Pearse Doherty (Donegal, Sinn Fein)
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On what is World Cancer Day, I extend my solidarity to Ms Lynsey Bennett and express my deep anger at what we saw yesterday - another woman and family failed by the State, another woman who was forced to go to the courts despite assurances that such would never happen again. It is a scandal. The Tánaiste gave a commitment to these women in 2018 and it is time that it was delivered upon. My thoughts are with Ms Bennett and her family today.

D'fhógair an Rialtas inné nach mbeidh an vacsaín AstraZeneca á húsáid orthu sin atá thar 70 bliain d'aois. Cruthaíonn an bhacainn seo dúshlán mór don Rialtas ó thaobh an phlean chun vacasíní a chur ar fáil don phobal. Tá an cuma ar an scéal anois nach bhfuil plean mar is ceart ag an Rialtas maidir le vacsaín a thabhairt dóibh atá thar 70 bliain d'aois. Níl amlíne ar bith ann agus níl a fhios ag dóibh siúd sa phobal atá thar 70 bliain cén uair a bheidh siad ag fáil na vacsaíne nó cén dóigh. Beidh siad ag brath ar dhochtúirí teaghlaigh ach ní bheidh cumas stórála ag cuid mhór dochtúirí teaghlaigh leis an vacsaín a chur i bhfeidhm gan AstraZeneca. An bhfuil ról ag na cógaiseoirí ina leith sin? Tá soiléiriú agus freagraí de dhíth ar an phobal.

Yesterday, it was announced that the Government had taken the decision that the AstraZeneca vaccine would not be used to vaccinate those over 70 years of age. This vaccine was repeatedly described as a game changer and we all hoped that it would be, but yesterday's development presents major challenges for the roll-out of Covid-19 vaccines throughout the State, not least because this vaccine is far easier to store and the need to roll out other vaccines to over-70s will present major logistical challenges for GPs, who are expected to roll out the vaccination programme in the community. The Taoiseach acknowledged as much yesterday when he stated that it would mean a change in the operation of the plan and would be a significant logistical challenge. However, the Tánaiste stated that it should not delay the roll-out. I find it difficult to believe how it cannot delay the roll-out in respect of over-70s. Timelines and targets were already thrown out the window with the reduced number of AstraZeneca vaccines coming to the State, and now there seems to be no sense of a plan.

What is proposed in respect of the roll-out of the AstraZeneca vaccine? Who will get it? When will they get it? What is the situation facing over-70s? When will they be vaccinated? What is the new ambition in that regard? We do not know how long it will take to vaccinate over-70s without the AstraZeneca vaccine. There is no sense of a new strategy or timeframe.

People are asking questions. For example, can GPs still be to the fore in administering vaccines that are deemed suitable for over-70s, given the major logistical challenges posed by how those vaccines are stored? Many GPs do not have suitable storage systems. Where will the vaccines be administered? Questions remain for pharmacies. When will pharmacists and their staff be vaccinated, when will they be part of the roll-out and what part will they play?

These are genuine questions that people like my mum, who falls into this category, want answered. They are alarmed at the news and want to be assured that the Government has a plan and what it will mean. They saw the advertisements placed in national media saying that GPs would be in contact with them over the next number of days, but now they are questioning what the plan is. Since the news emerged yesterday, there has been no clarity about how the situation will be managed. When will we see the revised targets and when will we have clarity? Will the Tánaiste answer some of the questions on capacity and the logistics involved in rolling the programme out through GPs? What will be the role of pharmacies? When will over-70s be vaccinated as a result of the Government's decision yesterday?

Leo Varadkar (Dublin West, Fine Gael)
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It is important to say that the nation's vaccination programme is well under way. More than 200,000 vaccines have been given. Compared with our peer European countries, we are among the top countries in the EU in terms of getting the vaccines out to people once we have received them. By last Sunday, we had received 207,000 doses, 200,000 of which had been given. The only constraints at the moment are factors that are not in our control - first, supply from the companies and, second, approvals by the European Medicines Agency, EMA.

We have faced setbacks in the past week. We now know that AstraZeneca will provide us with 200,000 fewer doses in February and March than we had anticipated and our public health and scientific advisers have recommended that over-70s be given an mRNA vaccine - the Pfizer or Moderna vaccine - rather than the AstraZeneca vaccine. I should say that all three vaccines are safe and effective, particularly in terms of reducing hospitalisations and deaths, and they have been licensed for all age groups. However, because of the lack of detail and the relatively small number of older people involved in the AstraZeneca study, the recommendation for now - this will probably change - is to give the Pfizer or Moderna vaccine to over-70s where possible. This means that the same number of vaccines will be given over the next couple of weeks as had been intended, but there will need to be some changes as to which groups are vaccinated and in what order. It means that we will still be able to start the vaccination programme for the over-85s in the middle of this month as planned, but they will get the Pfizer or Moderna vaccine rather than the AstraZeneca vaccine. For over-70s, the roll-out may be slower, but it will be faster for healthcare workers and other groups. In total, however, the same number of people will be vaccinated.

GPs can give the mRNA vaccines - the Pfizer vaccine and the Moderna vaccine - but there are logistical challenges to that. They have to be kept at a very low temperature and can then be kept for up to five days at a moderate temperature of between 2o and 8o Celsius. It is possible for GPs to be the lead players, as it were, in the vaccination programme in respect of over-85s, but it might not be possible to administer vaccines in all surgeries. It may require vaccination centres and particular practices with the necessary infrastructure, but it can be done. GPs are willing to take part, want to be a part of it and believe they can do it. We believe they can do it, too.

As will be the case elsewhere for the next couple of months, we will have to adapt our plans as the situation develops, supplies come in, the science changes and recommendations change, and we will do that. At least 1.2 million doses will still be delivered and given to people by the end of March, but there will need to be changes to the schedule.

My understanding is that pharmacists are part of group 2. They are considered to be healthcare workers who are patient facing. They will be vaccinated starting this month, most likely with the AstraZeneca vaccine for reasons the Deputy will understand.

Pearse Doherty (Donegal, Sinn Fein)
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Gabhaim buíochas leis an Tánaiste for his answers. I ask him in his supplementary reply to address the other point I made to him, which was that in May 2018, when he was Taoiseach, he gave a commitment that no woman would be forced to go to court to seek compensation due to the failures associated with the CervicalCheck scandal. We know that promise has been broken time and time again and it needs to come to an end. No woman should be forced to go to court to seek justice and still not even have an apology from the State or the HSE. I ask the Tánaiste to address this.

The Tánaiste said the vaccine roll-out will be slower for those aged over 70. Will he give an indication of what the timeframe is and when those aged over 70, which is the group that is most at risk, will be vaccinated? The original date was the end of March. What is the new date? Does the Tánaiste have any information on the number of GP surgeries that have the ability to vaccinate using the other two vaccines that have to be stored at lower temperatures of up to -20°C, as he has acknowledged? Will the pharmacists now be involved in the rolling out of the vaccination programme? How will they be able to take part in it?

Catherine Connolly (Galway West, Independent)
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I thank the Deputy.

Pearse Doherty (Donegal, Sinn Fein)
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When will we get clarity on this? Which group will be availing of the AstraZeneca vaccine, since it will not be given to those aged over 70?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. I am advised that the vaccination of those aged over 85 will begin in the middle of February as planned but because we will have to use the Pfizer and Moderna vaccines, of which there is less supply, as opposed to the AstraZeneca vaccine, the roll-out will be slower. I cannot give the Deputy exact timeframes and dates on it at this stage. It will allow us to speed up the vaccine programme for healthcare workers and high-risk people who are under 70. A lot of the details of this have to be worked out. This new development only happened in recent days with regard to the use of the AstraZeneca vaccine for those aged over 70. We will have that detail and share it with people as soon as we have it.

In relation to Lynsey Bennett, my thoughts are with her today also, and with her daughters Zoe and Haley. I do not want to comment too much on an individual case because I do not know the details of the case. I imagine the Deputy does not know either. It is the objective of the State and the Government to settle all cases by mediation where possible. I understand this case was settled by mediation and did not have to go to trial but perhaps it could have been settled earlier. Only the legal teams know that. At the time I made the commitment, as I have explained before, I believed and hoped it would be possible to settle all cases by mediation or negotiation but, unfortunately, that has not proved possible.

Catherine Connolly (Galway West, Independent)
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I thank the Tánaiste.

Leo Varadkar (Dublin West, Fine Gael)
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It is the case that on occasion, and on more than one occasion, the facts are disputed. Scientists and doctors say they were not negligent.

Catherine Connolly (Galway West, Independent)
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I thank the Tánaiste.

Leo Varadkar (Dublin West, Fine Gael)
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If the Deputy can come up with a solution to resolve this, I am all ears. Unfortunately, there will be individual cases where the facts are disputed.

Catherine Connolly (Galway West, Independent)
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I thank the Tánaiste. We are beyond time.

Leo Varadkar (Dublin West, Fine Gael)
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Therefore, there has to be some sort of hearing, hopefully at a tribunal rather than in court.

Catherine Connolly (Galway West, Independent)
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I thank the Tánaiste. I realise the issue is sensitive but I have to move on.

Alan Kelly (Tipperary, Labour)
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The Leas-Cheann Comhairle need not worry. I will give the Tánaiste another go on the issue.

The Tánaiste's use of language was a bit unfortunate. This is not a confrontational issue and I think he misspoke when he used the word "trial". They certainly are not trials. My heart dropped, as, I think, did that of everybody in the nation who watched the video of Lynsey outside the court. It was another woman failed by the State over the misreading of her slides. She is 32 years of age. She is fighting for her daughters Zoe and Haley. I have a number of questions and I have put solutions to the Government. Why is she being dragged through the High Court fighting when she should be spending time with Zoe and Haley? Negligence was found here. Why is the Government and, dare I say it, the previous Government continuing to treat women like this? Why, three years after the Tánaiste stated on the "Six One News", which I remember watching live, that women would not have to go through courts are there an estimated 200 more cases lined up?

It is two months since poor Patricia Carrick, may she rest in peace, passed away. I remember the Taoiseach offered yet another apology. Her family had to go into the courts after she passed away to instruct on her payment and get €2.75 million. The landmark Morrissey judgment was appealed by the State. It should never have been appealed and I, and possibly one or two others in the House, opposed but no other party did so. The State lost. That judgment changed the criteria whereby the HSE is liable. I have to ask a question based on the inertia from the Minister, Deputy Stephen Donnelly, and the Government. Is the State Claims Agency literally waiting for women to die because it will be cheaper for the State because of the law, which the Chief Justice has said needs to be amended, whereby the next of kin pursuing cases will not get the same amount of award?

The Tánaiste asked for solutions in his previous contribution. Last September, I sent the Minister, Deputy Stephen Donnelly, a civil liabilities (amendment) Bill to deal with this issue and I said I would work with him. There has not been an iota. The Taoiseach rang me about this and explained it all but not an iota. Not alone this but the Minister, Deputy Stephen Donnelly, could not even engage properly to fulfil the requests of the 221+ group on the CervicalCheck tribunal, which is now out also for an overwhelming majority of women. This is proven by the fact there are almost 200 cases lining up in the High Court.

Will the Tánaiste and the Government direct the State Claims Agency to act in a humane and quick way for all of the women where negligence is not being disputed so that Lynsey and all those who follow her will be treated in a better way and allowed to spend their precious time with their families?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy very much for raising this issue again. I agree with him that it is not something we should be sparring about. It is too sensitive for that. My thoughts are with Lynsey Bennett today and particularly with her daughters Zoe and Haley. I hope her treatment goes as well as possible and that she gets as much time as is possible with her daughters. I do not know the details of this case because, as the Deputy knows, once things go to law they are handled by legal people rather than politicians. I understand from media reports that the case was settled. I am sorry it was not settled sooner. I do not know whether it could have been settled sooner but it is a good thing that it was settled. The term "trial" is a legal term. It applies to any court hearing but I accept that may not be the way people hear it so I am happy to rephrase and use the term "hearing" rather than "trial" because perhaps it is more sensitive.

Like I have said, I am not familiar with the details of the case and, therefore, I do not want to comment on it. When something goes to law, by law it is handled by the State Claims Agency. That law was passed by the Oireachtas. The answer to the Deputy's question on whether the State Claims Agency can be directed to deal with cases in a humane and quick way where negligence is not disputed is "Yes". I have done this at meetings with the head of the State Claims Agency. I am sure we can we emphasise and reiterate this point again. Where negligence is not disputed, these cases should be settled quickly, sensitively and in a humane way. I absolutely agree with the Deputy in this regard. Where a problem will arise is where facts are disputed. That will happen in some cases where the doctors and scientists will say they did not misread the smear, and they are also entitled to have their side of the story heard. We do not want that to happen in courts. This is why we established the CervicalCheck tribunal. This has now been established and it will allow cases to be fast-tracked. It will allow them to be heard in a more sensitive way and, hopefully, it will produce quicker and better outcomes for the women concerned.

The Civil Liability Act it is under review by the Government and the options are being considered. It is a complicated legal area, as I understand it, and there are issues about retrospectivity. It is something that is being examined by the Government.

Alan Kelly (Tipperary, Labour)
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The Tánaiste needs to direct the State Claims Agency to deal with these issues quickly and more sensitively, particularly where negligence has been found. It was found in this case, it has been found in a number of other cases and it will be found in a number of future cases. We will judge the Tánaiste's words over the coming weeks and months. I have drafted a civil liability Bill but I have had no engagement from the Government. Why is this? The tribunal is a waste of time because the 221+ group will not support it.

That is not the answer. If it was the answer, there would not be 200 cases lining up in the High Court as I stand here.

Finally, and more to the point, many women watching that yesterday, and watching Vicky Phelan in the United States at this moment in time, are getting worried. They want to have their smears done but they cannot get appointments. My colleague, Senator Rebecca Moynihan, had to ring around to five GPs to get an appointment. The Well Woman clinics are not taking appointments at the moment. Will the Government, through the HSE, ensure a lessening of this worry and stress and that, on the CervicalCheck website, a list of GPs and clinics that are taking appointments will be put up so the women of Ireland can have some solace that they will be able to get appointments? If they are delayed, we all know the consequences.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. As he knows, the Oireachtas some time ago decided that the management of medical negligence cases should be delegated to the State Claims Agency. That is the law. I think it might even have been brought in by Deputy Brendan Howlin as Minister, giving that power to the State Claims Agency to manage medical negligence cases on behalf of the State, so these are not dealt with by politicians or Ministers, and Ministers have no input into how these cases are managed.

I am not sure if the Government even has the authority to make a direction to the State Claims Agency. We have asked it, we have advised it and we have told it - I have done it in meetings with the head of the State Claims Agency - that where negligence is not disputed, these cases should be settled quickly, sensitively and in a kind and decent manner. We will restate that message to it and I can give the Deputy that assurance. I know the Taoiseach feels the same about it.

In regard to women getting their smear tests, I think we all agree. Today is world cancer day. We know that cervical screening works and we know it has reduced mortality - the number of women who die from that disease - by nearly 7% year-on-year. It is a very successful programme, notwithstanding the problems that have been encountered. I will certainly take up the issue as to whether we can do that on the website and give women information about which GPs will provide the service.

Peadar Tóibín (Meath West, Aontú)
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Nursing homes have been the ground zero of the Covid crisis. A total of 1,543 people have died in nursing homes since the start of the crisis and 369 people have died in nursing homes with Covid just in the last month; and my deepest sympathy goes to each and every one of those families. I am not aware of so many people dying so quickly in any other institutions in the history of this State. In the month of January, Covid has been out of control in nursing homes, to devastating effect, with 193 outbreaks in one month.

We in Aontú have been calling for a public investigation into what has happened in the nursing homes since the start of last year. We did this so the State would learn from the mistakes made and make sure it prevented them in the future. The investigation did not happen and the mistakes were repeated. In the last couple of days, I have reached out to many nursing homes around the country, and I have to say the reports coming back from those nursing homes have been devastatingly uniform. The delay in the vaccine has led to hundreds of deaths - that is what I am being told from the nursing homes.

Take Greenpark nursing home in Tuam, for example. It survived thus far without any infections only to witness 35 of the 49 residents test positive in the week they were due to receive the vaccine. One fifth of those residents have now died. In Blackrock Abbey near Dundalk, 14 people have died, one man dying just a week after receiving the first dose of the vaccine. Nazareth House lost 11 people to Covid in two weeks, and I am told the cemetery for those men who died in Nazareth House is akin to a war grave at the moment.

These deaths happened just before the vaccine was to be administered. It took two weeks from when the vaccines arrived in Ireland until they were first administered in a nursing home. That is a scandal. Why did it happen? Why were just 10% of the initial 77,000 vaccines that were administered by mid-January administered in a nursing home? It is a scandal. Who is responsible for it?

It is heartbreaking to see the devastation that has happened in nursing homes the length and breadth of this country. Those nursing homes are still in crisis. What is doubly heart-breaking is that many of those deaths could have been prevented. They could have been prevented with timely action with regard to these vaccines. Yet, from the Minister for Health, every single interviewer struggles to get a specific date on which vaccines will be rolled out. Why is the Minister for Health allergic to specific dates with regard to delivery of vaccines, especially to nursing homes?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. More than 3,000 people in this State and nearly 5,000 people on this island have lost their lives as a consequence of, or at least with, Covid-19, and our condolences go to all of those families, and all who are still grieving in Ireland, North and South. Sadly, it is the case across the developed world that a very high proportion of people who have died from Covid, or died with Covid, were residents of nursing homes. Ireland is not unique in that regard. Even in countries where they have had a very low number of deaths, like Norway and New Zealand, for example, the majority have occurred among residents of nursing homes, care homes or rest homes, as they use the term, and it does not always mean a failing on behalf of the nursing homes or the people who work there, or the health services or the State. The truth is that people who live in nursing homes tend to be very elderly and tend to have underlying conditions and, therefore, are at higher risk of getting very sick and dying if they get coronavirus.

Once coronavirus is prevalent in the community, it is very hard to keep it out of a nursing home, in the same way that it is not possible to keep flu out of a nursing home in any given winter. For exactly this reason, because nursing home residents are at such high risk of getting sick and dying from this virus, they were the group that was prioritised for vaccination. The decision was made to prioritise two groups, nursing home residents and staff, because nursing home residents are at the highest risk of dying from the virus, and our healthcare staff, because they are at a very high risk of contracting the virus and getting sick from it, and we need them to stay well so they can staff our hospitals and nursing homes. Those two groups were prioritised ahead of anyone else. Lots of other countries gave vaccines to politicians, Government members, senior officials - you name it - ahead of nursing homes and health care staff. We took a decision in this country to prioritise our healthcare staff and nursing home residents and staff, and I believe that was the right decision.

I think it is a little simplistic and not entirely correct to say that had the vaccines started a week or two earlier in nursing homes, lives would have been saved. The Deputy cannot say that definitively. He should bear in mind it is only two or three weeks after people get the first dose that they get protection, and only two or three weeks after the second dose that they get full protection, so I do not think the Deputy can necessarily draw the conclusions that he draws.

In terms of responsibility, the decision on prioritisation was made by the National Immunisation Advisory Council, with the support of NPHET. The practical roll-out of the vaccine was carried out by the HSE and, I think, in fairness to the HSE, it has done a really good job; once it has got the vaccines, it has got them out to people. It is a shame we did not get the vaccines a month or two months earlier but we did not, and those things were not under our control.

Peadar Tóibín (Meath West, Aontú)
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If the Tánaiste wants to contradict the medical professionals I have spoken to in some of these nursing homes with regard to the timing of delivery of vaccines into those nursing homes, he can, but timing is key, and every single nursing home that is experiencing the wave at the moment will tell him that timing has been absolutely shocking. Things could not have been worse with regard to the timing that has happened. The roll-out of the vaccine in the first number of weeks in this State was scandalously slow.

The other issue that comes up with nursing homes is the fact they are struggling with regard to staff. Nursing home after nursing home will tell the Tánaiste that if any of their staff gets Covid, they are wiped out and they struggle to get replacements. I have asked the Tánaiste about Be On Call for Ireland and he has given me loads of excuses why it has not been used. I got a reply to a parliamentary question this week which states there are 680 people on the Be On Call for Ireland database who are job-ready and ready to go. How can a human resource so critically needed be available and not be used by the State in a sector that is experiencing so much death and destruction?

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputy. The sad fact is it could have been worse - it could have been much worse. Many countries around the world have not even started their vaccination programmes yet, and most EU countries are well behind us. We are in the top three or four European countries now in terms of the speed of the roll-out.

Yes, there are countries ahead of us, the United Kingdom, the United States and Israel, for example, but those countries are not part of the European Union. The vaccine was approved earlier in those places than it was here. That is not something that was under our control as a Government.

The majority of nursing home staff and residents have received a first dose of the vaccine. Some have received the second dose. In some cases it was not possible to give the vaccine because either the residents had coronavirus at the time or were sick or ineligible for another reason. Now the HSE is sweeping back to about 100 nursing homes to ensure they vaccinate anyone who was missed or could not have been vaccinated earlier.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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Around the country, community employment, CE, workers do valuable work, especially in small towns and villages in rural Ireland. The work they do for Tidy Towns and making Ireland look better is commendable. Prior to 3 July 2017, those over 55 years were entitled to six years on that scheme. It was changed on 3 July so that thereafter a person would get three years, and if he or she took a year out, he or she could apply again. That was accepted. It was updated again in September 2019. On page 30 of the community employment procedures manual, the gospel of the Department which is given to every CE supervisor, it states that participants who started before 3 July 2017 are eligible to remain on the scheme for the six years. That was accepted by all. Unfortunately, for whatever reason, the Department has decided not to accept its own rules. We now face situations where people who are eligible under the guidelines, the gospel that is given to the CE scheme supervisors, to stay on schemes for six years must take a year out and reapply. Will the Tánaiste approach the Department or contact the Minister and resolve this issue? The Department cannot have its bible of rules and regulations that everyone adheres to and six months or a year later try to move the goal posts. There are some 19,500 people on the scheme around the country and, unfortunately, about 1,500 to 2,000 vacancies. People adhered to all the regulations as did the supervisors who took them on. If the Department does not change its attitude, I believe it will be wide open to legal challenge. It would be common sense for the Tánaiste to speak to the Minister on this and to tell the Department to adhere to its own guidelines. I ask him to do so.

Leo Varadkar (Dublin West, Fine Gael)
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I will do that. I will contact with the Minister, Deputy Humphreys, today or tomorrow to raise this. I agree that if the Department writes a set of guidelines it should follow them. I will definitely look into that and see what the situation is. I very much agree with the Deputy that community employment schemes, rural and urban alike, do really valuable work that needs to be done, whether it is Tidy Towns, meals-on-wheels, community centres or sports clubs. It also provides valuable work experience for people to help them get on a pathway to work, education or training. At the same time, it is important that we have churn and turnover, and that we do not have people staying on CE schemes for years and years or even for life because we need those opportunities to be made available to others and we need people to move on, using their experience of the CE scheme, to mainstream employment or other training and education opportunities. We do appreciate that for some, and there maybe people who have difficulty holding down a job in the regular job market, that this can be a valuable alternative too. That is understood.

Michael Fitzmaurice (Roscommon-Galway, Independent)
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I thank the Tánaiste for his reply. I agree with him wholeheartedly. Under the community employment procedures manual, it is called a saver clause. On page 30, it states:

Participants who commenced on CE prior to 3rd July 2017 will be entitled to remain under their existing CE eligibility rules, where this is to their advantage. If it is more advantageous to the person, the current criteria can be applied.

What is written in the manual is pretty much black and white. However for some reason, there are people in the Department trying to move the goal posts. As the Tánaiste rightly pointed out, it has been of huge help to people's mental health for them to be out there, helping their community, doing work in it, and perhaps for some, getting to say hello to people, helping work against rural isolation. I thank the Tánaiste for his reply and ask again that he get on to the Minister immediately to resolve this.

Leo Varadkar (Dublin West, Fine Gael)
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As I said, I will check out this with the Minister, Deputy Humphreys today or tomorrow. Hopefully I will get back to the Deputy with some clarity.

Catherine Connolly (Galway West, Independent)
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That concludes Leaders Questions. I thank Deputies for co-operating on time.