Louise O'Reilly (Dublin Fingal, Sinn Fein)
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This has been a tough week for the women of Ireland. Last night, we had a heartwrenching and emotional debate on the Government's proposals to seal the records of survivors of mother and baby homes, women who were vilified, abused and treated as outcasts by this State. In the same week, issues surrounding CervicalCheck have unfortunately arisen again. Some 12 months ago, the Tánaiste delivered a formal State apology for the litany of failures in respect of CervicalCheck and he said sorry for the humiliation, disrespect and deceit meted out to the hundreds of women affected by that scandal. This came in the aftermath of the State joining US laboratories that were at fault in dragging a terminally ill woman through the courts and fighting her tooth and nail every step of the way. It was accurately described as deathbed litigation.

The Tánaiste promised the women concerned that this would never happen again and that an alternative to the courts would be provided for women to seek justice. The truth is that this adversarial and aggressive approach has been maintained. Vicky Phelan has come forward to express her shock and anger that women and their families have been let down by the State yet again this week. The Minister, Deputy Donnelly, has written to women and their families to say that the tribunal will be established next week. They got that news at the same time as the public announcement. It is like the mistakes that were made were brushed under the carpet and forgotten about. It is as if the voices of the women concerned do not matter. We heard women say last night that their voices did not matter. Against their wishes and pleas for a non-adversarial route, the Minister, ignoring those calls, insists that the laboratories must be involved in the proceedings if taken before the tribunal. This is entirely wrong. The Government should not be joining these laboratories in fighting these women and their families. A decent Government would stand up for and protect these women and ensure that it worked with them to get the justice that they deserve.

We need to fix the system and that is the least that we owe these women. I am a user of the CervicalCheck service and I want it to work. In order for it to work, there has to be transparency and trust. The women who are the victims of this scandal have to be listened to, so that all women can know they can have confidence in the service because they are having input into it. These women have been let down repeatedly and now the Minister for Health intends to proceed on a basis that is not acceptable to those women. Vicky Phelan said she is pleading with the Minister to redouble efforts to sit down again with the members of the 221+ group to identify an alternative solution for redress, which is what members have asked for and deserve. Will the Tánaiste accept that there is a failure to live up to the promise that he gave when he was Taoiseach, that women would not be dragged through the courts and an adversarial process? Will he accept that this has caused significant distress for women and their families, all of which could have been avoided? Will he intervene ahead of this tribunal being established next week and ensure that the cruel treatment of women is stopped immediately and that the tribunal is constituted in a way that will deliver justice for them?

Leo Varadkar (Dublin West, Fine Gael)
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I thank Deputy O'Reilly for raising this very important issue. The CervicalCheck tribunal is being established in good faith by Government, honouring a commitment made by Government after the Meenan report of 2018. It is being established as an alternative to court for those who want it where cases cannot be settled by mediation or negotiation, which is of course the preferred solution and has happened in many cases but is not always possible, especially when there is a dispute about the facts and whether or not there was negligence. The idea is that the tribunal will be quicker, will have fewer legal costs, can be done in private and can be less adversarial as the tribunal will have access to independent experts. The Minister, Deputy Donnelly, has met the 221+ group. I heard him say this morning that he is willing and will be happy to meet again with the 221+ group to hear its members concerns, sit down with them and listen to their ideas and suggestions. He has made that commitment and that is welcome. I know he will follow through on that.

On the issue of a system being adversarial or not, it is worth paying attention to the words of Ms Justice Mary Irvine. She said that adversarial, in this context, describes a process whereby the evidence of each witness may be tested on cross-examination. It does not necessarily mean that it has to be confrontational. Unfortunately, in some of these cases, it may not be clear-cut. The person taking the case may feel that her smear was misread negligently. However, the scientist who read it or the doctor who signed off on it may feel otherwise. There is then a dispute about the facts. The evidence is set out and each side gets to question the evidence. That is what happens and I have not seen anyone come up with a solution to get around that. I do not think it would be fair to deny a scientist or doctor the right to be heard and to say that they were not negligent and read the smear correctly. I have not seen any solution to that conundrum other than to refuse to allow people to make a defence. I do not see how that would work.

On the issue of the laboratories being involved, following from the recent Carrick case in the High Court, I understand that laboratories can be involved as third parties rather than as defendants. That follows on from the Morrissey case, which established that the HSE has primary liability and cannot delegate its liability. It will be possible for the HSE and the State to be the defendant but the laboratories will only be there as a third party. That may be necessary because third parties have indemnified the State and will have to pick up the tab for any compensation. If they are totally excluded from saying that there was not negligence, that would create an issue and require the State to sue the laboratories, resulting in a second trial and second court hearing. I do not think that would be in anyone's interests.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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The Tánaiste has just read out a description of the process that has been rejected by the women and their families. I genuinely do not believe that the Tánaiste is doing them any service by seeking either to defend that or indeed to dismiss their concerns in this way. I do not think the Tánaiste is being fair. He says there is no perfect solution and no solution has been offered. Would the Tánaiste not intervene and request that the Tuesday deadline be lifted to give time for proper, meaningful engagement with these women? This matter came from the fact that information about women's healthcare and diagnosis was withheld from them.

They have already been left out of this process, sidelined and had the State try to shut them up. The Tánaiste should intervene and request that the Tuesday deadline be put back to allow sufficient time for engagement with the women and the families in the 221+ group.

Leo Varadkar (Dublin West, Fine Gael)
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The Minister for Health, Deputy Stephen Donnelly, said this morning that he is happy to meet again, listen to and engage with the 221+ group. It is his judgment then as to whether the Government would make a decision on Tuesday to defer the establishment of the tribunal. Obviously, I will be guided by him in that regard. Bear in mind that it is being established as an alternative to court for those who want it. Nobody has ever suggested, or is suggesting, that somebody would not be able to court if the person felt that it was in the person's best interests. It is the wish of everybody in government, and I believe every Member of the House, that as many cases as possible should be settled by mediation and negotiation, with no need for a court trial or a tribunal. That is happening in a number of cases.

However, there is an issue which is different from other issues in the past. That is where the facts are disputed. On the one hand, the person taking the case says her smear was misread and has experts to back that up, while, on the other hand, the doctors and scientists say they did not misread the smear and that they have a right to defend themselves and say they did not get it wrong. I am not sure what the Deputy is proposing. Would she like to take away that right from them? I do not believe she is proposing that, but that is where the difficulty arises.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy for raising this sensitive issue. It is an ongoing issue and many people have taken an interest in it in recent weeks, including Senator Currie, members of the Labour Party and others. I recognise the constructive and measured approach the Labour Party has taken in recent weeks with regard to the country trying to deal with this Covid crisis. The Deputy has taken the time to attend all the briefings, to speak to the Taoiseach afterwards and to take a position on whether we should go to level 4 or level 5 when other parties would not. The approach shown by the Labour Party is in stark contrast to the behaviour of other Opposition parties when it comes to Covid and when we should all be very much on the same side in doing everything we can to contain the virus, North and South.

On the specific issue raised by the Deputy, I understand that partners and fathers are allowed to attend for the labour in the maternity hospitals, but there are tight restrictions on attending for antenatal appointments and scans. Mechanisms are being put in place, where possible, to allow the father or the partner to attend remotely. However, that is not the same as being there in person. One cannot hold hands over Zoom and one certainly cannot comfort somebody who is getting bad news virtually or remotely. What concerns the clinical directors and masters is that the more people who come into the hospital, the greater is the risk that coronavirus will be brought into the hospital. With the virus at such high levels in the community, the risk increases each time a visitor comes into the hospital. We must be cognisant of that. The vast majority of pregnant women are very healthy, and even if they contracted coronavirus there will probably be no negative sequelae as a result. However, some women are not. Some have complicated pregnancies and have co-morbidities. If they got coronavirus while pregnant, it could result in bad outcomes for them and their babies. So far, no pregnant woman in Ireland has died of coronavirus, and we would like to keep it that way.

We must balance the concerns. However, I have listened to what the Deputy said and I will take it up with the HSE and CMO the next time we talk.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. I will certainly check that out or ask the Minister for Employment Affairs and Social Protection, Deputy Humphreys, to do so. The person concerned will be applying for both maternity benefit and child benefit. In most cases, that is when people get their PSC if they do not have one already. I am not sure what arrangements exist at the moment to facilitate people who do not have a PSC and cannot travel to an Intreo centre but I am happy to look into the matter.

Michael Lowry (Tipperary, Independent)
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People are frightened and struggling to cope with what lies ahead. However, they will endure this lockdown. They will do so because it gives them the hope that Christmas can be saved. This is how it has been sold to them. If they focus on the fact that Christmas can be celebrated with some semblance of our "old normal", they are willing to take the darkness now, so that the lights can shimmer in December.

We have been down this road before. In March, we aimed to save summer. In October, we aim to save Christmas. What will our next aim be? The question I pose today is whether we are learning from the actions we are taking. Are we being proactive or reactive? Are we locking down people and locking up the economy while neglecting to rethink our strategy and vary our approach?

There are two weapons we can use to win this battle of survival, namely, technology and enforcement. We need a renewed emphasis on the importance of testing and tracing. We also need the implementation of fast turnaround diagnostic testing in schools and at airports and ports. We must sanction screening for workplaces to detect asymptomatic cases. I have been told by those working on the front line that people are hanging up when they are phoned and told they are a close contact of a positive case. This sounds alarming, but it is factual. People are revolting in a dangerous way. We need rapid testing to get people back onside.

All of our strategic decisions around Covid are based on critical care bed capacity and the fear of our hospitals being overwhelmed. We have to close down our economy because our bed capacity is totally inadequate. This is due to the abject failure of the HSE over many years to proactively manage our health system. The country and its people are now paying an enormous price for the years of failure in the administration and political oversight of the health service. The alarm bells have been deafening for many years. We now have a healthcare system that cannot handle a winter crisis, never mind a pandemic. We throw money at the problem, but we do not see results.

Issues such as these must be tackled without delay. The next six weeks cannot simply be about suppressing a virus that will come out to join us again after the Christmas celebrations. This lockdown must be a time to tackle the problems that have led us to where we are now. Everything must be scrutinised, every success recorded, every failure rectified and every alternative analysed. We must use this time to harness the medical and healthcare industry to investigate and implement additional initiatives to urgently increase high-level bed capacity.

The shock and harsh reality of the closure has again hit our bewildered business community. This further lockdown will have incredibly negative consequences for business. To address this the Government has introduced the Covid restrictions support scheme, CRSS. Could the Tánaiste explain the value of this fund and the criteria and procedures relating to drawing it down?

Leo Varadkar (Dublin West, Fine Gael)
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It is very hard to be sure of things at this time. One thing I am sure of is that Christmas will not be cancelled, it will still be a public holiday. It will still be a religious festival. Christmas mass will still be said. Santa will still arrive and put presents under the tree. I am sure that families will still be able to meet up. It just might not be the Christmas that we are used to in terms of having parties and doing other things that we would like to do.

Michael McNamara (Clare, Independent)
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Will people be able to go to Christmas mass?

Leo Varadkar (Dublin West, Fine Gael)
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Christmas mass will of course be said.

Deputy Lowry asked if we are always rethinking and varying our strategy. We are. Anyone who speaks with absolute certainty about the coronavirus is probably bluffing. We have learned a lot about this virus, and we have a lot yet to learn about it. We have learned a lot about how to handle a pandemic, and we have a lot yet to learn about it. We are always rethinking and varying our strategy as facts change and as new evidence becomes available.

Bed capacity is always a concern. It is an issue but in many ways the position in this regard has been overstated in recent weeks. Since the start of the year we have added 800 beds to the hospital system, 400 acute and 400 sub-acute and 30 additional ICU beds, with more to come. As things stand, there are approximately 300 or so patients in hospital with Covid. They are occupying that number of hospital beds out of a total of 11,000. There are approximately 35 patients in ICU with Covid and they are occupying that number of ICU beds out of a total of approximately 280. It is only when the total number of people in ICU goes over 280 that the ICU system goes from green to amber, let alone red.

A rough measure of overcrowding in hospitals is the number of patients on trolleys. Today, it is 133 and many of those people are on trolleys because they need to be isolated, not because a bed is not available. That is down 65% on this time last year and 66% on the previous year. In fact, the number of patients on trolleys and the level of overcrowding in hospitals is probably at an all-time low. Indicative of this is the fact that the Irish Nurses and Midwives Organisation, INMO, still produces a daily count but no longer produces a monthly count. That is because these are the months with the lowest numbers on record in terms of overcrowding. That may not come across sometimes in the debate about this matter.

The CRSS is being run by the Revenue Commissioners and will open to applications this week, if not next week, and will apply any time we are at level 3 or above. It will kick in retrospectively from the budget date for that reason. The way it works is that any company whose premises is closed as a result of a Government order can claim a weekly grant based on its previous turnover. This will amount to 10% of €1 million in the first year and 5% on the second million. I can perhaps go into more detail during the follow-up response.

Michael Lowry (Tipperary, Independent)
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I wish to speak on behalf of student healthcare nurses. We need to listen and respond when we hear words such as "discouraged", "dismay", "anger" and "injustice" coming from any group within our healthcare system. Student nurses have long felt that they have been taken for granted and exploited for the work they carry out in hospitals across the health service. These feelings are mounting. The student nurses and midwives of Ireland are taking to the front line in the battle against Covid. In doing so, they are risking themselves and the health of their family members. They are not paid for a job which carries great responsibility. To compound their grievance, they are still being asked to pay college fees of €3,500 per year. These students say they feel forgotten and disrespected by the Government and they are pleading to have their voices heard and to get proper financial recognition. While nursing is considered to be a labour of love, this, unfortunately, will not pay the bills. Could we make progress in the context of financial recognition for this group of people?

Leo Varadkar (Dublin West, Fine Gael)
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The Government's priority is to protect and support the education of all students, including student nurses and midwives. Student nurses are paid in their fourth, or pre-registration year, but not in earlier years. The process of student nurses and midwives training to meet educational standards and requirements involves a supernumerary clinical placement and this places them on the front line for certain periods during each year of their training. This is considered to be a form of work experience. The Minister for Health and his Department recognise that Covid-19 has had a real effect on the placements of student nurses and midwives. The Department is considering proposals for a revision of the existing allowance for clinical placements for student nurse and midwives in the short term to support them financially with their ongoing training. The Department expects to conclude this process in the coming days. The revision will also include measures that will protect student nurse education and welfare during this time.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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Last night I was preparing to raise an agricultural matter but this morning, unfortunately, I got a phone call on my way here from a director of nursing who was distressed and who felt helpless. The person was actually crying because they could not do anything as they were self-isolating. In a nursing home in my constituency, 25 of the 27 residents have tested positive. Unfortunately, one of the residents has died. Of the eight nursing staff, seven have tested positive. Ten of the 11 care assistants have tested positive. Those who run the home went through the protocols and contacted the HSE.

They were told not to panic and get agency staff. There are no agency staff, however. The one nurse and the one care assistant who have not tested positive did 14 hours yesterday. The HSE promised staff this morning but nobody showed up. This morning, two residents were admitted to hospital. This nursing home is looking at having to send the rest of its patients to hospital because the HSE did not send any staff to help it out.

HIQA was informed and every protocol was followed. The spin, however, that came from the HSE to all politicians of what would be done when our elderly were in trouble has not been adhered to. Does the Tánaiste think what has gone on there to old people in my constituency in the west is right? Does he think after what the HSE has done in this that it is fit for purpose? I would like to hear what the Tánaiste has to say.

Leo Varadkar (Dublin West, Fine Gael)
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I am afraid I do not have any information about the nursing home he raised or the current situation there. The Deputy will forgive me if it is not possible for me to comment on or answer his questions without knowing any of the facts. I will certainly make inquiries about it. Without knowing anything about the nursing home or anything about what is happening there, it would be inappropriate for me to try to answer questions about something about which I have no knowledge.

What I do know is that the HSE has put in many protocols and supports to help nursing homes over the past couple of months. The Deputy will be aware of the serial testing that happens in nursing homes. Ireland was one of the first countries to regularly test residents and staff in order that outbreaks can be detected and dealt with early. Additional funding has been provided for nursing homes through the nursing homes support scheme. Where possible and where asked for, I understand the HSE can provide staff and, in some cases, can even take over the clinical governance of a nursing home. That happened back in the spring.

Again, however, without knowing anything about this particular situation, it is really not possible for me to speak to it.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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The Tánaiste said he does not know the facts. I am giving him the facts. I did not stand up here to make things up. I have talked to the director of nursing in the nursing home. They have one care assistant and one nurse to try to run that nursing home. These are the facts. Whether the Tánaiste wants to check it somewhere else, that is fine. I do not go telling the Tánaiste something that is not accurate, however.

Does he think it is acceptable that the HSE promised staff this morning and they did not come? Does he think it is acceptable that over the past number of days when the HSE was contacted, it said not to panic and get agency staff? The dogs on the street know agency staff are not available. If I give the Tánaiste the details after Leaders' Questions, will he personally intervene in this case? Every evening when we look at the figures, we look at the number of people in hospitals. We are now looking at 22 or 23 more people being sent to hospital because of a lack of staff, staff the HSE said it would send. The numbers are going up in the hospitals because the HSE said it would help out the nursing homes when they hit problems but it is not adhering to that.

Leo Varadkar (Dublin West, Fine Gael)
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I do not doubt the Deputy's sincerity or veracity for a moment but this is not an issue that I know about I do not know even the name of the nursing home. If the Deputy wants to provide me with more information, I will certainly make contact with the CEO of the HSE about it and follow up on it.