Seanad debates

Thursday, 22 October 2020

Health (Preservation and Protection and other Emergency Measures in the Public Interest) Act 2020 and Emergency Measures in the Public Interest (Covid-19) Act 2020: Motions

 

10:30 am

Photo of Mary ButlerMary Butler (Waterford, Fianna Fail) | Oireachtas source

I thank all Senators for their contributions, all of which were constructive and well thought out. As they all will know, we face a very difficult period. All indicators of the incidence and severity of the disease have continued to worsen in recent weeks, while in the past four weeks alone, there have been almost 9,000 cases. The national 14-day incidence rate is now 229 per 100,000. Ensuring a balanced and proportionate response to Covid-19 is a complex task. Since the beginning of the crisis, the dilemma facing us concerns how to implement public health measures in response to the pandemic in a way that is fair, reasonable and proportionate. This is neither easy nor straightforward, but I assure the House we will continue to use these powers responsibly.

The nursing home matter that was raised by several Senators is an issue on which I have been receiving updates all day. There are 585 nursing homes in Ireland, of which 45 are experiencing outbreaks. It is, therefore, a serious issue. As for the specific nursing home that was mentioned, I do not want to go into too much detail. The director of nursing on that Covid response team, of which there are 23 in the country, has been on site this afternoon. She is assessing the stability, safety and staffing there. The HSE has advised that it will provide supplementary staff, including a night nurse, for the next three nights. I do not for a moment deny that it has been a very difficult week for the nursing home. The HSE was informed on Sunday and testing of all the patients and staff was carried out on Monday. As was noted, the figures arising from those tests are very frightening for the community in question, given that the nursing home is their home from home. The real issue, however, is that the nursing home is finding it impossible to get agency staff to cover for the staff who are out sick due to Covid or because they are self-isolating with symptoms. That is where the matter is really difficult.

I have been very concerned about nursing homes throughout the pandemic, and I have spoken about this issue weekly in the Houses. A total of 54% of deaths in the first surge happened in the nursing home sector, where 985 people lost their lives. Much work has been done since. I spoke to Tadhg Daly, the chief executive of Nursing Homes Ireland, NHI, less than two hours ago. NHI has responsibility for 480 nursing homes. All nursing homes currently have sufficient personal protective equipment. Fortnightly testing has been ongoing for three months and has been very helpful because it allows a nursing home to know if an asymptomatic staff member is positive, and he or she can then be asked to self-isolate for 14 days. Accommodation is still being provided by the HSE for staff members who feel they cannot go home if they are worried about passing on the virus to children or elderly parents. The temporary assistance payment scheme has proven very important for nursing homes, whether private, public or residential, so they can ensure they have the correct infection prevention control, sufficient staff and tip-top cleanliness.

There is an issue with staff; I will not pretend otherwise. Nursing homes are finding that difficult at the moment. All nursing home employees are entitled to leave their job and move to another. I was talking to management at a nursing home this week where three members of staff, who had been working there for quite a while, have decided to move. They have now been employed in testing and tracing. Many people have been employed in that regard, at an average of 70 people per week at the moment. Unfortunately, everyone is entitled to apply for another job and to move on, which is proving difficult. I was speaking to officials from the Department and the HSE all afternoon before I came to the Chamber. The supports are in place but it is very difficult.

There are 45 outbreaks currently in nursing homes in various parts of the country. We were reduced to having just window visits on level 3. When the virus is rampant in the community, even with the best of intentions it will enter nursing homes. Our older people, unfortunately, are the most vulnerable. As Minister of State with responsibility for older people, I am very conscious of this and we are doing everything we can. On Thursday night last, for example, the Minister, Deputy Stephen Donnelly, and I held a meeting with Mr. Paul Reid and Ms Anne O'Connor from the HSE and other representatives of HIQA, the Department and the HSE. We were all there until 8 p.m.

My main worry relates to the staff at nursing homes. When seven of eight nurses have been infected with Covid, it is very difficult to replace them overnight when agency staff are not available. I compliment all the people who have worked in the residential sector. We always speak about front-line workers, who are fantastic, but people working in nursing homes have worked so hard. Nursing homes are a home from home for the community of 25,000 people who live in them. We are doing everything we can to protect them and will continue to do so.

The issue of testing and tracing was raised. As Senators will be aware, the HSE has worked intensively over recent months to put in place comprehensive testing and tracing capacity, which is currently at 20,000 tests per day. While I acknowledge there were issues earlier in the week, more than 400 people are now working at contact tracing centres and the HSE is bringing on board a further 60 to 70 every week.By the end of next month, there should be up to 800 people doing that work.

I assure the House that work is continuing on developing and enhancing our broader public health response further, for example, our capacity, our testing strategy, including the potential use of alternative diagnostic approaches, and our testing and contact tracing service. Significant progress has been made and we now have a solid platform, but we need to build on it. One can never do enough and always has to do more.

While by no means a panacea for managing the disease into the future, a robust and timely public health response to cases and clusters will continue to form one of the most important elements of our overall response. Unfortunately, however, it is unlikely to be enough on its own. I was struck by Senator McDowell's three Ws - wash, wear and watch your distance. That is a fantastic mantra. Members should take that message with us today and get it out into the public domain. The three Ws are the basics to which we must return.

While we all accept that the imposed measures are, by their nature, blunt instruments, they are nonetheless essential to enable the level of virus suppression that is now required. The extension of these regulations is time-bound and aligns with the timeframe of the Government's current strategy, which we believe to be reasonable and proportionate. These temporary measures may be ended early by ministerial order should the public health situation improve to such a point that they are no longer required. They will be subject to ongoing review and will be repealed if the circumstances allow.

This motion will allow mental health services to plan appropriately for the medium term. Senator Keogan asked why we were doing this, but it has already been done for the past seven months and the Mental Health Commission has not flagged anything about it as not working. A measure was put in place whereby, if necessary, only one person would attend the tribunal, but such a situation has not arisen. On all occasions, the three people were able to attend the tribunal.

The amendments to the Mental Health Act have helped to reduce cross-infection within inpatient psychiatric facilities. If the measures are not extended, we will be putting at risk the health and well-being of patients and healthcare workers. Anyone who is involuntarily detained is entitled to have a tribunal hearing within 21 days. The most important element is that tribunals proceed, but in order for that to happen, we had to move them online and insert the caveat that, if two people were not available to attend, one person would be sufficient. However, that situation has not arisen and there have been three people present at every tribunal. It is important to note that.

I thank Senators for their time, but I will make another point before I conclude. Between 85% and 90% of all mental health services were retained during the lockdown. Obviously, I have only been in this job for three or four months - I believe it is approximately 15 weeks. These supports were kept going even when other supports, for example, for children with disabilities, could not be retained. Admittedly, some mental health supports had to change to a blended approach. They were not always provided face to face and many supports moved online, but the most important aspect is that they were retained.

Facing into the winter, there will be six weeks of major challenges, including to people's mental health, finances and businesses, but I honestly believe that we have no other choice. There seems to be an acceptance among people, especially older people, who are so resilient, that we need to get through the next six weeks. Senator Bacik was vocal on the issue of social bubbles. They are a fantastic idea. We are not asking older people to cocoon. Rather, we are asking older people who are living alone, single parents caring for a couple of small kids and someone who is caring for a person with dementia to pair with another family or household so that they have support during the six weeks. We have to learn, and we have certainly learned where cocooning is concerned. It was very difficult on people and their mental health. They were fantastic and resilient and they did it, but the bubble approach can work and should make a difference.

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