Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

---- is to continue to expand that. I thank Members for their support for the Bill and what it is trying to do.

I have taken a lot of notes and I apologise in advance as inevitably, I will not be able to speak to all the points raised. Some were local. Myself or the team will revert to Senators with updates.

Regarding Covid, public health officials have been increasingly worried over the past five weeks. The number of new cases per week was climbing considerably. A key number they look at is the cumulative number of cases in the previous two weeks per 100,000 population. Ireland was down to nine and that climbed up to 22 and was continuing to rise. An R-nought number of less than one means the virus is dying out in society and if it is much over one means that it is growing, while a little over 1 means that we are holding our own. We had it below one and it began to grow again. Approximately a week ago, their best estimate was between 1.2 and 1.8. They calculate this in multiple ways and when the numbers are low in Ireland the range widens because it is harder to calculate given the rate is low. That is why the Government decision was made to pause on phase four and introduce face masks on public transport and in retail outlets. It is why we pushed very quickly to get the app launched.

I have had long conversations with the acting Chief Medical Officer almost daily, including today and yesterday, about what happened in the past ten days. NPHET met yesterday. The good news is that things have stabilised in the last ten days. Critically, the R-nought number has come down. The latest estimate is between 0.7 and 1.4, with the best estimate at 1.1. There were seven new cases yesterday. Tragically, nine deaths were announced yesterday, which we mourn. Eight had become unwell during previous weeks and months, while one was more recent. Every death that can be avoided needs to be avoided. It is an imperfect science, but the sense is that the improvements we have seen, the stabilisation in the past ten days, the reductions in the R-nought number and the number of new cases, is largely due to the response of the public. We all remember that two weeks ago, there was a weekend when a relatively small number of people let loose and there was probably a week when people might have relaxed a little in following public health guidelines. One cannot blame anyone, after everything the entire country has been through. There was a big, positive response to that and public health officials made another big ask to everyone to wear face masks and comply with social distancing. People reacted and yet again they are doing the right thing. Even as we have opened up our society over the past ten days, things have stabilised. The people who deserve credit for that are the Irish people for stepping back up.It is not an easy thing to do. That is very positive. There has been much comment recently about travel, which is fair. It is sorted out now and I hope the messaging is very clear.

There is something worth reflecting to the House. I had a fantastic conversation with one of the top advisors at the WHO. I asked him about Ireland and he could not have been more positive. He said it was obvious to look at what was happening and what needed to improve but he said that we are doing an incredible job, with one of the lowest rates of the disease anywhere in the world. He particularly singled out political solidarity. He said when the WHO looks around the world at the things that are important and working, Ireland is not unique but unusual in the political solidarity that has been shown right from the start in February. I was in opposition then and I and Deputies O'Reilly and Kelly and many others across the political spectrum got together and got the advice. We - that is, I and those in Sinn Féin and other parties - disagreed, we brought things to each other and discussed them. We had great access to the HSE and officials and things worked.

I wish to extend the same offer here as I did in the Dáil earlier. It is fair to say that in the past week or two some of the solidarity has slipped a little. Some of the responsibility for that lies with me. It may have been unavoidable with the change of Government but the level of political interaction probably slipped. The briefings we all had stopped. No decision was made about that and there was no intention, but I made an offer to the Dáil earlier and say here that we need to get those conversations going again. That is not to say that there should not be criticism. The job of Members is to challenge, give ideas and call each other out, but I am making the offer that we should engage as much as possible and maintain the solidarity, because the public looks partly to us to see how we are leading.

It is important that we remember that, by international standards, we are doing incredibly well. The Irish people have done and continue to do an extraordinary job. The healthcare system has been incredible. Have mistakes been made? Absolutely, of course mistakes have been made, and we all know that. However, what our healthcare professionals, the Department, the HSE, section 38 and 39 organisations, and communities throughout the country have done in stepping up and mobilising around this one threat and helping each other has been incredible. We all remember the scenes in Italy and elsewhere where very sick people were being treated in the car parks of hospitals because their health systems were overwhelmed. Even though our healthcare system was over capacity before Covid arrived here, it created the capacity and the surge was dealt with. It is an enormous credit, first and foremost, to the people and families of Ireland, who stepped up, and to our healthcare professionals, some of whom lost their lives. There was a funeral yesterday of a doctor who was a front-line worker on Covid who passed away. They literally gave up their lives to keep us safe. The solidarity from healthcare professionals, the public and across the political spectrum has been fantastic. Sometimes we miss that we are doing really well. It is hard and it will be bumpy, there will be more outbreaks and some will almost certainly be bigger than we would like, but we are doing well and need to bear that in mind.

On the Bill, many Senators have raised the issue of the timing. I will deal with them separately. The context of these and other measures outside the Bill which do not require legislation and which were in the budget for this year is that they were contingent on savings. They had been agreed in the budget for this year but without new money. They were contingent on the HSE saving money in other areas. Obviously, that has not happened because of Covid. Not only has it not happened, but on my second day as Minister, I had to ask the Dáil for an additional €2 billion, and told it I would be back for more.The savings had not happened. I need to ask for new money, which is obviously a difficult thing to do. That is what is required when it comes to the issue of people over 70 years, and it is my intention to do that. This is a decision of Government, as is any such decision requiring new money, and I will be pushing very hard for it.

The GP access is different because this is €50 million in a full year, and as Senators Martin and Buttimer have said, there is a philosophical question with all of this, which is what is the best way to spend €50 million? Senator Keogan referred to scoliosis and various Senators have referred to medical cards for terminally ill people together with many other very important things. The question for us all in health care is how we spend the money. There is not, unfortunately, any right answer to that question. We are in a particularly tricky spot where our healthcare system is over capacity. Before Covid-19 arrived, we had the longest waiting lists in Europe, the lowest number of hospital consultants, and the second lowest number of beds. I am not attributing that to any political reason but it has happened over many years with different Governments. What do we do? Do we deploy the money on the trolley crisis, on scoliosis, on mental health, on maternity care or on free GP access? There is no right answer to that question.

We are trying to do both at the same time, which is very difficult and costs a great deal of money. Senator Buttimer raised the strategic question on the approach to all of this. My approach is that we have three huge tasks to deal with at the same time. The first is Covid-19, and we understand broadly what is involved in that. The second is capacity and the resumption of services coupled with winter planning, and this is a massive task. We started with the longest waiting list in Europe. We have had a significant increase in those waiting lists because of the necessary pausing of elective care. On top of that there is a huge unmet care need within the community. Due to people not going into healthcare facilities as they normally would, there are many people who are sick and who should be on the waiting lists whom we do not know about and they do not know about it yet either. They need to be added to the waiting lists. On top of that, the HSE capacity is significantly reduced because of Covid-19. I had a briefing from HSE this morning that said that its operating theatre and outpatient capacity will both be down by about 30% and its diagnostics will be down by about 50%. We are taking a system that already did not have the capacity it needed and significantly reducing that capacity while adding significant demand to that, such as adding Covid-19, winter requirements and a significant domestic and global recession, all at the same time.

That is the second challenge, therefore, how we put a plan together to get the services back up and running immediately, deal with the waiting lists that are now even longer than they were, deal with the fact that winter is coming, and deal with the reduced capacity. As soon as I was appointed I sat down with the Department and the HSE and said that we need to put both a winter plan and resumption of service plan together but not like any we have seen before. This is not a question of looking at what happened last year and doing more or even twice as much of that. Everything must be on the table. The plan has been developed at the moment. It needs to be comprehensive and is going to cost a great deal of money. The challenge that we are faced with right now is immense. I sat in this Chamber in December and January decrying the trolley lists. This year, that simply cannot happen. We cannot have 85 and 95 year old men and women on trolleys for three days. We should not have anyway but certainly not in a Covid-19 world. This is the second task which is a huge challenge, as I am sure all of the Members understand.

The third task is universal healthcare, which is the long-term vision piece, and it has three tests.The third task is universal healthcare which is the long-term, vision piece and it has three tests. Universal healthcare means that people get rapid access to consistently high quality care that is affordable. We are trying to deal with the Covid-19 pandemic and are advancing universal healthcare through this Bill, which is the Sláintecare strategy at work. At the same time we are putting a significant effort, which will require much resources, into dealing with the very serious capacity constraints that men, women and children are facing all over the country. That is where we are at strategically.

I will mention maternity care which has been raised by a number of Senators. This is something that I am going to be pushing very hard. There is a brilliant maternity care strategy in place since 2016. The first place I visited as Minister for Health was the Coombe Hospital, which was intentional on my part. I wanted to visit somewhere which had maternity care and women’s healthcare and serves a great many people from disadvantaged areas as well and wanted to make a point of going there first as a demonstration of what is required. Maternity and women’s health is something that is going to be very important to me and which I will prioritise in this Government.

Scoliosis was also mentioned. I am going to meet Children’s Health Ireland in Crumlin next week and I have been back and forth with the Scoliosis Advocacy Network and will be meeting it at some point after that to see what can be done to help. There is no hierarchy of needs. Everyone is as deserving as everyone else but this is an issue that I and many others have been very affected by. I am going there next week to see what the Government can do to try to help. The good news is that we have a new surgeon starting in the third quarter of this year which should be fantastic.

Finally, on the Bill on GP capacity, the phasing of GP care for children is exactly to this end. If we already had what was needed in the existing capacity and if general practice was saying to us that we are ready to go, give this to the children as we have the capacity, the ask I would be making then - whether I would get it or not - would be for €50 million to allow us to do it now. The GPs are very clearly saying now that we need to be careful and that we do not have the capacity. They have stepped up incredibly during Covid-19, which we are still right in the middle of, and we are going to need our GPs like never before this winter. What we are looking for to a great extent in the winter plan is how we keep people out of hospital. Much of this is about giving GPs direct access to diagnostics that they do not have and to other care pathways and direct access for people with respiratory issues and so forth. I am meeting the Irish Medical Organisation, IMO, next week and we will be discussing these very issues. Our approach is that we need to grow capacity in general practice which we want to do very quickly, and as that capacity grows we expand access at the same time. That is the broad approach. I wish that the capacity was there and we could do it all now but the very clear message from general practice is that the capacity is not there now. Let us get the capacity in place. We are going to be negotiating a new GP contract and rewiring many care pathways so that GPs have far more options than they have now where, in many cases, they have to refer people to an emergency department.

I hope that covers at least some of the issues raised in the Bill and also the wider healthcare aspects. I thank the Members.