Róisín Shortall (Dublin North West, Social Democrats)
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561. To ask the Minister for Health the detail of the public health guidance provided to hospitals in relation to health and safety and infection control in both emergency departments and in outpatient clinics; the arrangements in place to ensure adherence to this guidance; and if he will make a statement on the matter. [13641/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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As this is an operational matter, the Question has been referred to the Health Service Executive (HSE) for attention and direct reply to the Deputy.

Róisín Shortall (Dublin North West, Social Democrats)
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562. To ask the Minister for Health the reason for the delay in publishing the roadmap for the recommencement of non-Covid-19 health services which was promised three weeks ago; and when it will be published. [13642/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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The Covid-19 pandemic has led to an unprecedented interruption to normal health services both in the community and acute hospitals. While many vital services were maintained or restructured to respond more appropriately to Covid-19 related risks and evolving needs, other services were suspended or delivered on a reduced basis.

To ensure services are re-introduced in a safe, clinically aligned and prioritised way, the HSE have published a Strategic Framework for ‘Service Continuity in a Covid Environment’. This document was published on June 8th and can be found at the following link .

The implementation of the Framework will ensure service resumption is done in an integrated and phased manner. It will consolidate new ways of working and build on international knowledge.

While not all services can return to previous levels immediately, many health services have already resumed, particularly for priority cases. The HSE are currently developing a Service Continuity Roadmap for the resumption of services across the health system.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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563. To ask the Minister for Health if he will provide each of the advices and directions from the expert advisory group to NPHET in relation to the original Roadmap for Reopening Society and Business, the accelerated roadmap, the one metre versus two metre social distancing advice, travel and quarantine restrictions and the wearing of face coverings; and if he will make a statement on the matter. [13647/20]

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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564. To ask the Minister for Health if each of the minutes from the expert advisory group to NPHET for May and June 2020 will be made available; and if he will make a statement on the matter. [13648/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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I propose to take Questions Nos. 563 and 564 together.

The Deputy may wish to note that the Expert Advisory Group minutes up to mid-May and all Expert Advisory Group advices to the NPHET for the same period have been made available on the Department of Health's website. 

Further minutes and advices will be published on an ongoing basis and work is underway to facilitate publication of the next batch of Expert Advisory Group documentation as soon as possible.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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565. To ask the Minister for Health the plans in place for a second wave of Covid-19 in the view of the fact that a number of major hospitals are now working at 100% capacity and that the health service should only be running at 80% to provide for surge capacity; and if he will make a statement on the matter. [13649/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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The initial focus for acute hospital preparedness for Covid-19 was on building up surge capacity to ensure the maximum possible number of critical care and general acute beds were available to cope with the predicted number of Covid-19 cases requiring hospitalisation.

The acute hospital system and critical care service coped, largely due to the success of public health measures in flattening the curve and the fall-off in non-Covid care. The additional demand for critical care was met by surge ICU capacity, with clinical staff redeployed from other hospital services and locations. However, this was in the context of low levels of care being provided in other areas of the hospital.

The need to increase critical care capacity is a key learning of the pandemic response. Accordingly, consideration is being given to permanent strategic critical care capacity requirements, and the Department and the HSE are currently engaging in this regard.

On 8 June 8the HSE published a Strategic Framework for ‘Service Continuity in a Covid Environment’. The document can be found at the following link .

In the framework document the HSE outline the key actions for delivery to protect surge capacity. The key actions include;

1. Complete a service review and assessment of additional capacity / alternatives for service provision e.g Private hospitals, field hospitals, Community Assessment Hubs.

2. Develop continuity plans, including risk stratification, for the reintroduction and reduction of services within hospital groups and CHOs, to prepare for a potential COVID surge. 

3. Develop and implement pathways and support services across community and acute settings in order to promote hospital avoidance.

The implementation of the Framework will ensure service resumption is done in an integrated and phased manner. It will consolidate new ways of working and build on international knowledge.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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566. To ask the Minister for Health his plans to increase capacity permanently across the health service in order to ensure that in the event of a second wave of Covid-19, there will be immediate availability for Covid-19 patients to be separately cared for to other patients; his plans for emergency departments and for Covid-19 specific hospitals in this regard; and if he will make a statement on the matter. [13650/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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Health services must strive to deliver a safe service in all circumstances. In order to mitigate the spread of Covid 19 in health settings public health guidelines in relation to social distancing must be followed.  

The Programme for Government, Our Shared Future, commits to the provision of more health services in the community, increases in capacity, including bed, ICU and critical care capacity. It recognises that even before the impact of COVID-19 on our health service, significant additional capacity was required across all aspects of care to provide access to quality services and to meet the needs of our growing population. It specifically commits to continue to invest in healthcare infrastructure and equipment, together with the recommendations of the Capacity Review, in line with Project Ireland 2040 and to ensure capacity for a COVID-19 rapid response, including bed and ICU capacity and for non-COVID emergencies into the longer term, by utilising some private hospital capacity, if necessary.  

The Capacity Review found that the net requirement, in a reform scenario, is for an additional 2,590 hospital beds by 2031 (inpatient, day case, critical care) with an immediate requirement for 1,290 beds to address overcrowding and to ensure hospitals operated at 85% occupancy in line with other OECD countries. Approximately 770 of these beds have been provided. The National Development Plan provides for the full 2,590 beds by the earlier date of 2027.

The initial focus for acute hospital preparedness for Covid-19 was on building up surge capacity to ensure the maximum possible number of critical care and general acute beds were available to cope with the predicted number of Covid-19 cases requiring hospitalisation.

The acute hospital system and critical care service coped, largely due to the success of public health measures in flattening the curve and the fall-off in non-Covid care. The additional demand for critical care was met by surge ICU capacity, with clinical staff redeployed from other hospital services and locations.

The need to increase critical care capacity is a key learning of the pandemic response. Accordingly, consideration is being given to permanent strategic critical care capacity requirements, and the Department and the HSE are currently engaging in this regard.  

There are no plans for Covid 19 specific hospitals at the present. Hospitals have put in place Covid and non Covid patient pathways, in emergency departments and other areas,  to mitigate the risk of infection for patients and staff.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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567. To ask the Minister for Health the current permanent ICU and critical care capacity in the health service; the additional amount that was available during the peak of the Covid-19 crisis; if this capacity fluctuated or reduced in recent weeks; if there are plans to further increase the permanent ICU and critical care capacity; if so, the way this would breakdown between the public health system and the private system; the arrangements i that will exist between the public and private systems in relation to this capacity; and if he will make a statement on the matter. [13651/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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In early 2020, baseline permanent adult critical care capacity in Ireland was reported by the National Office of Clinical Audit (NOCA) to be 255 beds. Funding for a further 40 adult critical care beds, and two paediatric critical care beds, was provided as part of the response to Covid-19 in March 2020. Daily situational reports provided by the HSE during recent months have reported potential critical care beds, including surge capacity, to be in the region of 500, with the number open on any given day subject to fluctuation in respect of available staff. Training was provided to over 1,500 nursing staff to allow them to provide support to critical care as required.

The acute hospital system and critical care service has coped effectively during recent months, and this reflects the success of public health measures in flattening the curve.  The additional demand for critical care was met by surge ICU capacity, with clinical staff redeployed from other hospital services and locations.

My Department and the HSE are currently engaging in regard to critical care capacity requirements in the public hospital system. 

Cormac Devlin (Dún Laoghaire, Fianna Fail)
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568. To ask the Minister for Health if NPHET will be requested to consider preparing new guidelines for residential centres that allow for the differentiated risk level between nursing homes and social care homes during the next phase of the Covid-19 pandemic; and if he will make a statement on the matter. [13675/20]

Stephen Donnelly (Wicklow, Fianna Fail)
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It is recognised that the impact of COVID-19 on society in general as well as on those living in long term residential care setting has been considerable. The introduction of physical distancing, isolation, reduced social activities and restricted contact with family and loved ones has changed the accustomed daily routine and usual dynamic of social interaction for residents of those settings. The focus on interrupting the transmission of the virus is part of a wider requirement to prioritise the wellbeing of residents of disability centres, remain person-centred, be cognisant of their rights as citizens, and to be vigilant that in seeking to prevent infection that these rights are not infringed upon to an extent, or in a manner, that is disproportionate.

People living in long-term residential care facilities are particularly vulnerable populations in the context of Covid-19 and have been identified by the World Health Organisation (WHO) to be at a higher risk of being susceptible to infection from this disease and for subsequent adverse outcomes.

The actions and measures we have taken in Ireland to support long term residential care facilities and their residents have evolved on foot of epidemiological data and guidance from the WHO and the European Centre for Disease Prevention and Control (ECDC). These measures have been both society wide as well as focused specifically on residential facilities.

NPHET advice focused on all LTRC settings and its recommended actions were relevant for all residential care services - older people, disability and mental health.

NPHET established the NPHET Vulnerable Peoples Subgroup, which has broad membership from across Government Departments, Agencies and key stakeholders. This Subgroup was established to provide oversight and assurance with regard to the specific preparedness, measures and actions that need to be taken to protect vulnerable groups and individuals in society. The specific needs of vulnerable groups, including those with a disability, are being considered at a national level with representation from all Government Departments with responsibility for disability issues as part of an integrated cross government response. The Subgroup held its first meeting on 6th March and across Government Departments such as Education and Justice, the HSE and Disability Federation Ireland the interests of people with disabilities on the group were represented.

The HSE continues to plan the re-establishment of vital non-COVID-19 supports and services. This includes very careful and detailed work on the part of the Disability Sector with national guidance and will result in directing how all funded agencies can deliver services on a medium to long-term basis. Plans have to comply with guidance as set out by the National Public Health Emergency Team as well as Public Health specialists in the HSE.