Rónán Mullen (Independent)
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Cuirim fáilte roimh an Aire Stáit. I want to raise the issue of vaccinations for residents of care homes owned and operated by religious congregations and for those elderly members of religious orders who are living in congregated settings generally.

I wish to preface my remarks by saying how much I and others appreciate the hard work that is being done by the HSE and by people generally on the front line in the healthcare sector. I feel self-conscious raising issues but part of our role as politicians is to ask hard questions when we feel they need to be asked. It is not done in any way to minimise the stresses, strains and difficulties of the tasks that people face. My engagement with the HSE has been satisfactory and yet there are hard questions that I and others will feel the need to put.

I raised the issue of vaccinations for elderly members of religious orders living in congregated settings on the Order of Business on 19 January and during the statements on vaccinations on 26 January. I have had some private correspondence with the Minister and the task force in the intervening weeks. I have great concern that, despite reassurances I have received, the HSE has been behind the curve on this and that there is a risk of lives being lost as a result. The net issue here is that the care homes owned and operated by religious congregations were voluntary and private homes and were not monitored by HIQA. For a good while, there has been a great fear among residents, their families and staff that these care homes would fall through the cracks, as residents of other HIQA-regulated care homes were vaccinated. People who have been in touch with me have always been at pains to say they are not trying to jump any queue but that they want to make sure they do not fall through the cracks.

I have received helpful replies from Mr. David Walsh and Dr. Colm Henry on 2 February. The intention was expressed that vaccinations would begin in such facilities on or around 12 February and I believe that is happening. It was back in June 2020 that the issue of support to non-HIQA regulated settings where members of religious orders might reside was raised by Deputy Ó Cuív in the Dáil. It was clear at the time that Covid response teams were supporting all residential settings with issues such as specialist advice, personal protective equipment, PPE, oxygen and extra staff, including settings not obliged to register with HIQA, such as some religious congregated settings. I know there is great gratitude for the support that was received from the HSE in matters such as PPE and other such supports.

Yet, having learned the lessons of April and May of last year when the HSE was engaged directly with these non-HIQA regulated care homes, it was concerning to read on 5 February, last Friday, in The Irish Times, that the HSE stated it did not know how many retired clergy were living in congregated sittings. The chief operations officer said they had no line of sight outside what was registered with HIQA. She said the HSE was trying to capture them through different channels but there were channels it did not know about and it was making a list of them at that time. I have to ask why, 11 months into the pandemic, nine months after the scale of the loss of life in nursing homes had become clear and eight months after the HSE was putting procedures in place for such settings to be liaised with directly, that line of sight was not there right from the get-go? We are all deeply conscious that every day more lives are lost. That is why the question must be put.

I stressed at the outset that it is not a question of those in religious orders wanting to jump the queue but there is an issue of psychological reassurance. Even last night I was talking to the prior of a small elderly community who told me it would be helpful if they just knew when it would be. The prior also asked me who they should liaise with. There is no clarity or no sense that there is a go-to person who can give an answer and point out where they are on the list and when they will get the vaccine. That kind of thing is crucial and it brings tremendous psychological reassurance. There is also the concern about the associated staff who are supporting these people, even if they are not elderly themselves. However, if they have continuous contact then the question of cross-infection arises and the wisdom of vaccinating them as well comes into play.

Mary Butler (Waterford, Fianna Fail)
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I welcome the Acting Chairperson, Senator Hoey, to the Cathaoirleach's chair and congratulate her.

I thank Senator Mullen for his question. The Senator raised many valid points. It is an issue I have been working closely on for the past couple of weeks and it is great to get the opportunity to speak to it and provide an update.

We are now almost 50 days into the roll-out of the largest vaccination programme in the history of the State. Ireland is progressing well with our programme and our vaccination figures compare favourably with other EU member states. Our strategy is to distribute vaccines as we receive them while ensuring availability of the second dose. It is important that we accept that in terms of the Pfizer BioNTech vaccine, we have given a commitment to administer the second dose between 22 and 28 days after the first dose. The intention is that the vaccination programme will only be limited by supply.

As of 8 February, a total of 243,000 vaccines have been administered. As of the same date, 91,500 vaccines were administered in long-term residential care facilities, of which 69,038 comprised the first dose of the vaccine and 22,510, the second dose. From Monday next, 15 February, an additional 42,500 vaccines will be delivered in long-term residential care facilities.

This week the vaccination programme is continuing with the prioritisation of staff within disability and mental health settings who are managing the care of those over 65 years. A total of 9,000 vaccines will be administered in residential care facilities this week, including to staff.

We are also focusing our efforts on residents over the age of 65 in non-registered long-term residential settings, such as religious orders and, as the Senator might be familiar with, the Sue Ryder homes or the Matthew Shea homes whose residents would have their own front doors but live in congregated settings. They are being prioritised for vaccination this week and in line with vaccine supply, each community healthcare organisation commenced these vaccinations. In order to answer the Senator's question, for local knowledge it is best to contact HSE within their community healthcare organisations, CHOs.

Anyone over 70 who may not have a GP needs to contact the HSE as a priority. There is a telephone number: 1850 24 1850. There is a small cohort of people who may not be registered with a GP for some reason and a GP close to them will be found.

In relation to the other questions the Senator raised, the Senator quite rightly stated that initially the 580 nursing homes, public, private and voluntary, which are know to and registered with HIQA, were the first to be put on the list. Then it became known quickly that there were many carer-led homes, which were mostly religious orders, and some community-led homes which were also carer-led not nurse-led, that were not known specifically to HIQA. I intend to change that because I have received the list of these homes this week.

Local knowledge was very important. I was contacted by so many Deputies and Senators throughout the country to ask when such-and-such a facility would get its vaccinations. It has started this week. Carers in these homes have also been vaccinated. A niece of mine was one of them and I know for a fact that the carers and the workers were vaccinated also.

When we have the roll-out of the vaccine complete to all of these orders, I intend to write to them. I met with the Department last week to discuss this because I believe we must have oversight going forward of all people who are living in residential settings. Whether care-led or nurse-led, or whether religious, it makes no difference. They are our people and they need to be cared for. Even from a safeguarding point of view, it is important that we know where our older people are living and who is caring for them.

Rónán Mullen (Independent)
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I agree that it is a complex situation. I think of my own parents at home. There are many people living as individuals or couples who are elderly, for most of whom vaccination will happen through their GPs.

In addition to the carer-led setting the Minister of State referred to, there are quite a few religious houses in the country where everybody is elderly. There might be one 65-year-old living with three or four others who are well into their 70s. The point could be made that where three or more are gathered and there is a carer in their midst, the vaccine should be there as quickly as possible. I presume it is something we will have to do as we get queries from people to intervene and to contact the HSE on their behalf.We hope it is understood that the intention is not to jump any queue, but there appears to have been a lack of joined-up thinking. That is the regret in this situation. This is a difficult time and such things happen in systems, but there is a concern that the HSE was on hand last summer and gave great support yet, in hindsight, information was not collated for the vaccines quickly enough in the way that it should have been. Is that not why we are playing catch-up?

Mary Butler (Waterford, Fianna Fail)
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It is not so much about playing catch-up. I looked into this situation to see why some religious orders were registered with HIQA and others were not. They took that decision themselves. My understanding is that this situation dates to 1992 when nursing homes were first regulated. I am open to correction on that but there was an opportunity then. Some religious orders that operate nursing homes are registered with HIQA and others chose not to be.

Regarding the supply of PPE supports, 23 Covid teams are on the ground to support anyone in nursing homes. The HSE has been to the fore. Regardless of whether a home is public, private or voluntary, the supports are there for whoever needs them.

The roll-out of the vaccination programme to religious orders and those living in communal settings has started this week and we hope to have it finished by the end of February. I must temper that statement by saying it is dependent on supply, but that is our aim. Twenty-eight days later, people will receive their second doses. They are not being forgotten about. Now that we have the list of all of these settings, we have complete oversight of them.

Annie Hoey (Labour)
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I thank the Minister of State for her reply and engagement on this issue, which I thank Senator Mullen for raising.