Frank Feighan (Sligo-Leitrim, Fine Gael)
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I am sharing time with the Minister of State, Deputy Butler. I very much welcome this opportunity to update the House on the Government's easing of the Covid-19 restrictions. I am joined by the Ministers of State, Deputies Butler and Rabbitte.

Ireland has reached a major crossroads in our management of the Covid-19 crisis and, as we reflect on our journey to this point, we should recognise the positive position we are in as a result of the extraordinary efforts of people throughout the country. We acknowledge, in particular, the public support for our national vaccination programme, the continuing high levels of adherence to public health guidance and, of course, the extraordinary dedication of our front-line workers.

At every stage of this crisis, the Government has endeavoured to follow the science. We have been guided by the public health advice and, first and foremost, by the need to protect lives, public health and our essential services. In line with this approach, the decision of 21 January to lift the majority of the remaining Covid-19 restrictions was based in the first instance on the Government's consideration of the latest advice from the National Public Health Emergency Team, NPHET.

On 20 January, NPHET agreed that the current profile of the disease allowed for a fundamental change in the management of Covid-19 in Ireland. At that stage, NPHET noted that the epidemiological profile of Covid-19 provided a broadly positive outlook. While incidence of the disease remained high, the data indicated that this was reducing and demand for testing was also reducing. While the burden on acute hospital care remained significant, the number of cases in hospitals was also in decline. Numbers in ICU, daily admissions and cases requiring mechanical ventilation were also relatively stable. It was clear from the advice received that the incidence and force of infection in the population were past their peak and declining rapidly. Perhaps most significantly, the evidence confirmed the positive news that during the Omicron wave, there has been a reduced burden of severe health outcome compared to previous waves of infection.

We have seen these trends continue since then and the current epidemiological data continues to provide a broadly positive outlook. As of Monday, there were 692 confirmed cases in hospitals across the country, down from 855 a week previously. On the same day, there were 72 confirmed cases in ICU, compared with 76 on 24 January.

While the majority of restrictions have now been lifted, we must remember that the Covid-19 pandemic is not over. The threat of new variants remains, and the Government is now focusing on ensuring that systems of surveillance and response and broader health service capacity are strengthened to ensure Ireland is best placed to deal with any new emerging threat.

As Minister of State with responsibility for public health, well-being and the national drugs strategy, I take this opportunity to say a few words about the easing of Covid-19 restrictions within addiction services and the continuation of measures to protect people who use drugs and alcohol and to strengthen services. From the outset of the pandemic, the Government identified drug treatment and addiction services as essential services. I would like to take this opportunity to acknowledge the leadership and commitment of addiction services, including the HSE, community-based services and voluntary service providers in ensuring their services operated safely during the pandemic.

There were many innovations in the delivery of drug and alcohol services during Covid-19, especially the use of online services. I want to ensure that these gains are captured in the strategic priorities for the national drugs strategy in the period 2021 to 2025. The additional resources I am providing for community-based drug and alcohol services and HSE addiction services in 2022 will consolidate these gains. Drug and alcohol support groups and treatment programmes help individuals to build recovery capital and to avoid relapse into harmful patterns of substance use. Over the course of the pandemic, the Department of Health developed guidance to support the continued operation of drug and alcohol support groups and treatment programmes. I want to acknowledge the co-operation of support groups with this guidance. I am pleased to say that in line with the lifting of public health restrictions, drug and alcohol support groups and programmes can now operate as normal, while participants are advised to continue to wear masks as appropriate in crowded indoor settings.

I am aware of the constraints faced by residential drug and alcohol treatment services during Covid-19 due to social distancing and other public health measures. I support the efforts of the HSE and voluntary service providers to restore services to pre-Covid-19 levels. I have provided an additional €3.3 million to expand capacity in residential treatment services. Altogether, this funding will provide an additional 475 treatment episodes in a full year.

During Covid-19, the rapid induction of new clients on opioid agonist treatment resulted in approximately 1,000 additional people receiving treatment. Not alone did this treatment help them to manage their addiction, there is evidence that it was effective in minimising the risk of contracting Covid-19 among this vulnerable population. The Department of Health has provided an additional €4.2 million to continue to support these new clients in their care plans.

While I welcome reopening of the night-time economy, we must bear in mind the risk to public health from increased drug and alcohol use in this setting. While it is always safer not to use drugs, we have a duty to protect people who choose to use drugs in bars, nightclubs and at music festivals. The HSE nightlife campaign entitled “If you go, go slow”, seeks to create a safer nightlife experience for all participants. The HSE is promoting harm reduction messages through social media and providing information resources in nightclubs and colleges. I support the recommendations in the Emerging Drug Trends and Drug Checking Report 2021 for a health-led approach to drug use in the night-time economy and at festivals. The Department of Health will work with all stakeholders to ensure their implementation.

A range of measures were implemented to reduce the spread of Covid-19 among people who are homeless and other socially excluded groups. The public health response greatly minimised the risk of illness and death from Covid-19 for these groups and improved their access to health care services. These achievements highlight the importance of homeless services and addiction services continuing to work together, as is committed to in the Government’s Housing for All plan. The Department of Health has provided an additional budget allocation of €10 million in 2022 to maintain public health measures for people who are homeless and to consolidate improvements in health care delivery.

While we recognise that Ireland is today in a positive position because of the efforts of the public and the dedication of our front-line workers, we continue to call on people to remain vigilant. As we move forward with this new phase in our country’s management of Covid-19, the public health advice is to continue to take appropriate individual actions based on our own risk assessment. Those who have symptoms of, or a diagnosis of, Covid-19 should restrict their movements to protect others. Protective measures in schools will continue until the end of February as the vaccination programme for children progresses.

Masks will continue to play an important role in reducing transmission of Covid-19 and requirements to wear masks in a range of settings are still in place. It is important that masks are made correctly, well fitted and worn properly. It is recommended that medical grade or FFP2 masks are used in a number of settings, including by anyone aged 13 years and older who is a confirmed case, a close contact or who has symptoms suggestive of Covid-19. These masks are also recommended for those over 60 years of age and vulnerable people of all ages in indoor or crowded outdoor places, and by anyone visiting a healthcare setting.

The Minister of State, Deputy Butler, will update the House further.

Mary Butler (Waterford, Fianna Fail)
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The past two years have been hugely challenging for our public services, our health system and the people of Ireland. I would like to acknowledge the enormous and continuing contributions made by our health and social care staff in providing vital services across the country during the pandemic.

As the Minister of State, Deputy Feighan, outlined, the current outlook remains positive and the easing of the majority of restrictions is very welcome. We know, however, that the pandemic is not yet over. The highly transmissible Omicron variant is dominant in Ireland and incidence of disease remains high, although it is declining. Test positivity has reduced significantly in older age groups of people aged 65 and over, particularly in the latter part of January. However, those who are vulnerable and those who remain unvaccinated are still at risk of severe illness.

The public’s strong support for the national vaccination programme is essential and its success is a big part of what has enabled us to lift restrictions. More than 10.36 million doses of Covid-19 vaccine have been administered since the programme began in December last year, including more than 2.69 million booster doses. This has been an extraordinary national effort. We are immensely proud that Ireland continues to have one of the highest vaccination rates in Europe.

As Minister with responsibility for older people, I very much welcome the continued prioritisation of the booster vaccine programme among our older population.

More than 88% of eligible people aged between 60 to 69 and living in the community, more than 94% of people aged 70 to 79 and more than 93% of those aged 80 and over have received their booster dose. In total, approximately 933,000 booster doses have been administered to people aged 60 and over living in the community. I am pleased to inform the House that approximately 25,000 doses have been administered in long-term residential care settings, including mental health centres and nursing homes and the roll-out in these settings is now complete.

Vaccination is the best way to protect ourselves and others against the most severe impacts of Covid-19. The evidence is clear. People who have received a booster are less susceptible to infection and, if infected, are less infectious to others. Every effort is now being made to encourage everyone to complete their primary and booster vaccination programme and to reach those who are not yet fully vaccinated.

As Minister of State with responsibility for mental health and older people, I will take this opportunity to say a few words about what the easing of restrictions will mean for the most vulnerable in our society across a number of care facilities. In nursing homes, which were prioritised in our vaccination programme, we are again seeing the positive impact of the vaccines manifesting in a less severe disease profile among residents. However, there are still high numbers of outbreaks in nursing homes, with outbreaks currently being experienced in more than 40% of nursing homes. As of yesterday, 225 nursing homes currently have outbreaks. Residents who test positive are remaining largely well, however, and there are early indications that case numbers are reducing in nursing homes. The ongoing monitoring and management of Covid-19 across the nursing home sector remains a critical focus for me and for the Government as a whole.

The State continues to provide a range of supports to the nursing home sector. This includes the provision of personal protective equipment, PPE, supports, including FFP2 masks, free of charge. This amounts to €95 million in PPE for private nursing homes to date. It includes access to expert advice and support through the Covid-19 response teams and public health, temporary accommodation for staff, and training and education webinars on infection prevention and control standards and practices. I have recently met with the HSE and with the chief inspector of HIQA. Both confirmed that all of these supports continue to be deployed to assist nursing homes. Of note, serial testing was recently reintroduced as part of a targeted intervention to provide important information on the distribution of cases and risk across nursing homes. In addition to these supports, private and voluntary nursing homes still have access to outbreak assistance funding through the temporary assistance payment scheme. More than €122 million in payments have been made to date. That means the 225 nursing homes which currently have outbreaks can claim outbreak assistance at this time.

To continue the substantial progress being made in implementing the recommendations of the Covid-19 nursing homes expert panel report, almost €18 million was allocated in budget 2022, including investment in community support teams and safeguarding supports. The return to normal visiting arrangements is of critical importance to people living in nursing homes and their families. New public health guidance was published on Monday by the Health Protection Surveillance Centre and reflects many of the recent relaxations of public health measures. The new guidance will come into effect from 8 February. The primary change that residents will see is a move towards more normal visiting arrangements and access. Residents can expect to be able to receive visitors, indoors, on a daily basis at a minimum. To further support the mental health and well-being and social connection for residents, there will also be the introduction of a nominated support person. This person will be nominated by the resident and should normally have unrestricted access to the resident for most of the day, with the exception of some busy care times in the home. This will also support improved social connectedness during an outbreak. There will no longer be a need for visitors to show immunity through vaccination or previous infection. I very much welcome this approach to visiting and the further move to restoring normalised access in nursing homes.

I have received correspondence highlighting that, in some cases, visiting is not being facilitated at all in nursing homes. Last week, I met Sage Advocacy, which highlighted concerns of families and residents in respect of the implementation of visiting guidance. I want to be clear that this is not acceptable in the absence of a clear public health or infection prevention and control rationale. I wish to remind nursing home providers of their obligations for facilitating visiting in nursing homes and the right of residents to receive visitors. Significant support has been provided to nursing homes through the investment of significant public funding. It is of the utmost importance that providers facilitate visiting to the greatest extent possible.

The reopening of day care centres for older people has been an absolute priority for me following their closure last year due to Covid-19. I am pleased that 237 centres had reopened by the end of last year, with a further 18 expected to reopen in January and February. These centres are fundamental to promoting the health and well-being of our older population. I am also delighted to hear that active retirement groups across the country are planning for full resumption of meetings, days out, and many other activities. In our mental health settings, services continued to operate between 85 and 90% capacity of pre-Covid levels. Importantly, any services that were impacted by reduced capacity or temporary closure, such as day centres, are in the process of fully reopening. This will occur in line with evolving public health information and guidance. I am pleased to say that these developments coincide with a significant reduction in the number of outbreaks across our mental health services.

I am conscious of the impact that visiting restrictions in acute hospitals have had on patients and their families and of the value of regular personal contact with friends and loved ones in these settings. Throughout the pandemic, the HSE has developed and regularly updated guidance relating to visitor access to hospitals. This guidance is kept under constant review and updated in the context of the trajectory of the ongoing pandemic. The current guidance makes provision that all patients in inpatient areas of a hospital should be allowed to nominate one support person and access for that support person should be as flexible as possible. Visitor access can be accommodated in accordance with local hospital policy and it should also be acknowledged that visitor access may be limited when there is a significant number of Covid-19 cases in the hospital, Covid-19 outbreaks or high incidence within the community. At all times, guidance has sought to strike a balance between facilitating visitor access wherever possible while also recognising the need to keep patients and staff safe by reducing the risk of Covid.

With the removal of so many restrictions recently, I know people will look forward to seeing their loved ones again. However, it is important to remember that a hospital is very different to other settings in society, where social distancing may no longer be in place. Some of the most vulnerable to Covid are in our hospitals, and we have a duty to protect them to the greatest extent possible. That is why a greater degree of caution is required compared with other settings. While the easing of restrictions has been welcomed by many, I know that the reopening of our society and economy will cause concern and anxiety for some people. There are many people who are immunocompromised or more vulnerable to the severe effects of Covid-19. We must continue to collectively adhere to remaining public health measures and keep up the high levels of vaccination in our population to reduce the risk for the most vulnerable in our communities.

As we continue to adapt to the reopening of society, we can help by giving each other the space to respond to these changes in our own time and by supporting our friends and family who may be anxious and who continue to exercise caution. I encourage those who are concerned to be open about it and to share their feelings. It is okay to take your time. I hope and expect that we individually and collectively start to feel increasing benefits of the easing of restrictions and the reduction in harm caused by Covid-19. I look forward to Deputies' contributions.

David Cullinane (Waterford, Sinn Fein)
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Almost two years ago, when Covid first struck, none of us knew exactly how long we would have to live with the consequences of this disease and how far-reaching those consequences would be. If we cast our minds back to March 2020, when the first restrictions were imposed, they were designed to last for a few short weeks in order to flatten the curve. Weeks became years. For most of those two years, tough public health measures had to be put in place. My party supported those measures on the basis of the public health advice that was given. That is to say that we were not conscious of the impact those public health restrictions had on individuals, families and businesses. We will have to deal with the fallout from and legacy of those restrictions for some time to come.

Many people have mental health challenges and difficulties arising from the pandemic.

Many people lost their jobs and many found things very difficult. It has been a very tough two years but people stepped up to the plate. The public were absolutely fantastic in responding to the challenge. Despite all of the difficulties and the fact that nobody wanted restrictions and public health measures to be in place for as long as they were, people recognised what needed to be done. We know our front-line healthcare workers stepped up to the plate. People in essential retail also stepped up to the plate, as did many public sector workers, including teachers, gardaí, and others, and so too did the vast majority of the public. They took the public health advice, implemented it, got vaccinated, wore their masks and abided by the restrictions. That collective effort got us through what has been a very difficult two years.

It is fantastic that we now have an easing of restrictions. This is something that we can all rightly celebrate. As has been said by public health experts today and over the past few days, however, the disease is still here and we still have to exercise a degree of caution and continue to abide by the very limited restrictions that are still in place. The Government must spell out in the coming weeks exactly what public health infrastructure and public health surveillance will remain in place. We all anticipate that we will see a winding down of testing and tracing at some point. There will be questions around vaccination and whether that will be an annual occurrence. We also have to look at the whole area of public health and how we see it now in contrast to how we viewed it before. While we were caught on the hop or caught by surprise by the severity of this disease and this pandemic, the WHO has been warning for many years about the dangers of a pandemic and the fact that the world was not ready or prepared for it. Hopefully, all of those lessons will be learned.

On the issue of lessons being learned, there must be a full public inquiry into the State's pandemic response and into the level of preparedness of the State. I certainly do not want to see an inquiry that is long drawn out or that costs huge amounts of money or one that is about apportioning blame. I want an inquiry that is an opportunity to learn and that is about taking action and making changes where they are needed. In terms of some of the changes that need to be made, my party and others in opposition were making the case for them long before the pandemic struck. The pandemic caught the Government by surprise, but hopefully it has learned some lessons. I hope that it is now on the same page as the rest of us and understands that we need a single-tier health service that is fit for purpose, that is properly supported and staffed and has the beds and capacity to deliver better and fairer healthcare, as opposed to the deeply unfair two tier system that we had to deal with at the start of the pandemic.

If we hold a public inquiry, we have to look into what happened in nursing homes in the early stages of the pandemic. We have called for a non-statutory, Scally-type inquiry to examine issues of isolation, neglect and abuse but also to look at the clinical governance frameworks that need to be put in place. An expert group or panel has made recommendations in that regard and the Government has said that it is committed to implementing those. However, HIQA has said that the HSE did not understand the private nursing home sector that it was funding and important lessons need to be learned in that regard. As far back as 2009, the HSE said that we needed 579 critical care beds. We came into the pandemic with 255 such beds. That was subsequently increased but the total is still nowhere near what the capacity review sought. The same is true for inpatient bed capacity, beds in the community and staff. The Government can point to the billions of euro that have been invested in health in recent years but we must set that against decades of underinvestment and the fact that beds and staff were not put into the system over many years. That is why we do not have a health service that is fit for purpose.

Any review must also reflect on the huge collective effort of the people who stepped up to the plate. It must also, in fairness, reflect on where the Government got it right as well as where it got it wrong and, in particular, where Departments got it wrong. It has to be said that there was a lot of last-minute decision-making. While the Government might say that is what happens in a pandemic, there was also a lack of contingency planning, indecision at times, confusion around regulations, kite-flying and mixed messages, very often coming from senior Government representatives at the very top.

I have already mentioned the deficiencies in our health service and I could say the same about workers' rights. We do not have a statutory sick pay scheme or safe working environments in some areas. Meat plants are a good example of the latter. I hope these are all lessons that we can learn. We also need to learn the lesson of the importance of an all-island response. We did not get that right. Despite the fact that my party, both North and South, pushed hard, including in the Executive, for much greater collaboration between the two Ministers for Health, it did not happen. In a pandemic, on an island, we need to be responding on an all-island basis, making sure that whatever strategies, policies, supports or public health measures are put in place are aligned on an all-island basis as much as possible but that did not happen.

I hope all of those lessons will be learned. I hope that we can commit to building a better health service, one that does not leave people behind. The current health system is not delivering for many; it is certainly not delivering for the 900,000 people on waiting lists, the people who are on hospital trolleys every day, the children waiting for access to child and adolescent mental health services, CAMHS, or those with scoliosis and spina bifida who are waiting for life-changing operations for which funding is not being made available. I hope we have learned lessons and that if anything comes from this pandemic, it will be that the solidarity the public showed will be met with solidarity from this House and that we build a better health service and a better society for the people of this country.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I am grateful for the opportunity to speak on this important matter. Over the past 24 months, a variety of public health measures were introduced. While there might have been differing views on what needed to be done, we accept that at all times those measures were motivated by the public health interest and were guided by public health advice. Nevertheless, it is very welcome, not just from a social but also from an economic perspective, that we are in a position to lift many of those restrictions now. Businesses and workers are especially happy to see these measures eased. Contrary to what a lot of people said about people living it up on the very modest pandemic unemployment payment, PUP, workers flocked back to work. They could not wait to get back to work. The moment that they could do so, they went back. More should be done by the Government to recognise this. We should not allow the narrative to persist that people were living it large. There were people who were sitting on Government benches at the time talking about civil and public servants who were at home with their feet up watching box sets. That was not the case. People stepped up to the plate and worked really hard and that should be reflected and amplified a little by the Government.

The hospitality sector bore the brunt of much of the public health restrictions over the last two years and while the sector was understanding of the worsening public health situation at different stages over the past 24 months, it was frustrated at being singled out as part of the problem, especially when the vast majority of pubs, restaurants and entertainment venues were totally compliant with the public health measures, to the letter in fact. If we cast our minds back, many restaurants and pubs closed before they were even advised to do so. While the Government was dithering, trying to make up its mind on whether it should advise them to close, many of them did so out of concern for their staff and their customers.

While the scaling back of restrictions has been very welcome for hospitality workers, those who work remotely will have more mixed emotions when it comes to the relaxation of restrictions as they return to on-site working. We had cases of employers being able to summon workers back on site without proper provisions being put in place. The announcement was made, workers were told to go back and then, two weeks later, the return to work protocol was published. The Tánaiste is only now talking about remote working legislation. Working from home or remote working is not just a response to the pandemic, although it was an effective response; it is also a really serious workers' rights issue and we should take the opportunity now to run with it. A report on the right to request remote working was only recently published and it highlighted that workers want a hybrid or blended model. It is not surprising that workers were confused and really angry at the fact that they were summoned back to work without being given adequate protection.

Two years into the pandemic and we are only now starting to have that conversation. There is no statutory sick pay. There is no extra bank holiday although I am assured we will have one very shortly, which is good. But there was two years of time lost when we could have been capitalising on remote working and giving people the right to remote work, not simply the right to ask and 13 reasons, well crafted by the Tánaiste, why an employer could say no. That was an awful way to approach it. We spoke about it at the joint committee this morning. The Tánaiste says he is open to amendments. My God, the whole Bill needs to be amended. It comes from a very negative place altogether.

As the restrictions ease, I ask that the Ministers of State convey to their colleagues, and specifically to the Tánaiste, that there is a serious issue around warehoused debt. I call on the Government to monitor the situation for small to medium enterprises and ensure that the hidden debt does not effect their ability to bounce back to profitability in the short to medium term.

Maurice Quinlivan (Limerick City, Sinn Fein)
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First, I wish to acknowledge that the lifting of many of the Covid restrictions has been welcome news for citizens. People are beginning to return to their pre-Covid activities and this should be welcomed. The vast majority of people have been terrific. We looked after our neighbours and we followed the health advice which was asked of us. We all together have saved many lives. We should be proud of that. Well done to everybody.

The last two years have been a very difficult time for most of our people. We missed family funerals, weddings and events. Many of us were not with our loved ones when they died. We lost people we love. People lost their jobs and many lost part or most of their income. However, we now move into what will hopefully be a much brighter future.

If the Covid pandemic served any useful purpose, it was to highlight the abysmal state of our health services. Waiting lists were long before Covid and they have lengthened. The number of people being treated on hospital trolleys in hospital corridors was high prior to Covid and that has increased. The issues of the health service need to be addressed urgently. The numbers presenting to ICU with Covid symptoms have reduced so we can no longer hide behind the excuse of Covid for the failures of our health system.

I represent the constituency of Limerick which has consistently had the highest number of people on trolleys. This is not due to some sudden surge; it is always the most overcrowded. In the first month of this year there were 1,300 people treated on hospital trolleys at University Hospital Limerick. It is an utter disgrace. Staff at our hospitals, on a good day, have very challenging jobs. Having to cope with such levels of overcrowding only adds to the challenges of their roles. It is a credit to these staff that they keep showing up. They have done tremendous work in managing and treating the large number of people presenting at the hospital. However, they need a break. Staff at UHL have faced two years of working in the most challenging of environments, with the danger of infection always looming. These were the toughest of times for healthcare workers, hospital staff and their families. Now that we are exiting the period of Covid restrictions we need to ensure that the capacity and overcrowding issues are addressed in their workplace.

A 96-bed unit is to be delivered at UHL but construction will take at least 18 months to complete. The unit will not be operational until summer 2023 at the earliest. Staff and patients need solutions in the interim. I have pleaded with the Minister for Health and other Cabinet Ministers for efforts to shorten this time. I have received no definitive response. I have written to the Minister for Health on the challenges faced by staff, as recently as last week. To date I have not received a response from the Minister. I have advised him that I am open to meeting him, with other local Oireachtas Members, in Limerick to discuss what steps can be taken to fix the issues at the hospital.

Recent research from the UK indicates that there is one excess death for every 67 patients who stay in the emergency department for eight to 12 hours. It is believed that over 30% of patients were waiting to be discharged or admitted after waiting for more than six hours in Irish emergency departments.

As restrictions are lifted, I would like to take this opportunity to thank the staff at Limerick hospitals. For many, these past two years will have been the most difficult of their professional career. From treating those with Covid, to supporting those who could not spend their last moments with their families, they have gone above and beyond for us all. While we have issues at the University Hospital, we can be immensely proud of the contribution of our local health care professionals during this most challenging of periods. Now is the time to address the issues of capacity and overcrowding so that these staff can operate in the best environment available. They deserve no less. Let us deliver a national health service that is fit for purpose as part of a true legacy of Covid-19.

Duncan Smith (Dublin Fingal, Labour)
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I am not usually one to mention this because I know that Ministers need to travel on occasion. However, there are reasons for travel and there is the extent of the travel. We have had a week where we discussed south Kerry CAMHS, statements on youth mental health, a motion on the cost of cancer and now we have statements on the easing of Covid-19 restrictions and the Minister is not here again. All those issues that we discussed have been compounded by Covid. It is all interrelated. We have been discussing as an Opposition non-Covid care and the build up of crises in our health service because of the impact of the pandemic. We have had space to discuss it politically over the last week. The Minister not being here, when he is over in Dubai at some wellness expo, is frankly disappointing. He is there with the Secretary General in a week when it was learned that the Secretary General had accepted his pay increase. If anyone should be getting an acting-up allowance it should be the Ministers of State over the last week given that they are the ones who have been doing the work here in the Dáil and at committees on health related matters.

I am very conscious of how we discuss this phase of Covid. We do all have a feeling of optimism about where we are going on this. The public health advice is encouraging and positive but we still have Covid wards. We still have 692 people in hospital and there are still people working on the front line and will remain so as people are on wards receiving hospital care or are in ICU fighting for their lives. We still have advice from the WHO telling us that we need to be on guard. We know there is seasonality to this and that there will be new variants.

In the coming weeks I want to see plans from the Government on our PCR testing system and on antigen testing. Will the State be providing any? What is the plan for our vaccination strategy and our booster strategy for younger people? I am getting representations from the parents of children under 16 years who wonder when the national immunisation advisory committee, NIAC, will advise on the booster for that cohort.

We need to be careful. We need to acknowledge everything that has been done and the two years that we have had but be very clear that the work is still ongoing in our health service and will remain so. We cannot be caught on the hop if the virus takes another unexpected turn. The response that we have had from our health service has been exceptional. It has been great and ambitious. It has delivered in vaccinations and testing. However, there have been times when it has been caught on the hop when it has been under intense pressure. We have had delays and times where people could not get tests and so on. In all my visits to PCR testing, I have had nurses, people who work in social care and members of the Defence Forces. It can be an emotional experience just being present at a testing centre or at the vaccination centre when they are busy because it shows the best of what our country can do, not only our individual workers but also what the State can do and what our Government and politics can do. However, I get a sense that we feel as though it is over. We cannot allow that to creep in because I felt that it had crept in at times over the past two years and then we were caught on the hop.

Over the coming weeks, the Minister needs to publish the plans for vaccination in 2022 and when we will roll-out the next round of vaccinations for vulnerable people. Will it be when they are ready to go or will we take into account the seasonality of the virus? Will we wait until the summer to make sure that people are vaccinated right through to the winter? These are the practical questions.

What about the Covid army of people who came back from abroad to work in our health service on short term or fixed term contracts? Are they going to be regularised into our health service with proper long term contracts with good pay and good pensions? Is that something that is being worked on now? Maybe the Minister is going to bring back all our workers, whether in health, teaching or anywhere else, from Dubai to supplement further the services here. We are under pressure and under stress across the entire health service. We need the resources and plans. The Minister of State, Deputy Feighan, has mentioned it a few times in debates in the last week, as has the Minister of State, Deputy Rabbitte. There is acknowledgement at least of the resources that are needed but where is the plan?

Are we taking into account the cost of living when trying to attract workers back to Ireland and trying to ensure graduates coming out of the education system stay here and desire a long-term career in the HSE? I mean a career they know they will be able to progress in professionally, not just with respect to pay but also to career progression and fulfilment. I have been speaking to workers on the front line. Sometimes they have put their own careers on hold to work on Covid, be it in swabbing, testing and tracing or whatever. They are going back to other areas of healthcare and they need to be valued and valued in a real way. I want to see that plan being communicated to us clearly, including the numbers, levels and targets, so we know what 2022 is going to look like and so that if the virus takes another turn we know there is a plan in place. We cannot make the same mistake we have made before and treat the last wave we have had as the final one. We all hope it is but we cannot plan for that.

Fergus O'Dowd (Louth, Fine Gael)
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I welcome this debate. It is appropriate and timely it happens as restrictions are being eased and that we all pay fine and sincere tribute to all the people who worked in our homes, in hospitals, on the front line, on ambulances and so on. We pay tribute also to those who sadly passed away in this awful tragedy called Covid. About a year ago this week my own brother-in-law passed away from Covid in a nursing home. He was very well looked after, as were thousands of other people who died of Covid. However, some were not looked after well at all and that is why we need a full and complete inquiry, especially into the only home in the country, namely, Dealgan House nursing home in Dundalk, that the HSE went into and took over. It is clear to me and to the families concerned that the Department is avoiding a decision on this. We were told by the Taoiseach last week the Department is looking at options. I welcome that and ask the Minister of State, Deputy Butler, and her senior Minister to engage with the families to bring closure, transparency and accountability. I am not like the Sinn Féin spokesman who said he was not interested in accountability in this area. I am interested. The families of the people who passed away in these homes are interested in accountability. They demand it. If it had been 22 or 23 children who died in the home that the HSE went in to take over, would there not be a public inquiry? Would there not be protest marches? Would there not be ructions in this House over it? Age counts, old age matters and people who died in nursing homes were not properly looked after, especially in this particular case. Today I received word of a home in, I understand, County Clare where a protected disclosure was made, I think, to the Minister of State, Deputy Butler's Department, if not her office. I only got word of it this afternoon. I will send her the details later but it is very concerning. One thing we really need after this awful pandemic is a national centre of excellence for the training of all staff, be they nurses, healthcare staff, healthcare assistants, nursing home managers and so on. We need the best possible practice internationally to be at our centre of excellence and we need proper and appropriate national guidance on medical correctness, proper procedure and proper care. If that comes out of this appalling disaster of Covid, then that at least will be an important change.

The Minister of State, Deputy Feighan, who is present also, has done an excellent job on our addiction services. I welcome his speech and the work being done. Nevertheless, there is a review of drug addiction services in the Louth-Meath area that remains unpublished despite requests from me and a freedom of information request that has not been answered to date. It has now gone beyond its time and I must appeal it internally. What is being hidden by the Department or by the HSE? Why can we not see what happened? Why can we not see the impact and know the impact of Covid on drug addiction services in our region? There is a need for change and change is in the air and is coming but we must lead it as a Government and as a Dáil.

There is another serious issue that must be addressed, that is, the question of young people in our nursing homes. There are 1,330 people aged under 65 years living in nursing homes. Of those, 45% are 60 or more years of age and 20% are younger than 50 years of age. This number is very concerning. We must eliminate the practice of accommodating younger people with serious disabilities in nursing homes, which is a commitment of the programme for Government. The Ombudsman's report found many people were prisoners in the homes. They only went in there on a temporary basis but there is nowhere for them to go. It is expensive, obviously, to set them up in their own homes or their own accommodation but that must happen. It is unfair and wrong that they are prisoners and they cannot get out. Their choice is to leave but they do not have that choice right now. I urge the Minster of State that we do that. I do not have much time left.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The Deputy does not have any time left.

Fergus O'Dowd (Louth, Fine Gael)
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I do not have any time left. Maybe that is just as well. I thank the Ceann Comhairle. I am sorry about that.

John Paul Phelan (Carlow-Kilkenny, Fine Gael)
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I was going to stop him myself, a Cheann Comhairle, but thank you for that.

I begin by agreeing with Deputy O'Dowd's request about nursing homes and a review of the processes and procedures that led to some of the examples he gave. I join other Deputies in commending our front-line workers and commending other people involved in the services sector in particular who worked at their post, if you like, throughout Covid-19. Previous speakers have referenced how working patterns and lives have been changed forever by the impact of the virus. That is true and many people are now working from home and will continue to do so, to one extent or another, into the future. I commend also the people of the country. The response of the general public has been exceptional, especially when we look at vaccination rates. Ours is one of the best in the world.

I intend to flag a few issues in the short bit of time I have. Deputy McNamara and others were, throughout the process, eloquent in this House and other places about examining the role of Government in curtailing the personal liberties and freedoms of individuals. I share some of their concerns. As part of the review of what happened during Covid-19 we need to look at where we stand with respect to the potential for future pandemics. I welcome the fact the Minister with responsibility for communications and the Minister for Tourism, Culture, Arts, Gaeltacht, Sport and Media, Deputy Martin, are involved in recent announcements on fake news on social media and clamping down on some of that. Despite a torrent of it, the general public responded very positively in this country.

The other point I raise in the minute or two I have left concerns NPHET. I know some of the people who serve on it. I do not envy its members the job and the difficult task they had and continue to have as a group that deals with giving the Government guidance on public health. However, as part of the review process the interactions of NPHET, or whatever the NPHETs will be, should be considered. The methodology that prevailed towards the end of, for want of a better term, kite-flying, whether it was coming from the political sector or from those involved, either directly or indirectly, with the National Public Health Emergency Team was far from acceptable. I happened to be at some of the public health meetings at the end of the last Government when the virus was here first.

One thing that struck me even then was the swift response of the public services to try to deal with something we did not know the extent of at the time. Overall, the public services responded very well to unprecedented circumstances but that is not to say that as part of the review, difficulties such as the ones Deputy O'Dowd has pointed out and the ones that have been pointed out by others in relation to the Government interfering with people's liberty should be considered. The latter was something that had to be done and I support doing it. What are the mechanisms by which those decisions could or would be made if viruses or other public health or public order issues emerge into the future? There are lessons to be learned. I commend the Ministers of State present and their predecessors on their work during the pandemic.

Richard Bruton (Dublin Bay North, Fine Gael)
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I know this is a very short debate. There is no doubt that this pandemic has been an absolute watershed in our lives. Deputy O'Dowd mentioned some of the ways in which it has set us back on our heels. This is the time to start to take stock of what we have learned from this. One of the positives is the extraordinary way in which our export companies have helped us through this. We have had the highest ever creation of jobs by Enterprise Ireland and the Industrial Development Authority. It is our robust economic management that has helped us to protect people during this difficult period, but we have to now recognise that this pandemic has also exposed serious imbalances in the global economy that we have to knuckle down to. This pandemic gives us an opportunity to take a fresh look at them.

There is no doubt that the world has changed, with the emergence of extraordinarily strong data companies mine data have and have scant enough regulation of how that impacts on our lives. We have seen precarious working emerge from some of these models. We have seen the extraordinary frailty of our planet exposed by some of the practices that have developed and we have seen divisions and inequalities in access to skill and opportunities. We now have to knuckle down to see how we address these issues. We have been very successful in the global market, but if companies are to continue to serve the public interest and protect the gains they have delivered to consumers - health is one of those areas - we need appropriate regulation to match the pro-enterprise policy that has been so important. We need to see new principles underlie the success of our enterprises. The wave of new success will come to those who apply the lessons of how to avoid environmental damage, while at the same time delivering high quality standards, how they protect consumers, how they value and develop their workforce and how they ensure that any algorithms being used to access marketplaces have sound principles underpinning them. They have to protect families and offer the flexibility that allows families to thrive.

We need to start looking at a new social contract, where the new risks that are in people's lives are addressed. That will be the agenda we have to address in the coming months, but we do so starting from a good base in that we have a robust economy. It gives us the chance to achieve leadership roles in these important areas. I hope that will be the mark of how we learn from this pandemic, not just in the health area but in the wider area of economic progress.

Réada Cronin (Kildare North, Sinn Fein)
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I also acknowledge the major contribution made by our front-line care workers and our volunteers working in the vaccine centres. I am sorry to point out that the easing of Covid-19 restrictions has not brought any easing of stress for our leaving certificate students and their need for choice in this exam year. They suffered hugely from the restrictions and isolation imposed. No other leaving certificate students suffered as much as they did. They deserve better from the Minister and the Department of Education than a roll-out of the traditional leaving certificate following a couple of years that have been anything but traditional. This is bad for the well-being of leaving certificate students, who know what they need as citizens and as exam candidates.

It is also bad that there are cold and sometimes freezing conditions, which these students and teachers are reporting to me in classrooms across north Kildare, while HEPA filtration is still on the long finger. When did it become accepted that these children and their teachers and families should just get on and fend for themselves? Fending off an airborne virus is not science and restrictions cannot be confused with mitigation, especially when we have a positivity rate of more than 30%. Vulnerable people must also live, shop, work, go to school and college and take public transport so we still need working mitigations. These vulnerable people pay taxes and many provide care in their communities. The economy and health service would be in real trouble if they just locked themselves away to fend off the virus.

We also need a proper strategy for dealing with long Covid. I am extremely worried about this, given the extremely long waiting lists we have at present. Our front-line care workers are hanging on by a thread. It is only really their solidarity with each other that is keeping them going.

We are very optimistic. As a republican, I am always optimistic. The lifting of the restrictions is also optimistic but we have to be cautious. The WHO expressed concern about the narrative that the pandemic is over thanks to the vaccines, but until vaccination is available around the globe the issue of the Trade-Related Aspects of Intellectual Property Rights, TRIPS, waiver cannot be allowed to drop off the table because none of us wants to go backwards. People are happy and relieved that the restrictions are being lifted, especially our young people. We all generally regard those years as the best of our lives and young people put those years on hold to protect their families and communities.

I also welcome that we will have a new holiday next year, the feast of Imbolc, in honour of the Kildare feminist and Celtic goddess, Brigid, and in memory of all those we have lost due to Covid. This extra bank holiday will bring us closer to the EU average for public holidays and that too is welcome as a first step.

Paul Donnelly (Dublin West, Sinn Fein)
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I will raise the issue of disability day services in Dublin West. I have raised this issue on several occasions previously. Karl attends a service in our community. For the past two years, his family did everything right. They socially distanced, they accepted a service that had to close during lockdowns and they got their vaccines and boosters. They were willing to go the extra mile to keep themselves, their son and his friends well. However, the family have gone from being extremely supportive to deeply frustrated due to the continuing denial of a full service for Karl. He is entitled to a five-day service but has not got one full week since the Covid pandemic began. It has been a four-day service since it recently opened up. The straw that broke the camel's back this week, however, was when Karl was called into the office and told he would have zero days next week. He was distraught and upset that he was losing his service and losing out on being with his friends; he could not understand why. He got upset and was told there was nothing to cry about. After two years of isolation and being told time and again that there will not be a return to a full service for some time, you can understand why the family are upset and angry.

No community employment training centre or Youthreach centres have closed in recent weeks. Pubs, clubs, cinemas and restaurants have all fully opened, with virtually no restrictions. Football matches are at full capacity. Why are adult day disability services being treated differently from everything else? It is not a medical centre; it is a training centre. What would the Minister for Education say if schools said to students in primary and post-primary schools that it is their turn not to have an education next week? Does the Minister of State believe that this is acceptable? Will she demand that all services are opened full time as quickly as possible? I spoke on the phone to Karl yesterday. He was so upset because he could not see his friends next week. This issue is something that needs to be addressed.

Róisín Shortall (Dublin North West, Social Democrats)
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I note that we are having yet another health debate and the Minister for Health is not present. This has been the case for the past week when there have been a number of different health debates. It is really not acceptable that he is not here doing his job as Minister. We have had the breaking scandal of child and adolescent mental health services, CAMHS, in south Kerry and serious concerns about the standard of CAMHS services throughout the country. He is not around for any of that and nor is his Secretary General. Today, we are talking about the lifting of Covid restrictions, which is, again, a very important debate and he is not around for it. We had a debate last week on mental health services and we had a debate this morning on cancer services.

The idea of the Minister for Health being off in Dubai with the Secretary General for what will be more than a week is just not acceptable, especially given the nature of the event he is attending. I was gobsmacked to hear the justification the Taoiseach provided last week for that trip. This is a commercial expo. It seems it is an Enterprise Ireland expedition that includes a number of Irish start-up companies. The Taoiseach talked about leveraging capital, making important contacts and networking with the business community. That is nothing to do with public health. The Minister and the Secretary General are charged with providing a properly functioning public health service. We patently do not have that. There are serious problems and the Minister should be concentrating on those rather than on what appears to be feeding the kind of creeping privatisation that is going on and is doing so much damage to our public health service.

I am really disappointed that the Minister and his Secretary General have chosen to be away for a week at that event and that the Taoiseach chose to justify it on the grounds that these were business opportunities. We do not want business opportunities within our public health service, we want a properly functioning public health service that is accountable, answerable, adequately resourced and fully staffed. That is the Minister's primary responsibility and he is not living up to it.

Like most people, I welcome the easing of the Covid-19 restrictions. It is great to be at a point where we can start to live life fully and catch up on so many things that were missed out on over the past two years. Credit goes to everybody involved in that national effort at all levels to get us to this point. It is very much to be welcomed. However, I want to talk about a particular cohort of people who are not delighted that the restrictions have been lifted because it makes them even more vulnerable than they were previously. I refer to that cohort of people who are immunocompromised. We know that there are at least 109,000 people in this cohort, which is a significant number. I am not sure that adequate consideration or thought has been given to this cohort of people. I have received representations from Chronic Lymphocytic Leukaemia Ireland, CLLI, an advocacy group for people with blood cancer in particular. It has made a very strong case in writing to the Minister on these points. There is a lack of clarity.

At a meeting this morning of the Joint Committee on Health with representatives of NPHET, I asked a number of questions but the witnesses were not in a position to answer them. I will ask them again here. First, what is the position with regard to the fourth vaccination, which is the booster in the case of people who are immunocompromised? There has been a complete lack of information and advice in that regard. People have to wait three months after their third dose to get the fourth dose, but many people are at that stage now, having got their third dose in October. There is no information on that. These people want to know the arrangements for the roll-out of the booster, that is, the fourth dose and how people go about doing that. It came to light in recent days that there is a facility for booking an appointment but nobody has been told that. There is a need for clarity on that. These people have also expressed concern about the implications for them of going to vaccination centres. It is not the safest place to be if one is a vulnerable person with a serious underlying condition. Are other arrangements being made for them to receive their booster dose?

The second question is in regard to the issue of antivirals. For people who are medically vulnerable antivirals are essential. If they get the virus, it is really important that antivirals are provided to them as quickly as possible. There is a strict time limit of a matter of days involved. It is really important that there is clarity on what one should do if one is immunocompromised and one gets the virus. There is no direction on that. We know that orders have placed and that deliveries have been made of antivirals, but as of yet there is no plan for rolling them out. Time is of the essence in this regard. There should be clear protocols. There is a clear plan in, for example, the UK in regard to how a person in that situation should go about accessing antivirals.

The third issue is monoclonal antibody treatments. Regrettably, for some people who have serious underlying conditions the vaccination is not effective. It does not provide protection. It is really important that people can establish if they are one of those people so that they have access to antibody treatments. I ask the Ministers of State, Deputies Butler and Feighan, to pass on all of these issues to the Minister whenever he returns and please to provide clear information to the 109,000 people who feel very vulnerable at this stage.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Deputies Pádraig O'Sullivan, Burke and Creed are sharing time.

Pádraig O'Sullivan (Cork North Central, Fianna Fail)
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I start with a little bit of positivity, which has been bereft in this building for two years. I have listened to the contributions of Members opposite. There is reason to be optimistic. I would like to cite the words of Dr. Tony Holohan at a meeting of the Joint Committee on Health this morning. He said:

The number of confirmed cases in hospital has decreased, with the average number of newly confirmed cases in hospital each day also reducing. The total numbers of confirmed cases in ICU, daily admissions, and cases requiring mechanical ventilation have decreased. The number of COVID-19 patients in receipt of advanced respiratory support in hospital settings outside of ICU has also reduced.

We all know that this has been a collective effort. To be fair, everybody who has spoken thus far has acknowledged the great work of our front-line healthcare workers. We owe it to them to do that. So too we must acknowledge the compliance of the vast majority of people in terms of ensuring we got to where we are today. There is a note of optimism in the air. We should acknowledge that. Members opposite will call for public inquiries. I add my voice to that call, particularly in regard to Carechoice Nursing Home, Ballynoe, Cork, where there were a number of deaths. I believe that merits investigation. I am sure other Deputies will cite various other nursing homes across the country in that regard. It is important to stress, as Members opposite have done, that this cannot be about finger pointing or blame games. We want to get to the root cause of what happened in these institutions and what we can do going forward to ensure it never happens again if we find ourselves in this situation.

At this morning's meeting of the Joint Committee on Health the Chief Medical Officer also said, "The evidence in relation to Omicron, as well as our experience of it, indicate that the burden of severe health outcomes appears reduced compared to previous waves of infection." If that is the case, it is very encouraging. It shows the different strains of the virus are waning in terms of strength. If we have data on that, I would like to see it published. I would also like to know what the plans are in regard to long-Covid. Other countries across the Continent have established different units in medical settings, which will analyse and care for people who are suffering the ill effects of long-Covid now and into the future. God knows how long those people will suffer from the ill effects of Covid.

The issue of remote working was mentioned. The benefits of remote working may be lost. The Government is planning to introduce legislation in that regard. All of us can agree that in various settings remote working has been predominantly positive. We cannot lose the benefits of that. The Government needs to work with the unions and employers to encourage remote working where possible. It is something that we cannot afford to lose.

On disability services, in my area in Cork we are told that services are operating at 75% to 80%. They still have not fully resumed and that is being felt on the ground. A variety of posts remain unfilled. Organisations such as Cope Foundation and the Brothers of Charity, Cork, are struggling to hire staff. We need to double down and put great emphasis on getting staffing levels right again. Many of the people we are talking about have some of the most complex physical, mental and health needs. It is ironic that we are talking about the benefits of remote working and how people suffered in terms of having to commute two to three hours per day to and from work while at the same time we still have not had a debate on disability services and people going to ASD services in schools often for two or three hours a day, five days a week. I would welcome a debate on the adverse mental impact that is having on those people.

Undoubtedly, the pandemic has caught us all off guard and lessons have to be learned. I would like us to have a serious debate on preparations for the next event. I am not sure when that event might be and the hope is we will never have this experience, at least not in our lifetime. We need to build for the future and to have that open and honest debate.

Colm Burke (Cork North Central, Fine Gael)
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I thank the Ministers of State, Deputies Feighan and Butler, and all staff in the Department of Health for the work that has been done over the past two years. I further thank staff in our hospitals, front-line staff in our nursing homes and GPs and their staff for their work over the past two years and all of the people who have worked in vaccination centres across the country for their work over the past 12 months.

We have managed the pandemic very well. There were enormous challenges that changed by the day. We must admit that our responses were not the appropriate ones on all occasions but, in fairness, the vast majority were.

I have a concern around the opening up of services. I raised at a meeting of the Joint Committee on Health this morning the issue of the opening up of elective surgery. People want to get back to what they were doing previously and what they are good at. I am talking in that regard about nurses, staff, care assistants and all those who work in our hospitals. There still seems to be a problem in getting elective procedures back in place. There has been a restriction on that work. Where there are substantial delays, how do we fast-track procedures? Should we, for instance, be looking at opening facilities on Saturdays, especially for day procedures? Could we do such procedures on Saturdays? Could we look at outsourcing to other facilities? In Cork, for instance, there were more than 4,500 people on the gynaecology waiting list. The consultants in Cork University Hospital moved to the Mater Private Hospital and patients were seen there. Those HSE consultants went to another facility to get procedures done. Those were all day procedures. That action cut the waiting list by more than 3,500 in a short period of time.

I know the Minister of State is doing work in the home care area. Lessons relating to nursing homes have been learned. I understand that there are cases where home care is not appropriate and some people require the higher level of care available in nursing homes but many people are able to live comfortably provided there is adequate home care provided for them. An OECD report examined many countries and set out the need to look at better pay and conditions. On the basis of that report, we need comprehensive training, cultural change in the structures of our services and improvement of job design. We also need opportunities for carer advancement. All of those need to be looked at if we want to have a comprehensive home care facility. In the Cork and Kerry regions, for instance, 1,800 people were providing home care within the HSE approximately 14 months ago. That number has dropped to 1,400. There are 400 people fewer working in that area and we need to address that. How can we make working in that area attractive to people? How can we bring more people into the sector to provide that level of care?

When we talk about home care, we consider the cost. If we examine the cost of nursing home care at the moment, it is over €1,000 per bed per week. Home care is still a far cheaper option. At the same time, we must ensure the appropriate level of pay is given to those who provide that home care.

Michael Creed (Cork North West, Fine Gael)
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Like others, I will say something that cannot be said often enough, that is, I acknowledge the efforts made by everybody in the healthcare sector. It was not just the healthcare workers. It was a general, national endeavour that got us through the pandemic. Front-line healthcare workers and staff working in local supermarkets, meat plants and dairy farms made a collective endeavour that got us through the pandemic. I acknowledge all of those people.

I confess I was, and remain, one of the sceptics with regard to the front-line bonus payment the Government has announced. I acknowledge it is now a fait accompliand good luck to those who will get it. However, I think it incredible that we might contemplate differentiating between one form of front-line worker and another in the health service just because their pay cheques come from different authorities or organisations. Those who work in section 38 or section 38 organisations did work that was as valuable in delivering front-line services to people with disabilities and healthcare needs as did those who work in the HSE. I hope that when cheques are being written we will not differentiate between them.

One of the great takeaways from this period in respect of our health service is the response; what we can do and what we did. That was probably because of the fantastic level of scrutiny and observation of that response. There was daily and weekly accountability from the Chief Medical Officer and other senior officials and that got us through the pandemic. I acknowledge all the supports around that, including the National Public Health Emergency Team, the national immunisation advisory committee and everybody else. If we can do it for Covid-19, we can do it for cataracts, orthopaedics, waiting lists, disability services and mental health services. If there is one takeaway in particular, it is that we should bring forward that level of scrutiny, oversight and accountability, which is the thing we are lacking most in the health service. People can suggest their own explanations for what happened in the child and adolescent mental health service in Kerry but these are not isolated cases. When we bring a forensic accountability and shine a spotlight on the service, we can do it. I do not think people would shy away from committing more funds to the health service if they were satisfied they would be well spent and accounted for. The pandemic showed we can do that.

I will move on to consider mask-wearing and visits to public hospitals. It seems to the layperson rather illogical that we can have this level of opening up now because risk is so minimal and yet those who have been least at risk, that is, healthy young children, are still the subject of compulsory mask-wearing in certain circumstances. I am not a public health expert and I defer all the time in this debate to those who are but I think we need to review that as early as possible.

There was a case in my own constituency this morning of a person who was distressed because they were unable to visit their wife in hospital. Obviously, the risks still continue and we are not over Covid but we could allow visits. If we are doing it in nursing homes, we could do it in general hospital settings.

Thomas Gould (Cork North Central, Sinn Fein)
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I express my sincere and deepest gratitude to volunteers and workers, especially front-line workers. At a time when the State was in most need, people stood up to be counted. Everyone in this Chamber recognises that and we salute those people for their efforts and respect the work they have done.

In January this year, there were over 650 people waiting for access to residential rehabilitation beds. Waiting times in many facilities have doubled and even tripled with people now waiting four to five months to get into many rehabilitation facilities in the State. What is happening now is that when people are at the crucial stage where they want to make change, are ready for recovery and need a helping hand, it is not available. When they are not getting that support, the reality is that some people slip back into addiction and we lose that chance.

This is happening because facilities were forced to close beds during the Covid-19 crisis due to restrictions. It was also the case that lifesaving facilities such as Keltoi were closed down and still have not reopened. Now that Covid-19 restrictions are easing, can the Minister of State please provide a timeline for the reopening of Keltoi? It is desperately needed.

Something that those in recovery and other experts have raised with me is the need for more publicly run, secular residential facilities. We need to start opening more public addiction treatment beds and facilities. We need to see those beds moved under the remit of HIQA and held to the same standard as the rest of our healthcare services.

Sinn Fein’s alternative budget proposal for addiction services included ten times the funding of the Government’s budget because we recognise that investing in addiction services will save lives and will save the State money in the long run. Part of this plan included replacing those lost beds with public beds. We have an opportunity now. I ask the Minister of State to take the opportunity and run with it.

Chris Andrews (Dublin Bay South, Sinn Fein)
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It is great to be able to speak about the easing of Covid restrictions. It is a real boost to everybody. It has given everybody a lift and it is welcome. The sporting community probably welcomed the easing of restrictions more than most. Sport plays a large part in our lives. It strengthens communities, teaches young people about health and well-being, and boosts the morale of the nation when we are cheering on our international athletes and stars.

Under Sport Ireland, there are more than 40 affiliated sporting bodies covering a wide range of sports. While most people are used to hearing news of the big three, that is, the GAA, FAI and IRFU, the amazing work of many other smaller organisations such as Basketball Ireland, the Irish Athletic Boxing Association, IABA, Athletics Ireland and Rowing Ireland, is too often forgotten. These smaller organisations carry out amazing work in communities right across Ireland and across all backgrounds. Locally in Ringsend, we have two amazing rowing clubs, St. Patrick's Rowing Club and Stella Maris Rowing Club. These two clubs are intertwined in the local community. They are essential for the community and a model for what community engagement should be.

The success of sporting culture should be judged not only on the achievements of a few but on the strength and diversity of all sports on the island. The easing of Covid-19 restrictions has had a welcome impact on many of those sports, many of which are indoor-based, particularly basketball.

Often, additional supports are carried out by voluntary groups such as St. John Ambulance Ireland, which provides medical support to sporting and community events throughout the country every week. St. John Ambulance Ireland is currently under review due to sexual abuse by its members and I am deeply concerned that amid this review into sexual abuse it continues to provide support to community and sporting events. I do not think it is appropriate for national sporting bodies such as the FAI, IRFU and GAA to avail of its services while a review into sexual abuse is ongoing. This is effectively a transfer of State funds to St. John Ambulance Ireland via sports organisations. I do not believe St. John Ambulance Ireland should be funded. Other organisations can do the same job and sporting bodies should engage with them rather than using St. John Ambulance Ireland. I again call on NGOs not to use St. John Ambulance Ireland at their sporting events and use alternative service providers.

Gino Kenny (Dublin Mid West, People Before Profit Alliance)
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Two years ago, we were in the throes of a general election. We were all going around knocking on doors trying to get back into the Dáil and some of us did while others did not. Little did we know what was to come four or five weeks later. It really does feel like a lifetime ago; not only the general election but what has gone on in the last two years across the world. It has been a truly unprecedented event, not only in our lifetime but across generations.

Many of us never heard of Covid-19 but we got to know it very well in every pore of our society. Many of us thought it was something from far away; a pandemic from a hundred years ago. Little did we know what was to come. The events that happened were completely unprecedented. When we think back now about what was to happen with regard to our liberty, the economic effect it would have on people's jobs, our health, the 10,000 people who died on this island and 6 million and counting who died worldwide, it really is unbelievable. A virus that was invisible to us has asked a lot of us and what we want to do next as a society. In the throes of the pandemic, however, the virus did a number of - I hate to say this - positive things.

One of the things that happened was the commandeering of private healthcare. There was no such thing as the two-tier health system for a period of time. Most of the 19 private hospitals were commandeered by the State. It throws a big question into why we need a one-tier health system. We saw the potential for better public service. We saw the fault lines that exist in society but more importantly, on a human level, we saw something unbelievable in ourselves about how humanity can be so good when it comes together; not acting as individuals but as a collective. We can be amazing. We can beat any virus in the world.

In our health service, doctors, nurses, porters or whoever it may have been had to go into an environment that was like trench warfare. They had to go into the midst of the pandemic, where Covid-19 was ever-present, and hold the hands of some of our relatives at their very last moments when they had nobody to say goodbye to except those hospital staff. We owed everything to those people and we continue to do so. Hopefully, we see a different society where workers are treated better. Most workers who worked through this pandemic are poorly paid and sometimes not recognised. They are looked down on and their jobs are seen as menial. They drove and served us and did everything they possibly could under extreme circumstances. We pulled together, however. I do not want to be party political about it; sometimes we have to rise above party politics. There were times the Government got it wrong and let some bad things happen. It got some things right as well. However, I think we are coming to a conclusion, hopefully, in relation to the pandemic.

My final issue is with regard to a public inquiry into nursing homes. It is really important that this State has a public inquiry regarding all the deaths in nursing homes in the first year and a half of the pandemic. We owe it to the people who died in those circumstances and the relatives who are still asking questions. It is incumbent on the State to have a public inquiry with regard to all deaths in nursing homes.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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On the day that is in it, it might be worth paraphrasing Stephen Dedalus in James Joyce's Ulysses when he famously said, "History is a nightmare from which I am trying to awake." Covid-19 was certainly a nightmare from which we are all trying to awake. One of the great things about Ulysses, of which I am a big fan, is that Joyce takes as his characters the ordinary people, whereas in all previous literature of the 19th century, in novels and so on, it was the aristocrats, elites and upper middle classes. Joyce takes a hammer to that. In the opening chapter, Joyce brilliantly describes the art he wants to make as being "the cracked lookingglass of a servant," in other words, smashing the normal mirror we put up to ourselves, which does not actually give expression to the ordinary working people and making their voices heard. Of course, the servants, downtrodden, oppressed and minorities feature as central characters in Ulysses.

That is exactly what happened during Covid-19 and we need to remember the lessons. I want to shout out that we will remember those lessons for the musicians who live precarious, often impoverished lives, but who enrich our society no end. Just because Covid is over does not mean the need for a renewed support for musicians is over. They are asking that some of the supports will be maintained and that we recognise going forward that we will give them those additional supports to truly value our artists, musicians and so on.

The Minister of State might take note that some individual musicians, taxi drivers and so on were refused the pandemic unemployment payment, PUP, on the grounds that they had not made certain PRSI contributions. When some of them checked into that fact, they got it rectified because they were not properly awarded the PRSI contributions they should have been while they were receiving the PUP. It seems that may be quite a widespread administrative mistake. I would like the Minister of State to look into that and rectify it in order that people who should have been getting the PUP, particularly over the Christmas months and weeks, will actually be awarded the backdated PUP they deserve.

Neasa Hourigan (Dublin Central, Green Party)
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I will use my time to draw attention to the ongoing difficulties with homelessness, its interaction with addiction issues and how these have been impacted by the Covid-19 pandemic and its resulting restrictions. In the early days of the virus, there was a necessary and welcome urgency in Government to address the homelessness and housing crisis while individuals and families were asked to lock down in place.

Between April and May last year, there was a 12% decrease in the number of people in emergency accommodation. Unfortunately, since that time, the numbers of people seeking support have gradually crept up towards pre-pandemic levels following the lifting of the ban on evictions, and, as we all know, the cost of living, in particular rents for housing, has soared. The number of people in emergency accommodation has reached the 9,000 mark for the first time since April 2020.

As the world moves to a post-Covid reality, it is imperative that the Government does not allow a return to the norm of the last few years as regards the numbers of people who are in homeless and emergency accommodation. It is vital that every Department of the State works to ensure that long-term homelessness is considered completely unacceptable in Irish society. We know for certain that long-term stays in homeless accommodation and emergency accommodation lead to worse outcomes for those who receive services. That itself places great stress and demand on treatment and counselling services. Outcomes for people in emergency accommodation will not and cannot improve unless they have access to secure long-term housing and appropriate support services.

I will raise a couple of issues in that regard. The first is provision of dedicated LGBTQI+ emergency accommodation within homelessness services. A recent study by Focus Ireland, BeLonG To and UCD suggested that some LGBTQI+ persons experiencing homelessness were unwilling to enter a space such as a hostel or an emergency accommodation venue because they feared they would encounter a lack of understanding. People deserve to feel safe no matter what services they are accessing. We may need to have dedicated housing for that purpose.

Second, the Covid-19 pandemic raised grave concerns for people who are homeless and use drugs. In March 2020, in light of the pandemic, the HSE published a plan, which was welcomed, that guided the support and treatment of substance use and recognised that harm reduction interventions for substance users were necessary. People experiencing homelessness who were substance users were offered support both to reduce the risk of contracting the virus and reduce harm from drug use. I echo Deputy Creed’s call for staff who worked in high-support services to also be recognised in the recognition payment.

The two major initiatives that were undertaken were the faster processing of clients into treatment and temporary amendments to allow patients to access ongoing treatment and regular medicines. This was fantastic and I hope we can hold on to that. However, the one area that we did not significantly address is the continued dichotomy in Ireland between treatment for addiction and treatment for mental health. Service users often have to choose which treatment route they will take as we continue to separate out those two issues, despite best practice. People cannot get psychiatric care until they treat their addiction or vice versa. Of course, life does not work like that.

The proposed Citizens’ Assembly on drugs would be an ideal opportunity to discuss this lacuna. For the most part, from what I am hearing, service users and providers agree that some positive changes were made during the Covid-19 crisis and should be maintained. However, we have a lot more work to do, in particular on mental health.

Paul McAuliffe (Dublin North West, Fianna Fail)
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On 5 March 2020, the Ceann Comhairle called me to make my first contribution to the House. The previous weekend, a case of coronavirus had led to a closure of a school in my area. Local councillors and Deputies had been briefed in City Hall by people who we considered to be unknown public health officials but who the entire country would soon to get to see on a nightly basis. I left that meeting feeling incredibly afraid, not just for my community but for the country.

In a wave, Covid came upon us and our community and spread across the whole country. It changed everything for the two years that I have been a Member of this House. It has dominated every aspect of every day. It has taken twists and turns with its key characteristics being the ability to both surprise and mutate. As a population, we learned about R-numbers and social distancing. We watched as around the world countries and cities such as New York and Italy struggled with ventilator shortages. We learned of temporary army hospitals on battleships and body bags being piled up in corridors. We prayed that those things would not happen here.

Every person in this country, young and old, has borne the burden of Covid-19 but those on lower incomes, in poorer housing or in front-facing manual and service jobs have borne a heavier burden. Those in clinical settings with Covid-19 patients, many of whom died alone, bore the hardest burden of all. I pay tribute to all those people and all those who lost their lives.

In the past two years, I have voted for some extraordinary restrictions. These involved Government reaching into people’s lives, restricting their movements, employment and contact with family and friends. I want people outside the House to know that I took none of those votes lightly. I know Ministers in the previous and current Governments did not take any of them lightly either.

In an unprecedented pandemic, there were things that Ireland definitely got wrong. However, as I have said many times in this House, we crafted a path that was set neither by the zero-Covid zealots or the herd immunity champions. We never put the economy over public safety. We stepped in to help families and businesses financially in a much greater way and for much longer than many other countries did. By treading that middle ground, perhaps we doubled our critics, but this country has got through the last two years by balancing restrictions and freedoms. This was the right strategy, one which I believe it will be vindicated in the course of a full review. I look forward to such a review because I believe that we can learn many lessons. As a member of the Special Committee on Covid-19 Response, I echo the calls for an investigation into what happened in those early months in primary hospitals and nursing homes.

Ireland got many things right. That is why we had one of the lowest death rates in Europe. That is not a statistic but it is people's lives. It is why we had one of the most successful vaccine roll-outs. It is why independent analysis ranked us highly in how we balanced restrictions and freedoms. I saw both Opposition and Government Deputies call for this or that to open or close. I did it too. We all had good reasons for making those cases and we made them on behalf of good people. Government had the job of deciding on that balance. Decisions were required. While some in the House had the role of challenging those decisions, those of us on this side of the House had a role in making them. They were always made in the interests of the Irish people and in their interests alone.

As we emerge from Covid-19, we will have to learn lessons. For me, our reliance on key public services and their importance have been key learnings. Childcare, public health, drug support, education and caring professions all need resources. They need public funding and, importantly, public governance. On the return to work, Dublin is already seeing increased traffic and longer commuting times. Our city centre is seeing life again, but our urban villages are losing some of the life they gained. How do we retain the balance the Government had to strike at a national level? People saved hours of time commuting and gained those hours with their families. How do we challenge ourselves to ensure we maintain that balance? How can we set targets for those people who work for the Government to make sure more people are able to work from home?

By God, we have all missed travel but we discovered some new and old gems in Ireland. How do we ensure Irish tourism is the first choice for people travelling abroad? For international travel, with climate change being our next challenge, we have to ask whether we are really paying the full carbon cost of international travel and low-cost flights? There are so many things we could learn from Covid-19 but, as Deputy Creed said, the response to the Covid-19 challenge meant we learned how to say “Yes” to solutions and to supporting their implementation. That is the key lesson for me in how we learn from Covid and implement many of the solutions identified in the programme for Government.

Bernard Durkan (Kildare North, Fine Gael)
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I was reminiscing there. James Joyce was rightly quoted in the current context. If Seán O’Casey had been around two years ago when Covid-19 appeared on our shores, he would have squinted out the window and said, “The blinds is down Joxer, the blinds is down.” They were, and the challenges were huge. Nobody knew what was coming around the corner. It serves us well to remember what Deputy Creed and others have said. At a time of crisis, people with nerve are needed to stand up, do what has to be done, call on those who need to be called upon,and put the right people in the right places to ensure we are on the right track. I believe that was done. We were critical at many times in this House and we made contradictory statements in which we called for more, less or maybe nothing to be done.

The people at the helm and on the front line, those who managed the pandemic and the individuals and families who paid the price all had an influence. Some paid a huge price. Some paid with their lives. One way or the other, we muddled through it. It was not really muddling because it was well-charted and we were able to do it at least as well as anybody else across the globe and better than most, even though the Government, the Minister and the system were criticised. Our self-belief returned. It was possible to identify what we could do if we made up our minds to do it. We now have to apply those principles to the delivery of health services in general. We cannot go along indefinitely complaining about the system and saying somebody should do something. We have to do it ourselves and that can be done with the right will. If the will is there, we should utilise it.

Patricia Ryan (Kildare South, Sinn Fein)
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I welcome the easing of restrictions but for some in society this is a huge cause for concern. We have already seen our older people left out of Government announcements, particularly those living in nursing homes. The Government has been slow to consider their needs. Those who are medically vulnerable and those with suppressed immune systems have been left to fend for themselves. I urge the Government to be more inclusive and to consider the effect of its announcements on all of our citizens.

There must be a public inquiry into the pandemic response. It must include an investigation into the failures in some nursing homes and pre-existing failures such as low ICU capacity, which made us all more vulnerable. It should look at issues of poor planning, slow response times and mixed messaging by Government over the course of the pandemic. Mistakes were made and must be learned from. The terms of reference for this inquiry must be drawn up in consultation with civil society groups to encompass a wide range of concerns.

One thing made clear by this pandemic is that we need an independent nursing home regulator. There must be consequences for the minority of nursing homes that had serious shortcomings and the consequent isolation, neglect, and loss of health and life that were experienced. Any inquiry must also look at how failures to properly resource the health service, and failures to modernise and advance critical reforms, contributed to the difficulties faced by hospitals and the health system during the pandemic. It cannot ignore workers’ rights, such as sick pay entitlements, and how we can make a wide range of changes across society and the economy to ensure a fairer Ireland. The pandemic bonus payment is to be welcomed but the Government must commit to including workers in section 38 and 39 organisations, as well as family carers.

I have been inundated with emails from students who are worried about the recent leaving certificate announcement. I urge the Minister for Education to listen to our students, to rethink the path she has chosen and not to repeat the same mistake with our junior certificate students.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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It was very creative of the Deputy getting the leaving certificate into this debate.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Like previous speakers, I acknowledge the work and tireless efforts of all those who met and continue to meet the asks of the wider community throughout the pandemic. In March 2020, none of us here knew what lay ahead and nor did the public outside. I recall having a phone conversation with a HSE manager at the time and, to be frank, I was not the better of it when that conversation ended because of the sheer scale of what was being presented as a possibility. We have moved out of the emergency phase and lockdown and cocooning are hopefully consigned to the history books but there remains a fragility from those restrictions and there will be for some time to come because fear, anxiety and hesitancy remain. Accompanying that is a backlog of missed vital medical appointments, whether in the disability sector or physical or mental health sectors. Each and every one of those must be addressed. We also need a mechanism for dealing with long Covid. That impact must be forensically examined, as much every other sector and service.

We cannot ignore the response to Covid that happened in our nursing home sector, and we should not seek to do so. Events like that should never be seen again under any circumstances. There are scars, some of which are visible and some that are invisible. People said their first hellos and their last goodbyes through windows or on Zoom and they still need time and supports to heal. I still speak with mothers who are justifiably struggling to move on from giving birth under the most severe of maternity restrictions. They felt isolated and alone and they feel that to this day.

It will take some time to bounce back as a society. For some it will take longer and for others it will be less of an ask. While a new day may be dawning, we cannot walk away without taking steps to ensure that issues surrounding nursing homes, PPE, health, maternity services and the imbalance that existed in our society before Covid are examined in detail and that lessons are learned. None of us likes to think of it but we may be back in this situation again.

Peter Fitzpatrick (Louth, Independent)
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I am grateful for the opportunity to speak today. The Covid pandemic has been a life-changing experience for us all. Who would have thought a couple of years ago of the impact Covid has had on each and every one of us? Thankfully, it seems we are now over the worst of this pandemic and society is starting to get back to normal, although we need to remain cautious. We need to look after our front-line staff. There is a lot of work being done at the moment. I think of the medical staff who fought this disease with great courage and skill. They are the real heroes and they continue to do this heroic work on a daily basis, often in very difficult circumstances. I also thank the staff of the many retail businesses that remained open during the pandemic, ensuring that we all had access to vital supplies. It is important that we recognise the great efforts made by everyone who made these great sacrifices for our health system.

Unfortunately, many of our loved ones were taken from us as a direct result of this pandemic. It is very important going forward that we remember those who lost their lives as a direct result of Covid. These people made the ultimate sacrifice and we must never forget that. As we start to get to other side of this pandemic, we must learn from it. There was no roadmap when this pandemic hit and a lot of people died. It is easy to look back with hindsight and be an expert. What is important now is that we learn from our mistakes.

I am very disappointed that despite all the additional funding that was made available to tackle this pandemic, it seems we are no better off when it comes to the number of ICU beds available in the health service. The reason for such severe lockdown measures at the height of the pandemic was to protect the health system and ensure that ICUs in particular were not overrun. I would have thought that a logical approach would be to increase the number of ICU beds to ensure we have a buffer. A great exercise to carry out in the near future would be to look at how all the additional funding that was put into the healthcare system was spent and to see what long-term benefits will be achieved from it. My fear is that we could be hit with another pandemic and unless we learn from this one, we could face even greater challenges.

The bottom line is that we must now learn to live with Covid. Locking down society is not the answer. It has been clearly demonstrated that the vaccination roll-out was the main reason we are now past the worst of the pandemic. For this reason, I urge everybody to please get vaccinated.

The Minister of State, Deputy Butler, has left the Chamber but I wanted to raise with her the case of a 15-year-old girl in Dundalk who tried to commit suicide last week. This child was crying out for help. She contacted the helpline last week. Due to the cleverness of the operator, she realised there was something going on and contacted the Garda. Gardaí came to the young girl's house, saved her and took her to hospital. This is according to her mother. This is not the first time this child tried to commit suicide. The problem at the moment is that nobody seems to want to take responsibility. When the girl was brought to the hospital, the hospital told her she did not have a medical condition. CAMHS then got involved and got her to see a psychiatric consultant and social workers. She keeps telling them she wants to commit suicide but at the same time she wants to live. There is a lack of everything at the moment. The health service only seems to deal with mental health issues from Monday to Fridays from 9 a.m. to 5 p.m. If people go looking for anything at the weekend, they are wasting their time. If they go to the Garda, they are told "What can we do?" Gardaí can go to someone's house and take the person to the hospital but then he or she is released. What are we going to do going forward? I do not know the answer. Parents ring me saying they have a problem so I ring the hospital, which says it is nothing to do with it. I ring CAMHS, Tusla and everybody else and they all say the same. I am like a dog chasing its tail and going around in circles.

I heard the Minister of State say earlier that she was spending millions doing this and that. There is no point in spending millions if it will not help somebody. A 15-year-old child came to me to look for help. I contacted the office of the Minister of State, Deputy Butler, three or four months ago, the last time the girl tried to commit suicide, and nothing was done. I have a name which I will pass to the Minister of State, and I ask her to help this child.

Matt Shanahan (Waterford, Independent)
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Like everyone else in the House, I welcome the public health advice. It now signals, I hope, a transition out of Covid. We will be asking questions about what we have learned. There are a couple of issues I would like to raise in that regard, one of which is the use of antigen testing. We will have to figure out how for 15 months we could not implement a public health measure which has shown its value in the past three months. Another is how we ignored vitamin D. I believe much of the science will point to that as a great health omission.

Beyond that, we have the issue of HSE procurement and the dysfunction in it. We also have what I would call at this stage a forcing down of indigenous contractors who engaged with the HSE and now find the HSE trying to dictate new terms because it believes the Covid pandemic is passing. These include companies which had antiviral drugs approved by the EPA but the Department of Health did not engage with them.

In terms of the hospital situation, we have significant waiting lists throughout the country. I ask the Ministers of State to come up with a new strategy vis-à-visthe National Treatment Purchase Fund, NTPF. Where is Sláintecare? We know national community care networks are trying to organise but there is no evidence of that in the acute hospital sector. When will we start to see that happen?

The Minister of State, Deputy Butler, has left the Chamber but she is well aware we have significant deficiencies at University Hospital Waterford, UHW, in neurology, diabetes, trauma care and general diagnostics, not to mention trying to advance our 24-7 cardiac issue. I am seeking a forward capital development plan for University Hospital Waterford. Such a plan should be published for each of the other hospitals as well in order that we can see what plan we will take forward.

We have a significant issue with recruitment to residential care homes and with work permits, as the Minister of State knows. The Tánaiste advised this morning that work permits could take up to 20 further weeks. I ask that we look at taking an initiative in this regard. There are people in direct provision centres who are qualified and there is potentially an opportunity to get them out of these centres and working for a short time. We should give them some points towards their asylum applications based on that. They can be shadowed by other public health workers.

I heard the Minister of State, Deputy Feighan, mention the drugs strategy. I ask him again to look at supports for the drugs strategy, especially in Dublin. We will either pay now or we will pay later. It is as simple as that. I also ask the Minister of State to look at what is happening with opioid abuse in America. I am sure he is well aware of the problem, which is rampant in American universities. This begs a question about education on the use of recreational drugs.

As we know, a significant number of section 38 and 39 workers are excluded from the front-line recognition bonus. That is a mistake and I ask that it be revisited. How is the recognition bonus demonstrating social cohesion to family carers and those looking after disabled persons in their homes?

I welcome the future national CAMHS review. We cannot operate hospital care without multidisciplinary teams and we most definitely cannot do this for CAMHS either. I am sure a new review will show that. We need significant investment in that area.

We will have to consider setting up long Covid clinics throughout the country. There is ample evidence of its effects, similar to other post-viral syndromes. We will have to look at whether we are giving people the best care possible.

Will insiders or outsiders lead the proposed national Covid public inquiry, expert review or whatever it will be? What lessons will be discussed? A significant number of voices have been left outside public health policy over the past two years. If we want to have a full, frank and open discussion that will teach us anything, we have to allow other voices to be heard.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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The efforts Irish people have made in recent weeks to reduce social contacts and take care when they meet others, combined with the high uptake of the vaccination and booster programme, have made a considerable difference to the public health situation. I know this is the reason restrictions have been eased. We have heard from the Chief Medical Officer, CMO, that getting back to activity is possible now and we have much to look forward to.

However, I have concerns, one of which is the case numbers and that people are still getting sick. My understanding is that children are still getting sick. We very much need ongoing close monitoring of the virus. The message has to be that the pandemic is still not over. There is a sense that people who are highly vaccinated or have already contracted the virus have changed their attitudes about the virus. I have heard many people talk about that in the past few weeks. We still have to be very careful because there is always a risk. While Omicron infections led to a smaller share of hospitalisation than infections with the Delta variant, China, which is hosting the Winter Olympics, is taking measures to contain travellers from abroad and avoid mixing with the population of Beijing.

We have reopened, which is great for our economy, tourism and hospitality, but we must accept that we still have a protective role. While we must communicate that people should continue to follow the current advice for those with symptoms and are close contacts and continue to wear masks and maintain clean hands, we cannot lay everything on the good people of Ireland who have already done so much. We must take steps to continue to protect public health. We must maximise the uptake of the primary and booster vaccinations and those travelling to Ireland continue to follow guidance. We must also boost our public health sector to catch any outbreaks that may occur.

As we reopen, we need to look at the pinch points. As I raised with An Taoiseach yesterday, my understanding is that most dentists do not accept medical card patients for treatment. Many people have been unable to afford to pay privately and their dental health has suffered immensely. Only one dentist in Carlow is taking medical cards right now. That has been a very big issue for me.

I have also had people contact me about GPs. In fairness to GPs, they have been giving vaccinations and boosters but some of them have not been seeing patients. Some patients have contacted me to say they very much want to be able to see their doctor face to face when they have medical complaints. Doctors, GPs and nurses have been very good about telephoning patients and some doctors are seeing patients but there are still some who are not. I ask that this be looked at.

I have also had many people contact me who are waiting on operations and feel they need to get in to the hospitals to have their operations. One lady who contacted me needed a knee replacement. She is an elderly lady with a medical card and had been waiting. We understand we had to be careful during Covid about people visiting hospitals or going in for operations. She was told it would be a long time before she had her operation. She ended up going private and her family had to save the money to get the operation for her. We should deal with the issue of people needing operations, especially those who are experiencing significant pain. While it is good that we have moved on, we have to ensure people who need operations or to see their dentists or GPs are in a position to do so and will be seen.

Another lady who appealed to me is immunocompromised and she feels the immunocompromised have been left very much to fend for themselves and that no information is passed to the population as a whole which might make people think twice about what they can do and about the concerns of the immunocompromised. I ask the Ministers of State to look at that. It is a good day in that we are moving on and returning to normality.

James O'Connor (Cork East, Fianna Fail)
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I acknowledge the extraordinary effort and work that has been put in at all levels of our health service. I am sure the Ministers of State will join me in paying tribute to those who have been working on the front line of the Covid-19 situation in our hospitals, especially in intensive care units given the stress and strain on workers in that setting. The National Ambulance Service has also been absolutely extraordinary.

I have worked hand in hand with the Ministers of State, Deputies Butler and Rabbitte, throughout the past two years. It would be remiss of me not to acknowledge and thank both of them, most sincerely, for their work. I have also worked with the Minister of State, Deputy Feighan, on issues pertaining to drug addiction and other addiction issues throughout the pandemic which, of course, remain a concern for me.

I have ongoing concerns regarding drug addiction among younger people in our society. Sadly, the pandemic has brought unimaginable levels of stress and pressure on young people. It has had knock-on impacts on all sectors of society. I am not forgetting about anybody here but I want to focus particularly on teenagers and people in their 20s, and their growth and development in life. Every parent in the Chamber will join me in acknowledging this point. The group has been so badly impacted, it is hard to get a measure of the damage that has been done. That is something that the health service will have to be cognisant of in the next number of years.

When it comes to drug use, unfortunately, with pubs and other hospitality settings where alcohol is consumed having been closed, from my experience, the go to substance for people who were using for recreational use has been cocaine. I have many concerns about the level of cocaine consumption. Once upon a time, this was only an issue within cities. Acknowledging, of course, that it is an issue, it was not something that was seen in rural areas but no matter where anyone goes in rural Ireland now, whether in a pub in any town or village in my constituency or, indeed, in our cities, this is a serious and growing problem. According to the figures, drug consumption, particularly of cocaine, is climbing and the age bracket at which it is being consumed is lowering. That is frightening. It merits us putting additional focus and resources on particularly the area of advertising. It is so important.

I do not want to finish without acknowledging that the Minister of State, Deputy Feighan, has been very helpful in his communication to me on that particular issue but I would call on the Department of Health to focus on a public advertising campaign to inform young people about the dangers of drug use. It may not happen every drug user but there will be one or two individuals in a group of 20 who may have a bad reaction ,which, unfortunately, often leads to long-term consequences for their health and, in some cases, death. That is something that frightens me, as a 24-year old. I want to highlight that that should be prioritised within the Department.

I also want to acknowledge some of the points that were made by Deputy Murnane O'Connor regarding the immunocompromised. These points have been relayed to me. It is important for people within society to acknowledge that there are people among us who face many health risks and they are worried about, and fearful of, reintegrating back into normality, as we would have known it before 2019, given what we have lost out on over the past two years. It is important that there would be a focus on public information in this regard for the next number of months.

Kieran O'Donnell (Limerick City, Fine Gael)
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I welcome the Ministers of State.

In the time I have, I want to deal with Covid in the context of both Limerick, with University Hospital Limerick, UHL, and more widely.

At present, UHL has 89 patients on trolleys but there are 78 patients in the hospital with Covid. There is a direct correlation. We have a new 60-bed ward. That 60-bed ward was supposed to alleviate the emergency department, ED. That is being used as an isolation ward for Covid. There are 78 patients in UHL with Covid. There are five in ICU. It is welcome that the numbers are reducing but the task for Government at present is how to get the number of people with Covid in hospital down. If it can deal with that, the number of people in hospital with Covid will reduce and beds will be freed up for other elective work that is not happening and that had to be put back previously. That is primary task. Let us put a plan in action to get the number of patients in hospitals with Covid down. There are 89 in the ED in UHL and 78 in the hospital with Covid. That speaks for itself.

Once we deal with that task, we have to evolve the way we deal with Covid. We have to get to live with Covid fully. NPHET has done great work but the next strategies, and the medium-term strategy, are being developed. The Minister of State, Deputy Feighan, is looking at it with the Minister, Deputy Stephen Donnelly. I refer to this expert advisory group with Professor Brady. We now have to get to a point where we need to bring in the business, education and voluntary sectors as well as all the other sectors that are directly impacted by Covid. NPHET becomes part of that equation. Effectively, they provide public health advice. In the long term, we cannot have further major lockdowns because businesses and schools cannot withstand them. I ask that the new model that is considered be a more inclusive model where NPHET is part of it but there are business groups and other groups involved making decisions in real time to ensure that we bring in measures to enable us to live with Covid while at the same allowing business can function.

The big task for Government is to reduce the number of people with Covid in hospital. Omicron has not generated as many ICU cases but some people are ending up in hospital. If we get that number down, then at least we can then deal with large ED numbers in hospitals such as UHL with 89 patients on trolleys, and with 78 in hospital with Covid. The new 96-bed block needs to be built as quickly as possible.

Michael Collins (Cork South West, Independent)
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Rural Ireland is likely to be disproportionately affected by the impact of Covid-19. An ambitious and co-ordinated tourism plan from public and private stakeholders must be considered to prevent the industry from faltering. Tourism was one of the first sectors hit by Covid-19. It is likely to be the last to recover. A co-ordinated plan is now required in the short term. A rapid and sustainable financial recovery support package tailored to the needs of each tourism sub-sector alongside strategic operational supports must be established.

My time is short here but I, along with, I am sure, the rest of the Deputies present, have been inundated with requests from parents of children to get rid of face masks. If we do not need them in restaurants, bars, etc., why do our children have to suffer wearing them? They have become submissive enough because of this pandemic. It is time for us all to live with it, especially our children.

While I am on matters related to NPHET, I think it needs to be disbanded immediately. Lessons needs to be learnt that no one should have been given the power it was given.

Carol Nolan (Laois-Offaly, Independent)
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In the short time I have, I will focus on how the lockdowns clearly showed the inequalities that exist, particularly in education. They showed us the need to reassess how we support our schools. Inequality was deepened. There is an issue regarding schools accessing the delivering equality of opportunity in schools,DEIS, programme and in attaining DEIS status. The current process needs to be reassessed because disadvantaged communities are not being captured by the current programme. This needs to be reassessed.

Many schools have been told that the reason they have not been included is that they do not have the highest levels of concentrated disadvantage among their pupil cohort. The principals in many schools know their communities and their students well. We need to listen more to them. The DEIS model needs to be urgently reassessed to address the deep inequality that exists in education.

Richard O'Donoghue (Limerick County, Independent)
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HSE targets are like a moveable goal. Targets are set at random but are never met. Following a similar debate last year in the House, a target of 100,000 additional outpatient appointments were promised but we were to find that only 33,000 happened. What transpired with the person who set the 100,000 target or what happened to people who only had 33,000 come through the doors? Where is the accountability? In the first four weeks of January 500 procedures were cancelled. I was contacted by the parents of a young girl with cystic fibrosis who were getting her ready for an operation. They spent three months readying their young daughter for her operation. They got to the hospital, she was on the bed and she was being prepped for the operation. Half an hour before the operation was to go ahead, they told her it could not go ahead because they did not have a proper bed for her. What about the damage done to the parents and the daughter after what they had to do to get her there in the first place? She was on the operating bed in the hospital only to be told to go home. They were told they did not know when the reschedule the operation because they did not have a proper bed for that child. That can never happen again. We have to make sure the staff in our hospitals have the proper equipment and management skills to make sure no child or other patient who goes in for an operation has to leave the hospital and go home after three months of preparation for such a big operation?

Will the Ministers of State please ensure the accountability of management?

Danny Healy-Rae (Kerry, Independent)
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I sympathise with all the families of those who died alone in hospitals and nursing homes. That was the saddest part of the whole thing. It should not have happened and I ask that it not be allowed to happen again, especially as visitors are being severely impeded from entering hospitals. Some people became seriously sick, such as Jim Tangney from the Black Valley, a naturally fit man, and Teddy O'Connor, who is still sick. The front-line workers did so much for everyone under a great deal of pressure.

I am very disappointed with the plan for the leaving certificate and the way it was announced. The youngsters who missed so much should have been given a choice. They have been ringing me over and over again because they are very worried. I am concerned that this will create further problems. The Government made the wrong decision. I do not blame any individual, but the Government made the wrong decision. Students should be given a choice. Perhaps it is not too late. They are not happy in respect of this issue.

Most unusual advice and guidelines were given by NPHET. For example, there was the restriction whereby people had to leave indoor public spaces by 8 p.m. I do not have time to comment further so I will leave it at that.

Michael Healy-Rae (Kerry, Independent)
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I thank the people who worked in our nursing homes, community hospitals, large hospitals and regional hospitals. I thank all those who worked in the hospitality sector when it was allowed to stay open, and those who worked in shops that kept business going when that was allowed to keep going. I thank each and every one of them. I also thank the people involved in healthcare, such as those who provided home help, carers and individuals who visited homes in the most difficult of circumstances.

We need clarity with regard to the wearing of masks in the future. It is crazy that we have to wear them in shops but not in public houses. We need to know what we are and are not supposed to do.

Older people were kept separate from the rest of society, which was very hard on them. We need our hospitals to be able to open in a safe way for visits. We need to take care of people on waiting lists, who have had to play second fiddle all along, which we understand was necessary because of the Covid crisis. Most importantly, we need to acknowledge the families who lost someone during this crisis. We are all able to carry on now but we must reiterate to those who have lost relatives that we are so sorry for what happened to them, their families and the lovely and beautiful people who left before their time and who should be still here. Every time we have a debate in the House, we should remember those very important people.

Catherine Connolly (Galway West, Independent)
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I am sharing time with Deputy Joan Collins.

I asked for this debate and I welcome it. I do not have much time to contribute, so I must ask myself what points are important to make. I do not wish to waste that time commenting on a senior Minister's absence from the debate while he attends a well-being expo. I said earlier, and I reiterate it now for the record, that it is entirely unacceptable. The Ministers of State seem to be entirely overworked. I pay tribute to their work on the ground. The Minister for Health should be here because the announcement to lift the restrictions, while welcome, was made outside of the House, without any placing of it in the context of the draconian legislation still on the Statute Book and when that will be lifted, and without any reference to a human rights assessment of what we have been through. While I forgive everything that happened in the beginning because, clearly, the pandemic developed very suddenly, and while I participated in the debate on and gave my consent to the draconian legislation to which I refer, I never again did so on the basis that I never once accepted that the Government was being frank with me regarding either the facts and figures or a human rights assessment. In fact, when I raised this recently with the Taoiseach, I think his response, although I am subject to correction, was that he was too busy for a human rights assessment but that he would have no problem with one in the future.

This pandemic is now included in the national risk assessment register for the next time. When we look back on it, we will need to look at the preparedness and the planning, and we will need to learn from what has happened. A cross-party committee recommended an inquiry into what happened in nursing homes but no action has been taken on foot of any of its recommendations. There has been a press release about a look-back exercise but, again, no Minister has provided terms of reference or told us what we are setting out to learn. The main issue that has jumped out at me over the past two years related to the compliance of the public, which was noted repeatedly in the Policing Authority's very detailed reports. One of the very good mechanisms that was set up, I think by the then Minister for Justice and Equality, Deputy Flanagan, ensured that the policing powers would be monitored. The Policing Authority was given that role and carried it out very effectively. It praised the Garda when praise was due and it also highlighted some of the problems, but the main issue that was highlighted concerned the compliance of the population.

When we clap hands and give awards, that is for the people who showed us the way. The Government moved from a position of solidarity, whereby we were all in it together, to one of division. We did that first with the over-70s and we then ended up using our children to protect adults. It had never happened, to my knowledge, in the history of the world that we would use children, who were not themselves in danger, to protect adults. We then brought in a mandate of mask-wearing at school for them. I happily wear my mask and comply with everything, but this has been done without any built-in review until the end of February, although I acknowledge that seems to have begun happening. We are doing this without any thought about the effects on children. One has only to read the special rapporteur's report on the effects of Covid on children and the disproportionate effects on different groups. We were never all in this together, although we were given the illusion at the beginning by the people who led us that we were.

Joan Collins (Dublin South Central, Independents 4 Change)
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It seems that the most recent wave of Covid-19, caused by the Omicron variant, has passed its peak in Ireland, although the virus continues to rage in many other countries. I thank our front-line workers, who kept society together and kept it going. I offer my solidarity and sympathy to those who died, their families and, importantly, the people of Ireland because, as I have said many times, they have listened closely to NPHET and have been way ahead of the Government guidelines. We have an opportunity now to take certain actions to help us prepare for new variants and waves of infection and, I hope, to avoid the necessity of a return to restrictions or to have further lockdowns.

There are three key areas in which action is needed. First, we have to recognise that we entered the pandemic two years ago with a public health system that was not fit for purpose and that remains so. The recent revelations regarding mental healthcare for children and young adults in south Kerry are just one example of the effects of years of underfunding and under-resourcing. It is a system in crisis. The many problems cannot be resolved overnight. It is not just a question of funding, although that is badly needed, it is also a question of dealing with the fundamental reforms outlined in the Sláintecare report. There is now no excuse for the lack of urgency or the foot-dragging by the Department of Health and the HSE. Sláintecare must be prioritised, with clear targets set and achieved.

The second issue relates to ventilation. We need a national plan to monitor schools, hospitals, nursing homes, all public buildings, hospitality areas and workplaces in order to ensure they are properly ventilated. Where buildings or areas within them do not allow for adequate ventilation, specialised equipment must be installed to bring in fresh air and expel stale air. We need an inspection regime to monitor, in particular, workplaces and hospitality venues. If there are not enough inspectors, there are thousands of health and safety officers in trade unions in workplaces throughout the country and we could approach them to ask whether they would play a part in this.

Third, vaccine inequality must end. It is a killer. People have died because they did not get a vaccine or because they could not afford oxygen that was not provided by underfunded and under-resourced public health systems throughout the world. Vaccine inequality is not just obscene, it is madness. While large numbers of people in middle and low-income countries are unvaccinated, new variants of this killer disease are inevitable. It does not make sense, unless someone is a big investor in or an executive at Pfizer or Moderna. Within a week of the arrival of Omicron, these two companies saw their share prices increase by more than $10 billion, with the CEO of Moderna, Stéphane Bancel, adding more than $800 million to his personal wealth.

I want to end with a quote from Tim Bierley, a pharma campaigner at Global Justice Now, who stated:

Pharmaceutical companies knew that grotesque levels of vaccine inequality would create prime conditions for new variants to emerge. They let Covid-19 spread unabated in low and middle-income countries. And now the same pharma execs and shareholders are making a killing from a crisis they helped to create. It’s utterly obscene.

Human Rights Watch and Médecins Sans Frontières have identified over 100 factories which could produce mRNA vaccines if intellectual property barriers were removed. The blocking of these is absurd.

Anne Rabbitte (Galway East, Fianna Fail)
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I am grateful to have the time to talk about the easing of Covid-19 restrictions and I thank all speakers for their contributions. Without a doubt, Ireland has come through some dark and challenging days, and I hope and expect that we are now entering a brighter time. It is timely for the Minister for Further and Higher Education, Research, Innovation and Science, Deputy Harris, to be in the House because he was here at the start, while we are representing the current Minister for Health, Deputy Donnelly, this evening.

It has been more than 22 months since Covid-19 arrived with us, causing immense disruption across our health and social care services and society. I wish to recognise the extraordinary continuing contribution of all our front-line staff and the public during this unprecedented time. This has been essential to coping with Covid-19. As the Ministers of State, Deputies Feighan and Butler, have noted, it is thanks to their hard work, and the exceptional support of the Irish people for the necessary public health restrictions and for the national vaccination programme that we are in a position to ease these restrictions.

It is also important to remember the grief that is felt by so many who have lost loved ones to the pandemic. Covid-19 has taken a devastating toll on so many families around the country. However, no one should be in any doubt that the collective efforts of the Irish people during this difficult time have saved many lives. We will take time in March, around St. Patrick’s Day, to remember those we have lost and to recognise these efforts.

We have been learning and adapting our response throughout the pandemic and we have already established processes, as needed, as part of ensuring the best possible response to this unprecedented challenge. The Minister, Deputy Donnelly, recently established a new public health reform expert advisory group, with a membership of 13 national and international public health experts, chaired by Professor Hugh Brady. This expert group will initially focus on identifying learnings from the public health components of the response to the Covid-19 pandemic in Ireland. It will then look at strengthening health protection in Ireland generally and enhancing our future public health pandemic preparedness. It will also identify lessons from international best practice regarding reform and strengthening of our core public health functions. The first meeting of the group took place on Monday. We look forward to hearing its findings when it reports in the middle of this year.

As the Minster with responsibility for disabilities, it is important that I raise how Covid-19 also presented huge challenges for people with disabilities and their families over the course of the pandemic. Services were unavoidably impacted by necessary restrictions in line with public health guidance. All services continued to be provided to service users with the highest priority throughout the pandemic and, in line with the guidance provided, all services are currently being built back up to full capacity in a safe and robust manner.

One of the main issues raised with me over the pandemic relates to adult day services, which were probably the disability service most affected by the crisis. Approximately 18,000 people attend adult day services, including more than 4,000 people in receipt of both residential and day services, so it is a substantial cohort. Adult day services had been closed from March 2020 but I made it a priority to open them by deeming disability services an essential service in mid-2020. In September 2020, all day services reopened at reduced capacity, reflecting public health guidance, and then reopened at full capacity on 22 October 2021. While services were closed or reduced, innovative and original remote supports were developed. The curtailment and reduction in service was in line with public health guidance but also due to staff shortages in residential and day services due to Covid-19.

For those watching and listening in, I am aware that, more recently, significant staff shortages are still causing issues in residential and day services. Some locations have had to close for a short duration while other day services have had reduced service levels in line with the availability of staff. I am monitoring this closely from week to week but I am delighted that the HSE reports that the number of staff on Covid leave is decreasing. While there will continue to be a level of disruption to day services in the months ahead, the HSE is confident these are manageable. I can confirm that the HSE expects full restoration of day services by the end of March.

Another issue often raised with me is respite. While some centres remained open, others operated at a reduced capacity and some were temporarily repurposed as isolation facilities. I made €5 million available in the 2021 budget to open nine additional respite houses in 2021 to provide an additional 10,400 respite nights in a full year. Work continues to progress on the nine respite houses for 2021, with five of the houses now either fully or partially operational. Unfortunately, some of the houses were subject to delays relating to recruitment and procurement, and the remainder of the houses are due to open in the coming months. Notwithstanding this, it’s positive to see that the number of respite overnights operated at 4.5% ahead of the national service plan target for the first three quarters of 2021.

The delivery of therapeutic interventions to children awaiting services has been hindered by the pandemic. Disability service providers worked innovatively to ensure supports could be provided across the sector. This included assessments and therapeutic interventions for children either online or in person throughout the pandemic. I am continuing work to ensure there is an increase in the delivery of interventions on the ground so our children get the supports they so badly need. For me, this is the most important success I could achieve in 2022 after such a disruption in service.

Regarding the Government’s agreement to give a Covid-19 recognition payment to front-line public sector healthcare workers to recognise their unique role during the pandemic, it is important I take this opportunity to echo the Taoiseach’s comments during Leaders’ Questions yesterday regarding section 39 organisations as I have received many questions seeking clarity on this. Those eligible for the Covid-19 recognition payment are general front-line public healthcare workers who are directly employed by the public health sector and who worked or trained in environments exposed to Covid-19 or clinical settings. Aside from the staff covered by that, staff also intended to be covered by this arrangement are home carers working for and contracted out to the HSE and agency staff who worked in clinical settings for the HSE, including agency nurses, doctors, cleaners and paramedics. Those working in long-term disability care facilities under section 39 and in public-private voluntary nursing homes and hospices are also covered. The arrangements for processing this decision are currently being finalised by the Department of Health and the HSE.

As my colleagues have noted, while we are now in a positive position, it is important to stress that Covid-19 is not yet over in Ireland. There is a need for ongoing close monitoring of the virus. The emergence of new variants with increased levels of transmissibility, immune escape or virulence remains a high risk, both nationally and globally. This point is particularly important in the context of continued high levels of infection and variance in vaccine supply and uptake globally. It is important that we continue to follow public health advice and we must maximise the uptake of the primary and booster vaccinations. Our national vaccination programme will continue to work to reach those who have not yet been protected, and work is under way to ensure that a flexible and robust vaccine delivery system is in place for the future.

Throughout this crisis, the solidarity demonstrated across communities all around Ireland has helped us to rise to the immense challenges we have faced. As we move forward, it is important that we continue to show this same solidarity and give each other the space to adapt and respond to the lifting of restrictions in our own time. This is a shared responsibility for us all and it will be critical as we adapt to this new phase of management of the pandemic. We know what we can achieve by working together.

It is also important to acknowledge the role that carers in the home played throughout all of the pandemic. While I talk about respite or day services not being available, it is not wasted on me or my colleagues that the people who deliver that are also the carers in the home. I acknowledge the pressure and the stress that they are under. We all have to work together on this. One of the first things that I learned when I went into the Department of Health was about the collective approach by the Department of Health, HSE and the providers. We need to not lose that as we come out of Covid. We need to ensure that collaborative work together continues, because that is the only way that we can get jobs done.