Wednesday, 16 June 2021
Ceisteanna - Questions
I propose to take Questions Nos. 4 to 8, inclusive, together.
The Cabinet committee on health oversees implementation of programme for Government commitments in relation to health, receives detailed reports on identified policy areas and considers the implementation of health reforms, including Sláintecare. The Cabinet committee last met on Monday, 14 December. Since then, there have been eight meetings of the Cabinet committee on Covid-19. It is expected to meet again shortly. In addition to the meetings of the full Cabinet and of Cabinet committees, I meet with Ministers on an individual basis to focus on different issues. I meet regularly with the Minister for Health to discuss priorities in the area of health and, in particular, our management and response to Covid-19.
The pandemic has led to an unprecedented interruption to normal healthcare activity in both acute and community settings. This interruption has been severely exacerbated by the recent cyberattack on the HSE's IT systems. Healthcare services continue to be severely impacted. Essential services are continuing. However, systems are not operating as normal and patients are experiencing delays in some cases. Existing arrangements with private hospitals are being utilised to assist with urgent care requirements. The main focus of the HSE has been to get priority systems back online, such as radiology and diagnostic systems, maternity and infant care, patient administration systems, chemotherapy and radiation oncology. Most hospitals are still dealing with substantial challenges and limited functionality.
Work is ongoing to restore other hospital systems progressively. It is likely that it will be at least several more weeks before the system is operating normally.
I am blue in the face raising the issue of maternity restrictions here. I have raised some very personal stories of friends and neighbours of mine. The situation is still ongoing. Pictures emerged at the weekend of partners queuing outside the Rotunda Hospital waiting to get in. It was crazy and barbaric. Partners are not able to attend scans or help their partners through all stages of labour or induction, or even after the birth. Of those hospitals that are open, many have strict visiting hours.
A new dimension has arisen. In Clonmel in my county, an expectant mother was told by the hospital that she had to attend a foetal anomaly scan alone due to the cyberattack. How can that happen? How can a hospital issue a letter like that? Is this being used in any other way? It is absolutely outrageous, given the additional circumstances. The Better Maternity Care campaign has pointed out the anomalies that across all the hospitals despite the Government's advice. Who is in charge?
We are running into a serious crisis in the provision of home help. There are not enough people working in home help. Unless the Government finally acknowledges the conditions under which these well-qualified people work, there is a registered employment agreement and they are paid enough, we will face a serious crisis. In my political career, I have never seen such a lack of home help provision even where people are given their hours. I have never seen so many queries about this matter.
The Taoiseach stated that he had not taken gambles in terms of Covid. That is not historically accurate. I hope that we will have a public inquiry into the management of Covid and it will be for that inquiry to judge, but the Taoiseach also said something that is for us to discuss today, that no gamble is being taken at the moment.
There is a gamble or, to use a different word, a choice involved. The Taoiseach clearly accepts that there is a problem with the threat of the Delta variant becoming dominant here, that our quarantine regime, for those coming from England, Scotland and Wales, has been inadequate and that the Government is, therefore, changing the nature of that regime. The problem I see is how the nature of the regime is being changed. What is being altered is the length of quarantine, from five days to ten. at home. It seems that there is strong evidence to suggest that the main problem is not with the length of time but with the fact that it is at-home quarantine. What percentage of those who are supposed to be quarantining at home have got PCR tests after five days? That would be an interesting statistic to know. The main point is that there are flaws in the at-home quarantine model. There are many people who do not have a home in which they can self-isolate and quarantine safely. This is because they share a home and so on. Many others cannot do it without the kind of supports that come with a proper mandatory hotel quarantine regime. The Government is making a choice. It is taking a gamble by not opting for mandatory hotel quarantine, which would surely be more effective at slowing down the spread of the Delta variant.
I want to raise the issue of the escalating crisis in public dental health services. As the Taoiseach is aware, before the pandemic struck, waiting lists had been unacceptably high for many years and the shortfall in the context of the HSE hiring adequate numbers of staff for Covid testing made a bad situation worse throughout last year. In my constituency, Dublin Central, dentists in the public system have become increasingly frustrated as staff continue to be redeployed for vaccination duties. There are more than 10,000 schoolchildren in Dublin and north Dublin who rely on HSE-provided dental care. That figure does not include children who require specialist treatment. The families concerned do not have the option of private care when the public system lets them down.
Last week, the Irish Dental Association informed its members that the HSE dental services in Kildare and west Wicklow have been forced to confine the provision of dental care to emergency care only for children and adults. This decision has nothing to do with the recent cyberattack, it is about the historic under-resourcing of dental care in the public system. The association’s fear is that HSE dental services throughout the State will be forced to impose similar restrictions, sooner rather than later. Is the Taoiseach aware of the depth of this crisis and what action will he take to ensure that regulations, introduced by him more than 20 years ago to ensure and guarantee treatment, are finally implemented and resourced in full?
I have two points to make. The first relates to the changes to home quarantining. Those changes will be meaningless unless there is some element of supervision. At a minimum, what should be done is a linking up of the passenger locator form with the PCR test result, because we simply do not know what is happening, whether people are getting tested or what test results are.
My second point is about the Irish Cancer Society, which is warning very clearly that we are facing a tsunami of undiagnosed and, in some instances, advanced cancer cases. The Irish Cancer Society is looking for a number of things to be done. It wants leadership on the cancer strategy, which must be updated. We require more consultants working in this area and more theatre time and beds. The society says that, at the very minimum, there should be a public awareness campaign because it is conscious of the fact that people have, in the main, been reticent about seeing their GPs during Covid. People have been nervous about doing so. GPs are reporting that patients are not coming to see them with concerns about lumps, pains or cancer concerns. The Irish Cancer Society is asking that a clear public awareness campaign be put into operation to advise people that if they have particular concerns, they should go to their GP as soon as possible. Does the Taoiseach support this?
I thank the Deputies for raising these issues. On the points raised by Deputy Kelly, there is no reason partners and family members cannot attend scans and appointments relating to maternity services.
It should not be happening. Clear guidance has been given by the HSE to hospitals. That is clinical guidance. The question is often asked as to who is in charge. In health and in the world of medicine, politicians do not dictate - and have never done so - to medics in terms of clinical guidance. Given that we have had such a successful vaccination programme in hospitals and in view of the fact that the levels of disease are so low, risks are very low. It is difficult to comprehend why these restrictions are remaining in place, particularly in light of the national guidance given by the HSE. I will certainly have the issue of the woman being told to attend for a fatal foetal anomaly scan alone to which Deputy Kelly referred investigated. The cyberattack has put services under significant pressure, there is no question about that. However, that is more in terms of the front line. For those working on the front line, it has been very difficult and traumatic and for those rebuilding the system it has been extraordinarily difficult and challenging.
I am making the point generally. I am not saying it happened in this context. I am making the point generally, which we must acknowledge. We can criticise the health service a lot, but the work it has done in the context of Covid and in the aftermath of the cyberattack has been truly heroic. I must say that. It has stood up to the test and we must say that a bit more because we are always reluctant to affirm the health services because, very often, there is not much to be gained politically by the Opposition generally - I am not referring to Deputy Kelly in this respect – supporting or affirming the good work done.
As regard maternity hospitals, Deputy Kelly will know - and we all know - about the autonomy of hospitals, the autonomy of masters and the heads of maternity services having jurisdiction within the maternity hospitals and units. I do not know whether that was a factor here, but it needs to be sorted out because it has been raised in the House consistently. It is not just a political direction, but the clinical direction has been given and there needs to be uniformity and consistency of policy to benefit mothers-to-be and their partners.
On the issue of home care packages, unprecedented resources have been allocated. It is unprecedented in that there are 5 million home care hours.
As to the upskilling and recruitment of people, we will continue to work on that.
Deputy Paul Murphy stated that it is only a question of whether we use the word “gamble” or the word “choice”. There is a fundamental difference between taking a gamble and making a choice. I say emphatically that I do not gamble with peoples’ lives. I do not gamble with peoples’ health. I want to make that point and refute any implication or innuendo to the contrary.
The mandatory hotel quarantining that we introduced has worked in protecting public health. I think the positivity figure is 2.7% for those who have come through mandatory hotel quarantine. There is also a balance to be struck. There are choices and balances to be made. The vast majority of Deputies have been criticising the Government in the past two or three weeks because of the impact on aviation and the impact Covid has had on travel. Opposition Deputies have asserted that there is a Government policy on the situation of aviation. People cannot have it both ways. There is a balance to be struck also in making sure we have some semblance of an aviation sector when Covid is over and we emerge from it. I want to put that out there. It is something we must consider. We have funded and provided relief resources to airlines and airports. Notwithstanding that, the pandemic is having an impact throughout Europe and here as well. As a small open society, we depend a great deal on international connectivity. That said, we have acted in accordance with the advice so far. The advice we have received as to the decisions we have taken for June and July is that those measures are low to medium risk. That is the advice we have received.
As to the figures so far, we have been improving consistently since May in managing the impact and spread of the virus.
That said, we are very mindful of the dangers of the Delta variant and will not be slow to act.