Róisín Shortall (Dublin North West, Social Democrats)
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661. To ask the Minister for Health further to Parliamentary Question No. 1366 of 20 May 2020 to the Minister for Housing, Planning and Local Government, if his Department and the National Public Health Emergency Team for Covid-19 plan to issue direction, guidance and advice to local authorities in relation to the need for streets and public areas in towns and villages to be thoroughly cleaned and sanitised by means of deep clean to help address the Covid-19 pandemic in view of the fact that local authorities and an association (details supplied) have requested guidance on the matter; and if he will make a statement on the matter. [9149/20]

Simon Harris (Wicklow, Fine Gael)
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I have no plans to issue guidance of the type described by the Deputy. The services referred to by the Deputy are not matters within the responsibility of the Minister for Health.

The responsibility for providing guidance in relation to a particular sector of the economy or on a specific activity remains with the Government Department with responsibility for that sector or activity. Local authority services are a matter for the Minister for Housing, Planning and Local Government.

Róisín Shortall (Dublin North West, Social Democrats)
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662. To ask the Minister for Health if there is a written process for issuing Covid-19 sector-specific guidance by agencies (details supplied). [9151/20]

Simon Harris (Wicklow, Fine Gael)
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In line with its Terms of Reference, the role of the National Public Health Emergency Team (NPHET) is to oversee and provide direction, guidance, support and expert public health advice across the health service and the wider public service, for the overall national response to Coronavirus, including national and regional and other outbreak control arrangements, consider the most up to date national and international risk assessments, direct the collection and analysis of required data and information and review on an on-going basis the situational analyses and evaluation using reports received, expert advice and  international guidance.

The advices of the NPHET are communicated by letter to the Minister for Health for consideration, and these advices are used to assist Government in informing its decisions in responding to the public health emergency.  Furthermore, the NPHET communicates to the HSE and HPSC by letter following its meetings. 

The NPHET’s processes are set out in its Governance Document which can be found at .

The Government’s Roadmap for Reopening Society & Business, published on 1 May 2020, sets out an indicative path to the easing of COVID 19 restrictions and other actions in order to facilitate reopening  Ireland’s society and economy in a phased manner. The Roadmap specifies that decisions in relation to which actions will be taken and which public health measures might be lifted will be made in accordance with the Framework for Future Decision-Making which is as follows:

1. Before each Government consideration of the easing of restrictions, the Department of Health will provide a report to the Government regarding the following on/off trigger criteria:

a. The latest data regarding the progression of the disease,

b. The capacity and resilience of the health service in terms of hospital and ICU occupancy,

c. The capacity of the programme of sampling, testing and contact tracing,

d. The ability to shield and care for at risk groups,

e. An assessment of the risk of secondary morbidity and mortality as a consequence of the restrictions.

2. It will also provide risk-based public health advice on what measures could be modified in the next period.

3. The Government would then consider what restrictions could be lifted, having regard to the advice of the Department of Health as well as other social and economic considerations, e.g. the potential for increased employment, relative benefits for citizens and businesses, improving national morale and wellbeing etc.

4. It is acknowledged that there is also an ongoing possibility that restrictions could be re-imposed and this process will be carried out on an ongoing basis once every 3 weeks.

As is clear from the framework, it is the Government rather than I or my Department that will decide on any modifications to the current public health measures in place and those decisions will be informed by the status of the on/off trigger criteria and the public health advice received at the time that a decision is being made. Guidance in relation to business activities in specific sectors of the economy will be provided by the Government Department with responsibility for that sector.

The development of guidance by the HSE and the Health Protection Surveillance Centre (HPSC) are operational matters for the HSE and I have referred this part of the question to the HSE for answer and direct reply.

Róisín Shortall (Dublin North West, Social Democrats)
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663. To ask the Minister for Health the epidemiological reasons that have allowed physiotherapists to reopen while the BreastCheck and CervicalCheck screening programmes remain paused; if the decision to continue pausing the BreastCheck and CervicalCheck cancer screening programmes due to Covid-19 was made purely based on epidemiological reasons; and if other reasons fed into this decision, the reasons therefor. [9152/20]

Simon Harris (Wicklow, Fine Gael)
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Since COVID-19 was categorised as a national public health emergency, and to align with the advice issued by the World Health Organisation and the National Public Health Emergency Team (NPHET), the National Screening Service (NSS) took the difficult decision to pause all four population screening programmes, which includes CervicalCheck and BreastCheck.   Of note, a similar pausing of population screening programmes has occurred in Northern Ireland, Scotland, England and Wales.  

At the time it was necessary to evaluate and prioritise the services delivered by the health system.  The HSE had to ensure that health services were in a state of preparedness for the estimated increase in total patient load during this pandemic.  All non-essential surgery, health procedures and other non-essential health services had to be temporarily paused.   This was in line with epidemiological factors of COVID-19 which including social distance measures, the rising number of cases detected, an increasing number of hospital admissions, admissions to ICU and deaths.  These recommendations had as their goal to minimise the spread of COVID-19, protect patients and staff. 

It is important to note, that population screening programmes involve inviting asymptomatic individuals for examinations. This could not continue during the public health emergency because of the need for social distancing and prevention of person-to person spread of this infectious disease.  This temporary pause is for community testing (GPs and clinics) and not for symptomatic patients or patients already referred to or in the process of being managed within the acute system.  

It is important to emphasise that people who are in-between screening appointments, or waiting for rescheduled appointments, should continue to be aware of and act on any symptoms associated with the conditions being screened for. Any individual who has symptoms should contact their GP immediately who can then refer them for further investigation.

Since the COVID-19 pandemic started, the NSS has monitored the feasibility of restarting their screening programmes and assessing the associated risks.  The NSS is participating in a national process, led jointly by the Chief Clinical Officer and the Chief Operations Officer in the HSE to restore services safely across all parts of the healthcare system. The HSE are finalising a framework for the resumption of non-covid healthcare services in the current environment, the recommencement of the screening programmes will be incorporated into this framework.

Róisín Shortall (Dublin North West, Social Democrats)
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664. To ask the Minister for Health the consideration he has given to moving medical appointments into health centres during Covid-19 in order that safe social distancing can be maintained in accident and emergency departments. [9153/20]

Simon Harris (Wicklow, Fine Gael)
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There was a 21.1% reduction in Emergency Department (ED) attendances nationally this year up to the end of April 2020 compared to the same period last year. 

The numbers attending emergency departments has shown a steady increase in recent weeks. There were 22,078 ED attendances in Week 21(20 - 26 May 2020), up 4.6% from the previous week. The lowest attendance was 12,908 in week 13 (w/e 25 March). The expected weekly level of attendance at this time of year would be in the region of 25,000 to 26,000. 

Presentation at emergency departments are not appointment based and therefore moving medical appointments to health centres would not impact on the numbers attending ED's. Any decision to transfer additional activity to health centres would have to be carefully considered to ensure that health centres were operating in line with public health guidelines in relation to social distancing.

On 5 May 2020, the National Public Health Emergency Team (NPHET) agreed that its recommendation of 27 March to pause all non-essential health services should be replaced with a recommendation that delivery of acute care be determined by appropriate clinical and operational decision-making.

I have asked the HSE to respond to the Deputy directly in relation to the arrangement in place to ensure that emergency departments operate in line with public health guidelines.