful public health doctors and contact tracers who are now trying to contact trace the contacts of 1,000 people nearly every day. That is really tough on them. The best thing we can do for them is to follow the public health advice. If we are going to have several hundred or 1,000 positives per day, and each of those has six or seven contacts, then that is 7,000 people per day who have to be contact traced. We would need an army of people, probably an army bigger than our Army, to trace that many people every day. The best thing we can do to help our laboratories, doctors, contact tracers, medical scientists and all the people who are helping to keep this virus at bay is to follow the public health advice to reduce our contacts. We should reduce them to the minimum possible while still living a realistic and possible life. That is how we can help them.
The Tánaiste says that we need not blame anyone. I am not blaming anyone. I am pointing out an ineffective system of contact tracing. I am inundated with calls locally. I will give one serious call as an example. It is the most harrowing one I have heard to date. It is about a young man, a GAA player, who tested positive but had not actually been contact traced for six days. His girlfriend, with whom he lives, works in a nursing home. That nursing home is now infected. It took six days to contact trace someone who had played GAA and did all the right things. He simply played GAA and became infected. Unfortunately, six days later his girlfriend had not been contact traced to him and she had been working in the nursing home. There is no point in testing. We have 100,000 per week being tested. The Tánaiste says 1,000 per days are being contacted. We had 60 cases in Wexford on Tuesday. We would need at least 310 people contact traced immediately. If we need 310 people traced in Wexford and the Tánaiste says there is only 1,000 per day, that means the system is inefficient and totally ineffective. That is why we are at level 4 and, most likely, going to level 5. I am asking the Tánaiste to put an effective contact tracing system in place to go with the testing.
I wish to be very clear about this because people really need to understand the public health message. We are now six or seven months into this pandemic. If a GAA player or a player of anything or anyone tests positive for this virus, the close contacts of that person must restrict their movements. People should not wait to be called or contact traced. They do not have to wait to be tested. I had to do it myself.
If Deputy Murphy wants me to check on that particular case I would be happy to do so. However, I am advised by the HSE that the median turn-around time is approximately two days, but I imagine there are cases where that does not happen.
What is a primary medical certificate? A primary medical certificate allows a person with a disability to claim back VAT on a vehicle. It also allows for tax relief on the purchase and adoption of vehicles. For the past four years, the Minister for Finance has been embroiled in controversy over the criteria for this scheme. A case was challenged and went to the Supreme Court, and the Minister lost the case. Was this case warranted? How much did this court case cost? How many adults and children with disabilities could have been helped by the cost of this case? How can a person with a disability travel to a medical appointment, school, college or travel for their daily needs without this scheme being put in place? All five supreme judges ruled in favour against the Minister and the driver disability board on 18 June 2020. Yet, the Minister put nothing in place to substitute for the collapse of the scheme.
Why are disabled persons still getting replies and being put on a so-called list when the scheme does not even exist? I rang around the HSE and was told there were numbers in Limerick and Clare. Waterford had 54 and Kilkenny had 22. I was informed that in my neighbouring county of Tipperary assessments were being done virtually and Tipperary only has four. The authorities in other counties throughout the country are saying it is all being delayed over Covid-19 and that people cannot be assessed.
In Tipperary, however, they are doing it virtually and their list is down to four people. Is there a scheme or not?
I appreciate this is an important issue for the Deputy and for his constituents. I am afraid I am at a disadvantage in that I did not know this topic was going to be raised and I do not have a note on it. I am aware, however, that there are implications from that court case. The Minister for Finance is across that issue and is working on a solution, if it is possible to come up with one, which I am sure it will be.
On assessments, my strong view is that if an assessment can be carried out virtually it should be done virtually and if it is being done in some counties I do not see why it should not be done in all counties. There may be occasions where a physical examination or an inspection of a home needs to be done but where these assessments can be done virtually, that should be done.
On 6 October, a letter went out from the office of the Minister for Finance, Deputy Donohoe, to the community care centre stating that in light of the Supreme Court judgment, his officials had informed him not to restart the services for assessment. That letter was sent by the Minister. I also have copies of letters, dated 9 October, stating that a person with a disability was on the list. On 6 October the Minister told the community care centre to stop the assessments and on 9 October someone was being put on the list. Is this list for a scheme that does not exist? Where is the joined-up thinking? In addition, separate from the people who are on the phantom list, I have 170 people who are appealing the judgments. The Minister said this was to be stopped on 6 October and on 9 October someone was told he or she was on the list.
I beg the Deputy's indulgence in allowing me to come back to him on this. I do not have sight of any of those letters. I know this is an issue and it has been raised by other Deputies. I will be in contact with the Minister for Finance later today and I will get the Deputy a proper reply as soon as possible. I appreciate this is an issue that needs to be sorted but I do not want to give an assurance or make a comment here in the Dáil that might turn out to be incorrect.
I wish to raise a matter which pertains to a constituent of mine who has passed away. He stayed in University Hospital Limerick and was accommodated on a trolley in the corridor. After he passed away, his family were charged €813 per night. I raised this matter with the Minister for Health, who referred it to the hospital. The hospital replied to say the inpatient and day case charges are applied based on section 55 of the Health Act 1970, as amended by the Health (Amendment) Act 2013. I looked at that Act and it defines charges in respect of single occupancy rooms, multiple occupancy rooms and where overnight accommodation was not provided. A corridor is not a room. I am sure that in his previous time as Taoiseach and in various ministries, the Tánaiste has necessarily had to travel for work and rooms have been booked for him. I doubt if he was ever offered a corridor to sleep in and if he was, I doubt his officials paid for a room. Can the Tánaiste confirm to this House that a corridor is not a room?
Today is pregnancy and infant loss remembrance day and I refer to the restrictions in place at our maternity hospitals. Women attending for ultrasounds and antenatal visits cannot attend accompanied by partners. For anybody to first see the heartbeat of one's child is a profound and moving moment and one which should be made available to them. I can only imagine what it must be like to be told there is no heartbeat, and to have to go through that alone is inhumane. I accept this is a time of a pandemic and that restrictions are necessary. Equally, humanity has to prevail. Likewise, with regard to visits during birth and, in particular, after the birth of a baby, there is no uniformity of approach across the State. University Maternity Hospital Limerick does not allow visits and I know the National Maternity Hospital just across Merrion Square is in a position to allow visits. I ask that some guidance be provided and a uniformity of approach be adopted across the State in that regard.
When patients are admitted to a public hospital, they have the option of whether they wish to be treated as private or public patients, depending on their insurance status. Patients opting to be treated privately in a public hospital have chosen to pay the consultant and the hospital for the services each provides. The fee is not just for the bed, therefore, it is for the service of the consultant and for other services provided by the hospital. Under section 55 of the Health Act 1970, the HSE is required to levy statutory private inpatient charges on all patients opting to receive private inpatient services. The statutory hospital charges that apply for such an episode of care depend on the category of hospital, the duration of stay and whether the accommodation provided was in a single or multiple occupancy room.
The core purpose of the public hospital system is to provide services to public patients. Nonetheless, historically and currently, a proportion of activity in public hospitals involves the provision of care to private patients and income generated in this way is a key component of funding the public hospital system. It is Government policy that users of private services in public hospitals should pay towards the cost of providing those services. The charges applied in respect of private care in a public hospital relate to costs which include those associated with non-consultant hospital doctors; nursing staff; medicines; blood, medical and surgical supplies; radiology; diagnostics; operating theatres; laboratories; administration; and support staff.
On visiting maternity hospitals, I know this is an issue that has been spoken about a lot in recent weeks and an issue that is causing a lot of concern and worry for expectant mums and, in particular, dads who want to be able to be there for those important appointments and crucial scans. It is a difficult situation but we need to bear in mind that so far at least, no pregnant woman has died of Covid-19 in Ireland and we want to keep it that way. Most women who are pregnant are in good health but sometimes there can be women in a hospital or on a ward who have a complicated high risk pregnancy with underlying medical conditions. We need to be honest and be wise to the fact that the more people who come into the hospital, whether it is partners or visitors, the higher the risk that Covid-19 could be introduced to the hospital. Therefore, there would be the risk that somebody who has a high risk pregnancy could get Covid-19, which could possibly result in the loss of the life of both the mother and the child. That is the risk that has to be assessed by the clinical directors and masters of the maternity hospitals and we need to respect their decisions when it comes to visiting. I understand what the Deputy is saying and as much as is possible, we should allow partners to attend, particularly at anomaly scans and so on. That should be done but we have to put our trust in the masters and clinical directors of those hospitals to make the right decision, based on the situation in their hospitals.
If the Government is going to continue to treat a trolley in a corridor as a multiple occupancy room then we will inevitably have an expensive court case of the type to which Deputy O'Donoghue referred to sort out this anomaly because a corridor is not a room. It is that simple.
I want to move on to one other associated area, namely, the latest restrictions which have been announced for not visiting other homes or houses. I have no doubt the majority or a large number of people will adhere to those restrictions. However, others will not. Before this is put on a legislative footing, I ask and urge the Government to look at the potential for unintended consequence. This has the capability to seriously damage contact tracing because people will simply not give the names of the people with whom they have been in contact. That is a big problem in Britain, which has put everything on a legislative footing with penal provisions and if this provision is also put on a legislative footing, we risk damaging the ability to contact trace, which is the key weapon the State has at its disposal.
Charges are a matter for the HSE, operating under section 55 of the Health Act. Perhaps the solution for the HSE would be not to charge for the night if the person is in hospital for, let us say, four or five days. That is the average length of stay in hospital. Perhaps it would be sensible for the HSE not to charge for the first night if the patient ends up spending that night on a trolley or sitting on a chair, but that is a decision for the HSE to make. On the positive side, while there are still patients on trolleys every day, a very large number are on trolleys because they are in isolation rooms, so they are on trolleys for clinical reasons rather than reasons of overcrowding. It is positive to see that the level of overcrowding in our hospitals is at its lowest in many years, if not since records began.
I see that the Irish Nurses and Midwives Organisation still does a daily trolley count but has discontinued the monthly count, which used to show that X month or Y month was the worst month ever, because that is not the case any more and we have seen a huge reduction in overcrowding, which is a positive.
I do not know if that has something to do with Deputy McNamara getting great value out of his slot. Deputies are meant to ask one question about one topic but he managed to get three questions in.