Pearse Doherty (Donegal, Sinn Fein)
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Tá an cosc earcaíochta sna seirbhísí sláinte ag cruthú go leor deacrachtaí agus anois tá 70% d’altraí ag rá go bhfuil sábháilteacht othar i mbaol. The effects of the Government's recruitment embargo are to be seen right across the State. They are to be seen in the number of patients forced to languish on trolleys in hospitals. They are to be seen in the number of patients across the health service whose appointments are being cancelled, as well as in the length of time they are being forced to wait for critical care. Those who are working at the coalface - our nurses - are very clear about the impact the recruitment embargo is having on the health service. The impact is not just on them, but also on their patients.

Yesterday, the Irish Nurses and Midwives Organisation, INMO, published the results of its member survey. It tells us that 70% of nurses and midwives said they were concerned that patient safety was now at risk as a result of staffing shortfalls. It is shocking that this is the view of those working in our hospitals. It is, however, an inevitable consequence of the Government's recruitment embargo. According to the survey, 63% of nurses and midwives have considered leaving their jobs in the past month, and one in five nurses have presented to their GP because of work-related stress. This is simply unsustainable. Karen McGowan, the outgoing president of the INMO, said yesterday, "the Government has failed to make progress on hospital overcrowding, and conditions for staff and patients in many places has gotten far worse than we could have imagined". These are health professionals who want to do their very best for their patients and our people, but in many cases the Government is making it impossible for them to do that. It is causing many of them to leave Ireland and seek work abroad, denying this country their skills and service. We need them here.

Sarah contacted us recently. She is a recently graduated care professional who said that it is horrible to have to sit in interviews only then to be told at a later stage that there is no job because of the embargo. Dylan contacted us. Speaking about the embargo, he said he would love to come back home to Ireland and work as a nurse, but it is impossible to get a job because of the Government's embargo. Lorraine got in touch with us and said, “I am desperate to move home, but this embargo has left me stuck abroad. Please get me home.” The recruitment embargo the Government has imposed is making matters go from bad to worse. It is impacting every area of our health service. We were contacted by a young pharmacist from Waterford. She applied for a job last year and she was so enthusiastic about this job, but she is now being told that her interview will not be progressed because of the recruitment embargo. In her own words, she said that she has been left in limbo. We were contacted by a speech and language therapist who was offered a dream job last year. Everyone in this House knows that if we need one thing, it is more speech and language therapists. She was offered a dream job last year. She is working through an agency while waiting for the contract to come through from the HSE, but she has now been told that the job that was offered to her has been withdrawn as a result of the recruitment embargo. Under the recruitment embargo, job offers in our health services were instructed to be withdrawn. That is a fact.

It is patients and staff who are suffering as a result of this. Trained professional health service staff who want to come home are now being locked out of that opportunity because of this embargo. It is now May and the Government still has not approved workforce plan for the health service this year. It is five months into the year, but it still has not approved the workforce plan. When will the Government get its act together? When will it approve the workforce plan for our health service for 2024? Will it lift the recruitment embargo that is so badly damaging our health service and locking so many of our trained health professionals out of the potential to work in the health service, roll up their sleeves and care for the people they are trained to care for?

Micheál Martin (Cork South Central, Fianna Fail)
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First, ní aontaím go hiomlán leis an Teachta. Ní dóigh liom go bhfuil an méid atá ráite aige cruinn maidir leis an méid daoine atá ag obair sna seirbhísí sláinte, go háirithe agus an méid banaltraí ag dul in airde. Is é fianaise an scéil go bhfuil i bhfad níos mó daoine ag obair anois sna seirbhísí ná mar a bhí anuraidh agus an bhliain roimhe sin.

In the first instance, I will deal with the so-called embargo that is being touted about the place. We now have 9,614 more nurses and midwives working in our health service than we did in December 2019. A 2023 OECD report shows that Ireland has the second-highest number of practising nurses per 1,000 head of population among the reported European Union countries. We are second only to Finland. Over the last three years, we have increased the number of undergraduate education places for nurses and midwives by nearly 600 places. For the 2023-24 year, there are more than 200 additional places in higher education institutions in the Republic. Moreover, in 2023, there was a once-off arrangement for approximately 130 students to study in Northern Ireland. We are committed to doubling nursing and midwifery undergraduate education places over the next five to eight years.

The hiring of graduate nurses, qualified nurses and midwives committed to and coming through the international recruitment pipeline, ED, ICU, maternity and community nurses are all exempt from the recruitment pause. Recruitment of nurses has continued. An additional net 3,168 nurses and midwives have been recruited since May of last year. Overall, in terms of the broader health service, 28,500 more staff are now working in our health service than were there at the beginning of 2020. These are very substantial increases.

I make the further point to the Deputy, who is his party's finance spokesperson, that the level of expenditure in health continues to grow apace. The figures in the first three to four months of the year show a significant increase in expenditure, even above profile. It is significantly above profile, which means that spending is continuing within the health services, mainly in the areas of acute and trauma services. That is the reality. There was a very substantial increase in health spending in the first three to four months of this year. It is substantial in its own right because of the budget, but even ahead of what was profiled in the budget, we are looking at very substantial increases in health expenditure. More than €7.5 billion extra has been allocated to the health service over the past four years.

To be fair, the waiting lists are coming down. Additional services across the health service have been provided as a result of that, both in primary care community services and in the acute hospital sector.

About 4,200 extra health and social care professionals have been recruited over and above what we had in 2020 and about 3,000 extra doctors and dentists have been recruited. Across the health service, there has been a very significant increase in people employed. We need to focus on whether deployment correlates with outcomes in certain areas.

Pearse Doherty (Donegal, Sinn Fein)
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Are 70% of nurses and midwives who work in our hospitals wrong when they say they are concerned about patient safety because of the levels of staffing? Is the outgoing president of the INMO wrong which she says that things are far worse now for patients and staff in hospitals? There are people in Australia and elsewhere who cannot come back and get a job as nurses owing to the embargo. The HSE cannot recruit a nurse from abroad. Are those people also wrong? A person got a job offer and is now working for an agency. It costs the HSE 30% more to employ her because it is through the agency. Is she wrong when she says she was told that her offer of a job was withdrawn because of the embargo? The Tánaiste talks about the so-called embargo. He needs to open his eyes and look around at what is happening. There is an embargo.

Regarding the numbers of professionals that were to be recruited this year, the Tánaiste is responsible for this because he will be part of the Government making this decision. The Government does not have its act together. It is the month of May and the Government has not sat down to look at the workforce plan for 2024. The HSE is in limbo and does not know how many it can employ. Robert Watt was before the committee and said it is over to the political level. There is a dispute there. When will the Government sign off on the workforce plan? Will it lift the recruitment embargo so we can allow our nurses and other professionals to come home from Australia and elsewhere and work in our health service?

Micheál Martin (Cork South Central, Fianna Fail)
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I made the point already that graduate nurses, qualified nurses and midwives committed to and coming through the international recruitment pipeline, emergency department, ICU, maternity and community nurses are all exempt from the recruitment pause. Recruitment of nurses has continued. That is this issue. The other point, which the Deputy did not seem to pick up on, is that expenditure within the HSE in the first quarter of this year, as confirmed by the Department of Health, is way ahead of profile. Spending in the HSE has not stopped. Spending has not stopped in the health service. The Deputy is his party's finance spokesperson. There needs to be an evaluation of all of this, too.

Pearse Doherty (Donegal, Sinn Fein)
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A system in crisis will always cost more.

Micheál Martin (Cork South Central, Fianna Fail)
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An additional €7 billion has been invested in the health service since 2020. When people say it is worse, I do not accept that because our survival rates have improved significantly over the past decade. There is room for significant improvement in certain locations. We need very rigorous examination of certain sites as to how people are deployed to get optimal outcomes and improve quality.

Cian O'Callaghan (Dublin Bay North, Social Democrats)
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An image popped up on my social media last night showing two boys in Rafah, their tiny bodies crushed under mountains of debris, the latest victims of Israel's atrocities in Gaza. The world will probably never know their names. We will not know how many siblings they had, what their favourite hobby was, what they wanted to be when they grew up, how scared they were for the past seven months, how many horrors they endured, how many friends and family members they watched die, how many times they and their families had been displaced before they ended up in Rafah desperately seeking safety before a missile strike on the building they were staying in ended their short lives. Those boys were just two of the more than 14,000 children who have been killed Gaza. Nearly 35,000 people have now been killed in Gaza, the vast majority civilians.

Israel is slaughtering people in their tens of thousands and still the world sits idly by. Entirely absent from implementing any sanctions or even the threat of sanctions has been the European Union. From the outset the EU has not just acquiesced to the carnage; it has been complicit. There has yet to be a joint statement from EU leaders in which Israel's barbarism is even mildly criticised. I acknowledge and welcome that Ireland and a minority of other EU member states have been calling for action. However, it is now three months since the former Taoiseach and the Spanish Prime Minister wrote to the European Commission President, Ursula von der Leyen, to request an urgent review of the EU-Israel trade deal. As far as we know, von der Leyen has not even bothered to reply to that letter, never mind review or suspend the deal.

The Social Democrats welcome plans to recognise the state of Palestine later this month. When will the EU live up to its professed values and act to stop a genocide? Has the European Commission ignored the Irish Government's request to review the EU-Israel trade deal? If so, what will the Government do about it? The next European Council meeting is not scheduled until the end of June. Will the Government call for an emergency European Council meeting and put sanctions against Israel firmly on the agenda? Will the Government enact the occupied territories Bill, which Fianna Fáil supported when it was in opposition?

Micheál Martin (Cork South Central, Fianna Fail)
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I agree with the Deputy that the death toll and the horrors happening in Gaza are quite shocking. The death toll is now in excess of 34,000. Over 1.9 million people have been displaced and, of course, thousands of people have been badly injured as a result. On my recent visit to Rafah, UN representatives spoke about the degree of psychosocial trauma that the entire population, particularly children, have been subjected to. There are 17,000 unaccompanied minors in Gaza right now, 17,000 children without parents and so forth. They are going through enormous trauma and are being helped by other people who are also going through enormous trauma. There are 1.5 million people sheltering in Rafah and any operation there would be catastrophic.

When I visited Rafah, we saw a CT scanner which had been donated being denied access. A lot of other hospital equipment is being denied access by the Israeli authorities allegedly on the grounds of dual use. A green sleeping bag was denied access because it could be used as camouflage. A children's education pack was denied because it includes scissors. Croissants with chocolate and orange juice were considered luxury items. It is unbelievable what is being denied to Palestinian people within Gaza by the Israeli authorities given the enormity of the starvation and hunger that people are experiencing.

I am clear that the people of Gaza are being collectively punished. There is no other explanation for what is going on. Israel has obligations to facilitate full, rapid, safe and unhindered humanitarian access into and throughout the Gaza strip, in particular by road. Road is the most effective way of getting sufficient aid in. We have been clear that all restrictions on the work of UNRWA and other humanitarian groups must be immediately lifted.

The former Taoiseach, Leo Varadkar, and the Spanish Prime Minister wrote to the European Commission about the EU-Israel association agreement. It was discussed and will be discussed again at the Foreign Affairs Council but we want the Commission to do a formal review. We have already engaged with the Commission on this. If, ultimately, there are to be sanctions at EU level or if the essential element clauses of the agreement which involve human rights are invoked, in all likelihood it would need unanimity at Council level if the Commission were to recommend such action. We are under no illusion, given the composition of the European Union and the different perspectives of different EU member states on this question, that this is a challenging road. Nonetheless, we were correct in taking the first step and we will continue to pursue it.

Cian O'Callaghan (Dublin Bay North, Social Democrats)
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We agree with the Tánaiste. We need action because the situation is so appalling. One of the images I saw yesterday was of a small child whose parents have been lost looking after a toddler and a baby. These are appalling situations. People are being massacred in Gaza. Children with hopes and dreams for the future are being left buried under rubble. We urgently need action on this as quickly as possible. Will the Tánaiste call for an emergency meeting of the European Council? Will the Irish Government call for this and look for sanctions against Israel to be on the agenda? Will he do that urgently?

Regarding the occupied territories Bill which the Tánaiste supported when in opposition, will the Government now support the enactment of that Bill?

Micheál Martin (Cork South Central, Fianna Fail)
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I accept what the Deputy is saying. War crimes have been committed. I am in no doubt about that. What is happening is a shocking humanitarian catastrophe. The most immediate priority is this Friday, when the UN General Assembly will consider the question of admitting Palestine to the United Nations to enjoy the rights and the full gamut of what is available as a member. That vote and the scale of the vote is important. We are supporting and co-sponsoring it with a view to ensuring as large a number of people as possible support Palestinian membership. That would give further impetus and international urgency to this and also to the question of recognition of a Palestinian state. That vote on Friday is important in that respect.

On the occupied territories Bill, the advice is clear. We have no legal jurisdiction in that it is a EU legal competency. That is the legal advice from successive Attorneys General at this stage and it seems to us that the majority of senior legal opinion is to that effect. I am open to-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The time is up, Tánaiste.

Micheál Martin (Cork South Central, Fianna Fail)
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-----further examination of that from a legal perspective but the advice has been very strong to us.

Cian O'Callaghan (Dublin Bay North, Social Democrats)
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The Tánaiste is not going to call for a meeting of the European Council?

Micheál Martin (Cork South Central, Fianna Fail)
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Again, the European Council meeting is in June, I think.

Cian O'Callaghan (Dublin Bay North, Social Democrats)
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It is at the end of June.

Micheál Martin (Cork South Central, Fianna Fail)
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We will see what can happen there. The Foreign Affairs Council meeting will be held before that. We have the meeting of the UN on Friday and we will see where we go from there.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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Actions absolutely speak louder than words. I start by paying tribute to the very brave and committed students of Trinity College Dublin who, after five or six days of a sit-in, managed to get full boycott divestment from the Israeli state from the authorities in the university. This is a very hopeful sign in the midst of what is a desperate and hopeless situation as Israel moves to its next stage of onslaught against the people of Palestine and threatens the ground invasion of Rafah. Interestingly, Joe Biden stated this morning that he will not provide any more bombs. One shipment of bombs has been refused. That is a small amount of weaponry compared with what the USA has already provided to Israel but it is progress and that is an amazing thing to see. Where did that incentive come from? Where did that impetus come from? It came from the students across America who are occupying colleges there and driving from below the absolute imperative on our rulers across the world to do something; not just to talk, but to act. The students have acted and they are being listened to.

There is an historic context to this. Students acted when the Vietnam war was at its height. Students across America, Europe and Britain occupied and took action and began the end of the Vietnam war. The same is true of apartheid in South Africa. Student action began the end of apartheid and fed into a movement that spoke to the rulers of the world and said "Do something. Act. You must act now." When will the Government act? Rather than just talking about what needs to be done and bemoaning the fact that there is terrible genocide, children are being killed and the scenes are horrific, when will it actually do something that will force the hand of the Israeli state to back off and stop the genocide? We have a legal obligation under the Genocide Convention to do something rather than just sitting on our hands and waiting to see what happens and whether the European Council meeting will be called or not. We have to act and we should now start taking a leaf from the book of students. These young people, the locked-out generation who cannot get homes, who are living in their mammy and daddy's box room, who have to emigrate when they finish their education because they cannot afford to live in this country, have been inspiring. They have been courageous and gone the whole nine yards. They are at this in America and across Europe and Britain as we speak. They are trying to tell people like the Tánaiste, who rule these democratic countries, to do something. It is not just about being cool, young and a student. It is about telling the adults who are well-paid, well-resourced and powerful in this world to actually take action, stop the genocide and the slaughter of children, and tell Israel that this is not acceptable and the apartheid and the occupation of Palestine must end.

Micheál Martin (Cork South Central, Fianna Fail)
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First of all, I do not rule; I am elected-----

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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Hear, hear.

Micheál Martin (Cork South Central, Fianna Fail)
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-----as is everybody else in this House. We have a parliamentary democracy in this country which I respect, and I respect the views of all citizens. I am under no illusion about the strength of feeling across the entire Irish people about what is happening within Palestine, and to Palestinians in Gaza in particular. My own party has been consistently supportive of a Palestinian right to its own state. Indeed, in our programme for Government, the three Government parties put together a commitment to recognise a state of Palestine, again co-ordinating with other member states and other countries to try to have as big an impact as possible to give momentum on the question of recognition. We have been very active. It is not just words. We have been very focused on all areas - diplomatic, legal, humanitarian and political. We have been pursuing every avenue at our disposal where we can have practical and real impact. On the humanitarian side, Ireland was one of the first, if not the first, to stand up and call for a stop to the attempts to undermine UNRWA and the pulling back of its funding. We have been effective on that front. It is acknowledged by UNRWA and by others that Ireland stood up and it was not just words; it was action.

On the legal front, we are already one of the few countries to make an oral submission to the ICJ case on the advisory opinion from the UN. The Attorney General made a substantive contribution to the court, following on from a very substantive written legal submission we made back in July 2023. I may stand corrected on that date. We were consistent on these issues even before this terrible war started. We have worked hard to secure the safe passage of many Irish citizens out of Gaza and that has been effective, with more than a hundred Irish citizens now out of Gaza. We have made it clear we will legally intervene in the International Court of Justice on the case initiated by South Africa, but that will take time. I am not saying that is all we will do but it does speak to the issue of accountability. Israel has to be held accountable through the international court system for what it has done. We have to advocate with other countries to win them over to our position. We have been effective, given where we started. Ireland would have been considered an outlier within the European Union on this question in terms of the positions we have consistently adopted but now a majority within the EU are very much in line with our position in respect of an immediate ceasefire, the release of hostages and a political process to resolve this on a more sustainable basis.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I have not denied that the Tánaiste has said a lot. He has said a lot diplomatically and legally and about humanitarian criticism on stopping the aid to UNRWA. He has said a lot. What I am asking is what he is going to do? The question of deed is at the heart of my argument. I was a young shop steward when the Dunnes Stores strike against apartheid happened. I knew Karen Gearon and Mary Manning very well. For three years, they stayed on the picket line on Henry Street and, after three years, the Government in this House brought in legislation to ban the importation of South African fruit and vegetables. However, it took three years of a struggle by ordinary, decent young workers. Now we are seeing the struggle by ordinary, decent young students to try to get people like the Tánaiste, the rulers of the world, to listen.

I call him ruler. I understand he is an elected ruler, but he has much more power than I have. If it was within my power, the Israeli ambassador would have been put out of here long ago.

The Government could do that but it is refusing to do it. I love the talk but we need action. Children are dying, as we speak, as a result of famine. Places are being bombed as we speak, and we face the potential of an absolute catastrophe in Rafah. There is that potential still, even after Joe Biden said he will refuse to send one shipment of bombs to Israel following all the stuff he has sent. The Government needs to act. Act means sanctions. Sanctions can be anything from refusing its services, ending the contract with Hewlett-Packard that we have in this House and expelling the Israeli ambassador. Take action in the way students in the United States and Trinity College have done. They have made a difference.

Micheál Martin (Cork South Central, Fianna Fail)
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We have taken action. The Deputy is being very disingenuous. We have taken action long before this war and during it. We were one of the first to support the NGOs that Israel had, in our view, wrongly labelled as supporters of terrorism. We continued our support for those NGOs, which are human rights organisations, with finance. We met them. I already instanced the UNRWA situation and the wider supports we give to the Palestinian state in the areas of education and health. That is action; it is not words. It is practical action. The Deputy spoke about-----

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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It is not working.

Micheál Martin (Cork South Central, Fianna Fail)
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No one speaks more than-----

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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The Government needs to do more.

Micheál Martin (Cork South Central, Fianna Fail)
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The Deputy speaks a lot as well. I am not-----

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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The Government needs to do more.

Micheál Martin (Cork South Central, Fianna Fail)
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-----just about talk. I am about practical action and the hard yards of trying to persuade people.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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That is going to take a long time.

Micheál Martin (Cork South Central, Fianna Fail)
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The political accommodation in South Africa involved people on all sides taking momentous steps in the context of truth commissions and everything else.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The boycott precipitated it.

Micheál Martin (Cork South Central, Fianna Fail)
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Ultimately, if we want Palestinians and Israelis to live side by side in harmony, there will have to be a political resolution. That will involve-----

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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So while they slaughter the Palestinians, we wait for them to live in harmony?

Micheál Martin (Cork South Central, Fianna Fail)
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Everybody in this House has condemned the bombardment of Gaza.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Time is up now, Tánaiste, thank you.

Micheál Martin (Cork South Central, Fianna Fail)
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Everybody has to be fair. I am trying to say that, ultimately, there is no other way. It is like what happened in Northern Ireland. For 30 years, people were bombing and maiming each other. People are now living together in harmony-----

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Can we conclude, please? Time is up.

Micheál Martin (Cork South Central, Fianna Fail)
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-----and in peace. That ultimately has to happen in the Middle East. Otherwise, there will not be sustainable peace in the region. We have to work at that. That is hard work.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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If Palestinians are still alive; if they are not expelled or dead.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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If the Deputy wants to have a conversation with the Tánaiste, have it with him outside.

Bríd Smith (Dublin South Central, People Before Profit Alliance)
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I do not want to have a conversation with him.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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We have a set time for questions. We have to have some regard for the rules, please. I call Deputy Naughten.

Denis Naughten (Roscommon-Galway, Independent)
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Long Covid is the title given to a range of illnesses that have left previously healthy individuals who have not recovered from Covid infections with no quality of life. These patients once led busy professional and family lives are now, but they are now in some instances bedridden, unable to eat and unable to communicate. Despite the severity of their condition, many are being denied medications and treatment that, while they would not cure them, could help to manage their symptoms and improve their daily lives.

While health experts confidently advised that most people would recover over time, I have published data, based on a self-reporting national survey that I commissioned over the past 18 months, which paints a very different picture. The incidence of long Covid symptoms has remained stubbornly constant over that period, with a rate of 6% of adults reporting that they are suffering from these post-Covid symptoms. The poll data commissioned from the Ireland Thinks polling company, highlights the continued prevalence of these debilitating effects four years after the initial onset of the pandemic. The data indicates that more than 61,000 adults continue to suffer from the symptoms associated with long Covid for more than two years after contracting the disease. The most recent poll last month indicates that 27% of those with long Covid symptoms have had them for more than two years and that a further 28% of adults struggling with these symptoms for more than a year.

These figures clearly show that the HSE's long Covid clinics are failing tens of thousands of patients. Many clinics remain understaffed and, therefore, are not fully operational. Instead of a centre of excellence approach, it has become a potluck, pick and mix of services with no apparent specialised training in understanding and treating patients. Despite all of this, there have been some very positive reports from patients about individual doctors and some multidisciplinary supports, including occupational therapy and psychology. Unfortunately, these are the exception rather than the rule. The interim model of care in operation in these clinics is now 32 months old and has had zero updates. The HSE committed to establishing clinical guidelines in line with HIQA recommendations last year in order to achieve some consistency for patients, yet these clinical guidelines have not materialised. We need to ensure that long Covid patients are not forgotten and that they receive the care and support they need to manage their symptoms and improve the quality of their lives.

Micheál Martin (Cork South Central, Fianna Fail)
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I thank the Deputy for raising this important issue and for his long-term commitment in respect of it. He has consistently raised it in the House on a number of occasions. The Government continues to support the roll-out of a national service for long Covid. In 2022, about €2.2 million was provided for the implementation of the model of care. That trebled to €6.6 million in 2023. Now, €8.8 million has been allocated for 2024. There are six long Covid clinics and six post-acute Covid clinics operating nationally. These are staffed by consultants in the areas of infectious disease, respiratory medicine, psychiatry and neurology, as well as allied health professionals and clinical psychologists. St. Vincent's University Hospital, Beaumont Hospital, Tallaght University Hospital, St. James's Hospital, Cork University Hospital, University Hospital Galway and University Hospital Limerick have long Covid clinics. The post-acute Covid clinics operational under the model of care are located in the Mater Hospital, Tallaght University Hospital, St. James's Hospital, Cork University Hospital, University Hospital Galway and University Hospital Limerick. The HSE is working with Letterkenny University Hospital for a more definitive timeline around its anticipated launch date. The HSE also advises there is a tertiary neurocognitive clinic in St. James's Hospital led by a consultant neurologist with a background in neurocognitive disorders. That facility is accepting referrals from long Covid post-acute clinics around the country.

The Deputy spoke about a poll he commissioned. I have not seen the details of the polling or the methodology used. I do not know, for example, if it has been extrapolated from the poll that there are 60,000 people involved. In any event, there is the issue of how to develop effective therapeutic options for patients suffering from long Covid. The health service is still advising that this is very problematic and poses a number of challenges because the pathophysiology, which is the physical and biological abnormalities in the body that occur because of the disease, is not yet clearly understood. No evidence-based treatment options exist at present for long Covid, which has resulted in the use of a symptom-management approach, which mainly includes medical assessment and referral to the appropriate specialist.

The HIQA review, as the Deputy said, was commissioned and the results were published in December 2022. Monitoring of international data and research continues. The HSE has undertaken an epidemiological survey, FADA, which was launched in March last year. The results are due later this year. That survey will perhaps provide an up-to-date accurate insight into the prevalence of long Covid in the Irish population and risk factors for developing long Covid and inform service development. The HSE is engaging with GP representatives and patient groups including Long Covid Ireland, a patient advocacy group, on service development.

In respect of children, diagnosis and care are provided by GPs and existing referral pathways within paediatric services. The evolving evidence in the context of long Covid in children is again being monitored by the HSE. The challenge is to try to understand the impact of this disease in the first instanced and then to utilise existing research more effectively and quickly in terms of treatment options and a more comprehensive service for patients with long Covid.

In respect of children

Denis Naughten (Roscommon-Galway, Independent)
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The poll results also raise another issue of concern. It indicates that those aged between 55 and 64 are twice as likely as any other age group to state they have been managing the symptoms of long Covid for more than two years. This needs to be investigated further. Despite requests for patient involvement and feedback to the existing clinics, this has not happened. The latter has resulted in clinics failing to meet the needs of those with long Covid symptoms. This is clearly reflected in the poll numbers I have published. I call on the Government to work in tandem with the HSE, patients and front-line clinicians to expedite the delivery of a national action plan on long Covid that will include a revised model of care for patients, allocate funding to enable specialist clinics to become fully operational and recruit specialist clinicians across the health service.

Micheál Martin (Cork South Central, Fianna Fail)
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I am not sure if the Deputy has shared the data, methodology and so on he possesses with the HSE. It is important that this should happen in order that it can carry out a full assessment. It would be helpful to the HSE, although it is doing its own comprehensive epidemiological survey. Covid has always been a disease that affects older age groups more than younger age groups. That was a feature of the impact of Covid on people. The older cohort was the more challenging one.

Denis Naughten (Roscommon-Galway, Independent)
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That is not the position with long Covid, which is more challenging for younger people.

Micheál Martin (Cork South Central, Fianna Fail)
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The Deputy is saying that those aged between 55 and 64 are twice as likely to still be managing the symptoms after two years. That is relatively younger. I am probably in that category myself, so I had better be careful what I say. My sense is that it is going to take a bit more to understand this. Apart from a national action plan, I would like to see more research commissioned by ourselves, work on clinical trials and stuff like that around Covid. That is an important dimension we should now be embarking on.