Stephen Donnelly (Wicklow, Fianna Fail)
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I welcome this opportunity to update the House on Ireland's ongoing response to Covid-19. I start by expressing my deepest sympathies to the family and friends of all those who have lost their lives to Covid-19 in Ireland. It is a loss made harder for many by the limits Covid-19 has put on our lives, with families looking through windows of nursing homes to try to communicate with their loved ones and lifelong friends unable to walk to the graveside to bid farewell.

It has been such a difficult year for so many people in so many ways: for those who have lost their jobs or businesses they spent their entire lives building up, for those most vulnerable to the virus who had to shut themselves off from their families, friends and communities for very long periods, and for those who have lived in fear since this virus arrived on our shores.

Chapter 1 of Covid was flattening the curve. That meant accepting severe restrictions on our civil liberties and economic freedoms to stop transmission of the virus. Thanks to the sacrifices and solidarity of everyone in the country, it worked. As Minister for Health, I acknowledge the extraordinary work of the women and men across our health service and all they have done to date in response to the virus.

We do not want to go there again. Chapter 2 of Ireland dealing with Covid, which we are starting now, is about suppressing the virus to keep our society and our economy open, to protect our civil liberties and our economic freedoms, and to protect the ability of people to go about living their lives.

We have learned much about this virus since it came here in March. We can find the virus much more quickly, thanks to our testing and tracing capability, including the Covid Tracker app. We can send in local public health teams more quickly and help people isolate more quickly and better. We know more about the kinds of interactions that are spreading the virus. These are the types of interactions that the National Public Health Emergency Team, NPHET, targets when it recommends new measures. What happened in counties Kildare, Laois and Offaly demonstrated that local measures, applied quickly, targeting the ways in which we know the virus spreads and supported by local communities, can work, and thanks to the people in those counties can work very fast.

A new roadmap for chapter 2 will be published on Tuesday. It will apply what we have learned about the virus to help us find the virus quickly, suppress it quickly, and address our priorities of people's health, people's lives, keeping schools and colleges open, resuming our healthcare systems as much as possible, and protecting jobs.

This month marked a major achievement in Ireland as the schools returned. At the same time, we are seeing a high level of compliance with the public health measures. For example, new research shows a 90% compliance with face coverings. Younger people, whom I believe have been very unfairly criticised by some and whom I think are doing an incredible job, show the highest level of compliance at 97%. I applaud their ongoing efforts. If we are to continue with this type of success, people need to be confident in the public health measures; they need to be confident in the recommendations coming from the public health experts; they need to be confident in the measures in the roadmap; and they need to be confident in the measures in place now and which are working now.

I thank the many Deputies for their support of our public health experts and their recommendations. Some weeks ago, I spoke to officials in the World Health Organization, WHO. We were talking about Ireland's response, what we could do better, what we should do more of and what we might change. They said one area in which Ireland stood out was political solidarity. They observed that in some countries Covid was being used as a political football and political systems were tearing themselves apart. They said that Ireland was not unique, but was rare given its level of political solidarity. A message had gone out from our Parliament saying that we back a public-health-led and evidence-based approach. While there will always be differences, politicians were clearly seen to be working together. The WHO view was that this matters a great deal to public confidence.

I fully accept that leadership from Government matters. We must always strive to do what we can. We must always be open to fair criticisms. Leadership from the Oireachtas matters. While I applaud the work of many Deputies, we are not doing as well as we were. The WHO might score us a little less. Earlier in a debate on public health measures, some Deputies decried measures they know are saving lives. I heard some Deputies stand up and say they could not possibly understand why one measure is in place but another is not, while knowing very well why those measures are in place because they had been provided with the public health advice. I ask colleagues to reflect. We are not looking for free passes; there should be no free passes. The more solidarity we can show, the more confidence there will be in the public health measures, the more lives will be saved, the more jobs will be saved and the more people can live their lives, which I know is what we all want.

I wish to move on to the current Covid situation. Around the world the WHO has reported 27 million cases and almost 900,000 deaths. Yesterday Ireland passed 30,000 cases and, tragically, we have now recorded 1,778 deaths from Covid-19.

In the past two weeks, for every 100,000 people living in Ireland, we have had 35 new cases. In early July, it was just three cases per 100,000 population, representing more than a tenfold increase. While we are not at the levels that we saw back in April and May of this year, we are on an upward trajectory and it is a cause for concern. It is important to point out that the national measures introduced recently are working. The first slowed the upward trajectory and then began to stabilise it.

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I acknowledge that they are having a big stabilising effect and that the efforts and sacrifices being made across the country are having their intended effect. This rise is being seen across the EU. Most other member states have experienced an increase in the number of cases in recent weeks. Across the EU, the incidence rate is 55 cases per 100,000 people and 16 member states have a higher incidence rate now than they did two weeks ago, so the rate is rising. In the past fortnight, we in Ireland have been notified of 1,900 new cases and, tragically, one death, which was reported yesterday. The number of cases newly notified to us has been increasing over the past several weeks. The five-day average, which we look at very closely, is now 175 cases per day.

In the past two weeks, more than 50% of new cases identified have been close contacts of a confirmed case. Just under 40% of cases in the last two weeks have been linked with clusters. There were 145 additional new clusters notified in the past week to Saturday, 5 September. There has been an increase in the number of clusters identified around the country with smaller numbers of cases associated, such as those in private households. Some 70% of cases identified in the past two weeks have been in the cohort under 45 years of age. At the moment, there are 50 people with confirmed cases of Covid-19 in hospital, six of whom are in critical care. Our thoughts are very much with them and their families. The current levels are now much lower than the levels we saw earlier this year, for which we should be thankful. It is our hope to keep those numbers low and this is what the measures which have been introduced seek to do.

The National Public Health Emergency Team will meet on Thursday when it will review the current restrictions based on the most up-to-date epidemiological position and will advise Government accordingly.

In the past week, nearly 72,000 tests have been completed. Serial testing continues in nursing homes, direct provision centres and meat processing plants. Significant additional staff have been added in the past four weeks and the HSE is currently transitioning from seconded staff to a full-time staffing model.

The vast majority of Irish people are united in our fight against this virus. I know the House will join me in thanking every person and every sector for their hard work. There is no question but that it can be tiring to continue to live with the impacts of Covid-19. We have been dealing with it for quite some time and will be dealing it with for quite some time to come. Unfortunately, the virus does not get tired. We need to hold firm. The core advice from our public health doctors remains the same: wash your hands, follow coughing and sneezing etiquette, obey social distancing guidelines and reduce discretionary social interactions. Any and all public health measures introduced are intended to save lives and to prevent more people from getting seriously ill. By continuing to suppress community transmission, we will be able to continue reopening vital parts of our economy and society. The Government's new roadmap will inform our decisions and will be a key source of information for every person in Ireland as we continue to navigate life during this pandemic.

David Cullinane (Waterford, Sinn Fein)
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I welcome the Minister back. He has been here a few times over recent days. I welcome the opportunity to have this debate. The Covid-19 pandemic has exposed a decades-long failure to build a public health system with enough doctors, nurses and beds. It has resulted in an unprecedented interruption to normal healthcare services, affecting community and acute settings. Our health service is now under pressure on several fronts. It is dealing with overworked staff, Covid care, non-Covid care, catching up on delayed care, a vast reduction in capacity and the looming winter flu. Dealing with these crises will require substantial public investment in protecting capacity. We are facing a perfect storm such as we have never faced before and it is very worrying.

At the start of August, I launched Sinn Féin's plan for protecting capacity in the health service. This is a €1.9 billion package which would ensure the redeployment of the maximum number of beds through repurposing existing space and modular units as well as providing for a much-needed expansion in the numbers of doctors, nurses and allied health professionals. Many front-line workers are in a pool under Be On Call For Ireland and have still not been offered any work or a contract. All of this is desperately needed because our healthcare workers are at breaking point. They are burned out. Many are still dealing with the after-effects of having had Covid-19. They have not had a break, coming straight off the disaster of last winter and into a pandemic. They are now facing what may possibly be the worst winter for acute hospitals in the history of the State. A job guarantee is needed for all of those who joined the health service to tackle the pandemic. An expansion in staffing levels is also needed.

So far, there has been no plan from Government for protecting capacity and staff, although the Minister has said he will publish a winter plan. The health system must work for patients and families. We cannot continue to put them and healthcare workers in harm's way through inadequate facilities and understaffing. The health service does not just need a plan for winter, but a plan for change. The status quocannot be maintained and there cannot be more of the same. A new vision and a fresh start for healthcare are needed.

This Government has already broken many promises in respect of what was passed in last year's budget. We in this House collectively passed a Bill a number of weeks ago to expand medical card access for those over 70 and for children under 8 but there has still been no announcement from Government as to when any of that will happen.

I will raise an issue with the Minister and give him a minute of my time to respond. It is an issue which has been brought to my attention regarding those women who are pregnant and who have to go to hospitals for appointments. It is a very serious issue. Women understand that they have to play their part and that, when they go to hospital, they and everybody else have to be protected. In the early days of the pandemic, it made some sense to limit the number of people going into hospitals. A woman who is pregnant can now go to a bar, restaurant or other public place with her partner but is not able to bring that partner in for a very important hospital appointment relating to her pregnancy. That should be looked at.

I am writing to the heads of all of the maternity hospitals to ask that this be reviewed but the Minister has an opportunity to lead on this issue. I ask him to look at this issue, within the public health guidelines and to see what can be done to ensure that a pregnant woman may bring her partner to appointments. We have heard some distressing stories about women who have had complications in their pregnancies who could not have their partners with them when they got bad news. That is something which could be looked at. That is the type of easing of restrictions that builds public confidence because people can see it makes sense.

I also had the pleasure of meeting residents and workers at the St. Mary's and Caritas centres in Merrion earlier today. I am sure the Minister is aware of this issue. Some of the people I met, including trade union representatives, said that he has not responded to their emails or calls. He should engage with them. While this organisation is run by the Sisters of Charity, it is important that the workers are protected. They need their jobs maintained. There are issues with regard to redundancies. A number of centres are now under threat and as a result we could lose geriatric care beds, care beds and nursing home beds. There is a need for the HSE to step in.

Catherine Connolly (Galway West, Independent)
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I beg the Deputy's pardon. I thought he was sharing time with five minutes each.

David Cullinane (Waterford, Sinn Fein)
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I am sorry; I have seven minutes.

I again raise with the Minister the testing and tracing regime. I genuinely believe that we have to do better. I looked at the figures for Scotland and it is doing far more than us. I have consistently called for a Rolls-Royce testing and tracing regime which we would use to hunt down the virus. It would not be reactive, but proactive. We would test as many people as we could in a very targeted way. That is the most effective way to avoid more lockdowns and to put us in a strong position to ease restrictions, where possible, to enable more social interaction, which is important. I said I would give the Minister a minute to respond on the issue of maternity services, those women who are pregnant and their partners. My colleague will then have three minutes. I would be very grateful if he would address that issue.

Stephen Donnelly (Wicklow, Fianna Fail)
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I do not believe I can reply as we are on statements but I am happy to talk to the Deputy about the issue afterwards. It has already been raised with me and I am very happy to engage with him on it.

David Cullinane (Waterford, Sinn Fein)
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I will give my remaining time to my colleague.

Imelda Munster (Louth, Sinn Fein)
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We are facing into a very difficult winter. In fairness, we are used to difficult winters in this State and to what comes with them - delays, trolleys and overstretched services - but this year is expected to be much worse due to Covid-19.

Successive Fianna Fáil and Fine Gael Governments have developed and maintained a two-tier health system which has led to a poorly functioning public health service and a highly profitable, expensive private system. The health service in this State is dysfunctional at the best of times. Healthcare and hospital staff work hard and provide excellent healthcare but the State infrastructure is wholly inadequate to provide the health service we need in this State. In Our Lady of Lourdes Hospital, Drogheda, there were 13,750 people on outpatient waiting lists at the end of June. Almost 3,000 of those have been waiting for longer than a year. More than 1,800 of them are waiting on paediatric or paediatric ear, nose and throat, ENT, appointments. These numbers are shocking. We need a plan to ensure people are not left languishing on waiting lists for years, sick, worried and suffering. This has long been the case but given the backlogs caused by Covid, the Government needs to take this seriously and address the shortcomings in our health service.

Covid should have taught the Government the importance of investing in public healthcare. If we had been functioning in a normal way before Covid, the damage would have been much less. Services would have been more robust and better able to cope with the enormous challenges brought by Covid-19.

The ambulance service is another casualty of short staffing and under-resourcing. On Sunday night, a nursing home in Drogheda called for an ambulance for a seriously ill 95 year-old woman. It took the ambulance three and a half hours to arrive. That is an extraordinary length of time for a seriously ill elderly woman to wait for urgent healthcare. I have since learned that there are currently two paramedics in Drogheda ambulance station on managerial leave. This means they spend their 12-hour shifts sitting in an office in the station and not working. They have been in this position since last July and they want to work. This week, I am told 14 shifts will need to be covered due to staff being on Covid-19 leave, managerial leave or leave for another reason. This echoes the national picture of understaffing in our ambulance service, and that is before we head into the depths of winter. If we do not have a robust contingency plan, we are facing into disaster this winter, with staff having to take time off for Covid-related reasons. Having other fully qualified staff on managerial leave for extended periods, where they are at work but not allowed to do any work, is compounding the problem. It is only a matter of time before patient care is compromised by delays due to understaffing.

These are the same problems we have had for decades in our health system. It does not seem to matter how well we do economically, healthcare in this State is always in crisis. As such, it is high time that the Minister and Government put aside their ideological obsession with helping and funding private healthcare and focus instead on public healthcare services. They are the services that have been fighting Covid and do most of the heavy lifting on the front line-----

Catherine Connolly (Galway West, Independent)
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I thank the Deputy.

Imelda Munster (Louth, Sinn Fein)
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-----where healthcare provision in this country is concerned. They need the State to support them and they need intervention from the Minister.

Catherine Connolly (Galway West, Independent)
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Deputy Kelly is next but I remind the House that the Minister will have ten minutes at the end to respond to many of the issues raised.

Alan Kelly (Tipperary, Labour)
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My time is very short so I want to get straight to it. I would like the Minister, in his response, to propose some solutions, particularly regarding Covid versus non-Covid care. I am sick and tired of commentary, which I do not want any more. I want to know what the Minister's plan is, what his solutions are and where we are going. I would like him to tell us as much as he can. While I know the demarcations are tight, I do not want any more commentary.

Communications by the Minister and his team also need to improve because the Irish people need this. We do not need any more kite-flying about issues relating to entering people's homes, on-the-spot fines or all of the other mess we had last week about pubs and restaurants. From a communications standpoint, just throwing things out there is not good. It is bad and desperate and it has to stop. The Minister's predecessor, the current Minister with responsibility for higher education, Deputy Harris, is going around like an emeritus Minister for Health. He is not giving the Minister much space. I am sad to say this but in a way I am glad the previous Minister is doing that because at least there is some projection of confidence and consistency.

Earlier, the Minister said we all have to work together and I am 100% with him on that. As such, my criticisms are honest and come from the people who are talking to me. We also need to propose solutions to the Minister, however. The Labour Party produced the Sick Leave and Parental Leave (Covid-19) Bill 2020. These proposals would be the right thing to do at any time but they are absolutely necessary in a pandemic. We have outbreaks of Covid in meat plants in my home county, as the Minister knows. There will probably be more outbreaks in similar settings and other settings elsewhere in the country. Workers cannot be left in the position that if they do not go to work, they will not get paid and then decide, because they are human beings, to take paracetamol and go into work. The Minister has the capacity to deal with this issue, on which I have proposed a Bill that I have given to the Government. We also need to ensure that people who go home to look after their children do not lose their wages as well. All of those working in childcare also need to be looked after.

When the Minister was in opposition he often spoke about the health Vote. It is not organised along programme lines, meaning that for service areas, we cannot see where funding goes. The Minister had an issue with this, as did I. One cannot see where money is being spent. The Minister should sort this out because I want to see where the money is being spent. The Minister was absolutely aghast at this when he was in opposition so I ask him to please sort it out.

I have a quick-fire series of questions. The Minister may respond to them at the end as I have very little time left. We need the winter plan to be published and it must be comprehensive. I would like the Minister to focus on separating Covid from non-Covid treatment and, in particular, how we will move diagnostics into the community. I want to see how additional intensive care beds will be created and how the Minister will ensure we get the staffing we need considering the issues we will have with bringing in foreign staff. I want to see how we will ensure more supports are available for GPs and how we will start self-referrals for testing, which is absolutely necessary now. I want to see how we will ensure regular screening of healthcare workers takes place at all times given the figures showing the number of health staff becoming infected. I want to see how we will ensure we have more consultants. If there is one issue on which the Minister is out on a limb, it is the delivery of more consultants into the system. How will he do that?

I do not have enough time to go into the confusion about testing in airports. We need to deliver some solutions in this area. On the issue of testing in general, how will we bring in the population testing in use in the rest of the world? How will that fit in to what we are doing?

I ask the Minister to speak a little about where we are going on the capital side. There have been some very good initiatives, hospital prevention measures, etc. One announced in Thurles in my constituency involves scanning the elderly to prevent them ending up in acute care. What is the plan for capital and has there been any impact arising from the utter shambles of the National Children's Hospital?

Those are the types of issues on which I would like some clarity, although I have a whole range of others I would like to raise. Maybe the Minister will be able to respond later.

Róisín Shortall (Dublin North West, Social Democrats)
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It is unfortunate that the time allowed for these statements is so short. It is very unsatisfactory, as is much of the engagement. The Minister spoke of political solidarity but there has been very little opportunity for that in recent times. I will return to that in a moment. I ask the Minister if, when summing up, he will clarify exactly what the strategy is for responding to the Covid threat because I do not understand what it is.

We were told at the beginning that the strategy was about hunting down the virus. We know the international advice was to test, test and test. Our official strategy at that stage was test, trace and isolate. We heard that mantra repeated over again. We never got to implement that strategy fully. It seems the system was always playing catch-up with the virus. When, finally, the virus really reached its peak and figures started to drop substantially we did not use that opportunity to put in place a proper testing and tracing system. It is important to remind ourselves that the peak of the virus was back in April. There were steady reductions over the early summer and all of the indications were that the virus would be with us for some time and there was very high likelihood of a second wave. For this reason it was important that we got our testing and tracing system up and running fully. We have never done that. In spite of all of the promises of getting to a point where there would be a capacity of 100,000 per week we have never reached it. The highest was approximately 70% last week and that was an outlier.

What exactly is the strategy? We look at what other countries are doing and, for example, the New Zealand approach, where the strategy was elimination, has been rejected here. We look at what is happening in Sweden, which is to keep the country, society and the economy running and introducing measures to limit the spread of the virus other than closing down the entire economy. That is proving to be pretty successful when one takes everything into consideration.

We started off with the supposed strategy of test, trace and isolation. We never implemented it fully. Nor did we ever at any point review and reconsider what the strategy was. This is not about blaming anybody and there had to be an emergency response to the crisis situation back in early March and April. We saw this huge wave coming towards us and a need to respond very quickly. People did not understand the virus and there had to be an emergency response. It was not until everything was closed down that we succeeded in flattening the curve. That is not a medium-term strategy. It worked because everything was shut down. An enormous price was paid by everybody but it is continuing to be paid. I am concerned there has not been a review, or that the Government has not been upfront and clear about what exactly the aim now is. It seems that any time there is an upsurge the official response is a shutdown or lockdown. That is not a sustainable strategy. It cannot continue like this with two steps forward and one step back. What is the thinking at present on this?

Several months ago, I remember raising with the then Taoiseach, Deputy Varadkar, the need to establish a wide-ranging expert task force to look at the broader societal and economic issues beyond public health. The public health advice clearly has to be dominant in any strategy but it should not be the only element. Unfortunately, the proposal was rejected by the Government at that stage. I struggle to understand what the Government's strategy or plan is. I hope that next week we will have something a bit more sustainable and logical and based on balancing risk because there is huge risk in many ways. Irish society and Irish people, and young people in particular, have paid a huge price.

I ask the Minister to produce a realistic strategy based on evidence and to explain it to us next week. He will have my support and the support of the Social Democrats if it is based on evidence and experience but to date we have been losing patience I have to say. Unfortunately, the Government has been very weak on engagement with the Opposition.

Seán Haughey (Dublin Bay North, Fianna Fail)
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I want to put on the record of the Dáil my appreciation for the work undertaken by the Chief Medical Officer, Dr. Tony Holohan, and the acting Chief Medical Officer, Dr. Ronan Glynn, in respect of the Covid-19 pandemic. We are indebted to them for their calm and wise advice and their expertise at this very difficult time for everyone.

With regard to the pubs, in the past I strongly supported the enactment of the Public Health (Alcohol) Bill 2015. I am very much aware of the harmful effects of alcohol on our health system and on society in general. That said, it is clear that publicans have had a very difficult time since March and I fully appreciate the struggle they are engaged in to keep their businesses viable. We saw during the course of debates earlier today that publicans are well represented in the House by the Rural Independent Group Deputies and others and they do not need me to champion their case. However, it is obvious to me that it is far better at this time for people to be drinking in wet pubs where strict guidelines are in place then drinking in alternative locations such as house parties. I welcome the fact the wet pubs will be treated like any other business and that they are scheduled to open on 21 September.

The pub is the principal social outlet in many rural areas and social isolation is a key issue. However, I need to qualify this. I am very concerned about the number of Covid-19 cases in the Dublin area. We are told things are on a knife edge. If it emerges that the opening of the wet pubs is responsible for a rise in outbreaks of Covid-19 cases, we should not think twice about closing them again on a county-by-county basis in the interests of public health. The decision to open on 21 September must be kept under constant review.

Covid-19 has had a serious impact on the mental health and well-being of almost every sector in society, including children, teenagers, young adults, those with disabilities and their parents, workers, those who have lost their jobs and older people. People are facing huge uncertainties about their future at this time. In my role as a public representative I have never before seen such high levels of anxiety and stress in our communities. We really need to make mental health a priority. In this regard, Mental Health Reform, which represents 70 organisations, has launched its prebudget submission. Because of Covid-19, this is the year to make a real commitment to developing our mental health services. The sector was in crisis before the onset of Covid-19 but adequate investment in mental health services must be an absolute priority from here on in.

I welcome the news that the Government's medium-term plan for living with Covid-19 will be published next week. I ask the Minister to give serious consideration to allowing a greater number of spectators at outdoor events. I certainly think it is possible, given where we are now in this regard.

I also welcome the fact that clarification has been provided by the Minister that drug and alcohol support group meetings can continue to operate, subject to adherence to public health guidance relating to physical distancing and other protective measures. AA meetings are a very important part of our health service and I am delighted they can proceed.

We have heard a lot about opening our economy and society but now we need to rebuild our economy and society and a lot of work has to be done in this regard.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister, all our front-line services and particularly NPHET. The situation is very challenging at the moment with the increasing case figures.

I congratulate all our leaving certificate students who received their results this week and in many cases will go to college. My concern, however, is our student nurses and the supports in place for them and our midwives unable to work part-time while on placement. Student nurses on placement have been told they cannot work in other healthcare settings due to Covid-19. What supports are being put in place for these students who will be on the front line this winter and who will be working harder than ever? We will need our nurses more than ever, so what will we do to support them financially? What supports will be put in place for our students? The Union of Students in Ireland has contacted me as well as other Deputies, I am sure, as has the INMO, about what supports we can put in place. I would like the Minister to come back to me with an answer on that.

NPHET was before the Covid committee a few weeks ago and those of us on the committee spoke to its representatives. We asked various questions. I asked about children going back to school and what we had in place for them, particularly as far as testing is concerned. I asked about saliva testing, which has been talked about for a long time. It is less invasive, particularly for children and staff. NPHET told me at that committee meeting that it was looking at saliva testing and thought it would be put in place. Will this type of testing be put in place? If so, when and is there a timescale for it? That is really important.

I know it was brought up earlier but I wish to bring up maternity hospitals and birth partners not being allowed into hospitals. I think the biggest issue with this is the confusion. The reason there is confusion is that in certain hospitals one can go into the maternity hospital with one's partner but in other hospitals one cannot. This is where I think all of us have concerns. I realise how hard the Minister is working, but there is a lack of communication and information. A lady, a family member, rang my clinic yesterday and asked why some hospitals are allowing partners in and others are not. Unless we get everything in place across the board and everybody is given proper information, this cannot be sorted.

We have spoken about wet pubs. I have made myself very clear that I understand we have to agree with and totally go with NPHET guidelines. I also believe, however, that the wet pubs should have been allowed to open earlier. I was very strong on that last week and I still am. I have met the vintners. They are very willing to work with every guideline that is given to them. They are willing to work under proper control. They will do whatever they have to do to reopen. This is so important because, as I have said before, we are dealing with families who have had wet pubs for years and who now do not even know whether they can reopen because they do not know whether it will be viable for them to do so. That is a huge concern so I have been very strong on it.

My biggest issue as a Carlow-Kilkenny Deputy is that Carlow town borders Graiguecullen, and when what we would call restrictions or lockdowns - there was a bit of confusion about it - were put in place in Laois, Kildare and Offaly, there was such confusion over that because by 12 o'clock that night there were restrictions such that shops, hotels and restaurants had to close. I got so many phone calls about this because my town borders Laois. There was such confusion. The concern now is the case numbers in Dublin and Limerick. I understand that the Minister has to put in place restrictions, but the restrictions that night were announced for 12 o'clock and there was such confusion. I know the Minister has done his best and I am not here to criticise. I listened to his speech today and heard what he said. We all have to work together. The only way we can do this is by working together. I hope everybody is here to work together because that is the only way we can solve this. If there are restrictions, however, I ask the Minister and NPHET to look at them carefully and realise the need to sort something out for people. People need to be given that little bit more information rather than a 12 o'clock lockdown.

Catherine Connolly (Galway West, Independent)
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I wish to indicate to Members that I will go back to Sinn Féin now for three and a half minutes. Then it is back to the Government, followed by Sinn Féin and then People Before Profit-Solidarity. That is the list I have here.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The new pecking order.

Catherine Connolly (Galway West, Independent)
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I call Deputy Carthy.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The backbencher party, a new party.

Matt Carthy (Cavan-Monaghan, Sinn Fein)
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I thank the Minister for being here. He is obviously incredibly busy and he has made himself available for quite a number of sessions over recent days, so I thank him for that. I come from a county that has had a strangely high rate and prevalence of Covid-19 cases recently. At the moment I think it stands at 40.7 per 100,000, which is incredibly high, considering that Monaghan is such a rural county and, globally, rural areas seem to be a little insulated from some of the worst effects, by and large. Of course, we have a fair sense as to why this is the case in Monaghan as opposed to our neighbouring counties. Predominantly, it is because there is a meat factory in Monaghan and there was an outbreak in it, but we still cannot get answers. On the day it was announced that cases had emerged in the ABP plant in Clones, I emailed the Minister, NPHET, the HSA and the HSE for information on the position on the number of cases because rumours were circulating all over the place. I asked what the official response would be in order to deal with the outbreak. I got a response, in fairness, from the HSA to tell me I should ask the HSE. That is essentially the only substantive response I have received. We have to get on top and take control of the situation regarding meat factories and food processing plants because it is not good enough.

There may, however, be another reason we have a high prevalence. I received an email last Tuesday, at 10.21 a.m., from a constituent who told me about a situation in her workplace. She tells me of two people who worked in her company, one from Monaghan and one from Crossmaglen. Here are the exact words from the email:

Monaghan person feels unwell on a Saturday and rings doc on call. Told they need testing and will be contacted. Contacted Sunday and test Monday. Still waiting for results on the Tuesday. 2 days already missed off work. Could be more depends on when they get results back.

Crossmaglen person feels unwell Sunday. Goes on line at 11 and gets test for 1.30 on same day. Results back on Monday at 7am. They are negative [thank God] so no work missed.

People are asking questions and it is not just a North-South issue. In different parts of this State on different days people have related to me very positive experiences with the testing regime, but there are too many of these anomalies.

This is my first opportunity to address the Minister on health statements, so I have to refer him to the situation of the hospital in Monaghan. Thankfully, the HSE announced back in July that 23 additional community care beds will be restored at Monaghan Hospital. We need services restored to Monaghan Hospital because the implications of the decisions that were made when the Minister's party was last in government are profound. According to the National Treatment Purchase Fund, at the moment there are 755 people waiting for inpatient care at Cavan General Hospital. In January the corresponding figure was 340. The reason for this is that services have been removed from our smaller hospitals. I ask the Minister not to do what his predecessors have done and just fob this off to the HSE. The decision to remove services from Monaghan Hospital was a political one; we now need political intervention to restore services to our smaller hospitals.

Niamh Smyth (Cavan-Monaghan, Fianna Fail)
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I congratulate the new Minister for Health on his role and commend him on the remarkable achievements he has had so far along with the Minister for Education and Skills, Deputy Foley, over recent days. In one week or two we have had the reopening of the schools, our teachers back in place, our Montessoris back in place and our crèches back in recent months. That has all gone incredibly well in my view and from the feedback I have received from teachers and parents. Of course, parents are utterly delighted to see their little darlings all back in school and that has been one big positive in recent weeks.

I wish to raise a couple of issues with the Minister. The student nurses entering their final-year placements are a concern. I have had quite a number of queries in this regard. It is very obvious that they could not work part-time for fear of transmitting Covid during the peak of the virus. We ask, however, that financial supports be put in place or that the Minister consider something to support our student nurses.

They are coming to their final year of placement. They are our next generation of nurses. We are incredibly indebted to our nurses and healthcare staff throughout this global pandemic and it is important that we recognise that and give them encouragement for the future in terms of their own careers.

I agree with many of my colleagues that, for expectant mums, not being able to have their partner with them during the crucial time of giving birth has been difficult. We have received a number of calls on that. I understand that the less footfall there is in hospitals, the more the risk of Covid-19 spreading is suppressed but I ask the Minister to consider that as part of his roadmap for lifting restrictions.

There were outbreaks in Cavan General Hospital, meat plants and so on in my own constituency. The front-line staff in Cavan General Hospital have been exemplary in how they have dealt with Covid-19. The Minister during his time in opposition came to visit Cavan General Hospital and Monaghan Hospital, for which I am grateful. He met the staff and he knows the depth of compassion that they have. They are inspirational people. When Covid-19 hit, Cavan General Hospital had to be ingenious in how it dealt with space and social distancing, to the point that they had to hire Portakabins to deal with restrictions. Will the Minister, in his deliberations over future funding, please have a look at that? He has visited those hospitals. Capital investment is crucially needed.

I have received many calls from staff on the front line. Many are deeply affected by their dealings with Covid-19 and Covid-19 patients. Some of my colleagues have raised mental health and supports for front-line staff following this trauma. I ask that the Minister take this into consideration in any roadmap he lays out in the future.

I will comment on the reopening of wet pubs. Cavan and Monaghan are Border counties and we recently met many publicans who are mainly running rural pubs and have a problem that does not exist right elsewhere in the country, namely, the Border. These family-run businesses are mainly run on pride rather than financial gain. They are important fixtures in our community where people meet up and congregate with social distancing. I am convinced that these people know what they are doing. They are professionals. With the reopening of those pubs, they will adhere to guidelines. In the Border counties, they have seen a mass exodus of people going north. We have heard that from the publicans. They are concerned about whether they will ever see their businesses returning to what was normal.

We know there were lengthy delays for serious hospital appointments before Covid-19. We know that is compounded by Covid-19. Will the Minister consider speeding up of important operations?

Maurice Quinlivan (Limerick City, Sinn Fein)
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I will raise the issue of ongoing capacity and staffing issues at University Hospital Limerick, UHL. I am sure the Minister will be aware of it. The problems in this hospital are unresolved and figures show, unfortunately, we are a long way from having a resolution. In seven of the past eight days for which trolley figures are available, UHL has had the highest figure in the State. This is not shocking or unexpected to us anymore, unfortunately. It has become the norm but it cannot stay as the norm. Today, there are 46 people on trolleys; yesterday, there were 59 people on trolleys. We are almost back to pre-Covid figures. When Covid came to the country, trolley figures reduced significantly because people were refusing to attend their local hospital for a variety of reasons. Unfortunately, we are back to where we were. If the Minister for Health is leaving, is another Minister staying?

Anne Rabbitte (Galway East, Fianna Fail)
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I am.

Maurice Quinlivan (Limerick City, Sinn Fein)
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Go raibh maith agat. I welcome the commencement of the construction of a 60-bed modular unit in UHL and acknowledge the HSE's efforts to commence the process of seeking planning permission for a 96-bed block but why it is taking so long? We have had an ongoing crisis for a number of years, since the amalgamation of the three local hospitals in Ennis, Nenagh and St. John's into UHL. We have had nothing but massive increase in trolleys, with thousands of people year-on-year waiting on trolleys. It needs to be prioritised and we need a commitment from the Government that the 96-bed unit will be completed on time, if not sooner. Limerick and the mid-west cannot afford to wait. There have been too many false dawns and promises and not enough action when it comes to UHL. I plead with the Minister, as I did in the previous Dáil on almost a weekly basis, that something be done at the hospital. The wait times and trolley numbers are increasing. We are all but at pre-Covid levels of people waiting on trolleys. The new unit must open on time and be fully staffed. The HSE has to sit down and speak to the nurses' unions, particularly, and the staffing level needs to be addressed. The reality is simple: it is not fair on patients or on the wonderful staff who do a fantastic job in the hospital. People in Limerick and the mid-west will say they have a good experience once they get into the hospital. The problem is waiting and waiting on trolleys. Our patients deserve dignity but dignity is not afforded to anybody waiting on a trolley in a busy corridor. The hospital staff deserve optimum conditions in which to complete their vital work. Great work is being done by medical staff during the pandemic. Their effort are, despite significant risk of infection, saving many lives. I am concerned that such great efforts will be undone if we do not get a handle on the overcrowding and staffing issues at the hospital.

Unfortunately, my home county of Limerick has experienced a dramatic and concerning increase in Covid cases. The increase, coupled with the issues at the hospital, and the upcoming flu season will create the perfect storm that could ultimately overwhelm our overstretched hospital staff. I ask the Minister to intervene. He will say there is not, but there is an embargo on staffing at the hospital. I spoke to a hospital porter yesterday and he is absolutely exhausted. He is working every hour because additional staff cannot be hired. There needs to be an immediate intervention. I know that the Minister has left but I repeat my invitation to him to come to Limerick and ask him to do that as soon as he can.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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We just witnessed another reason the manipulation of the speaking order is very regressive step. The senior Minister has left before the opening spokespeople of four different groups in the Parliament will have a chance to put points to him, whereas he has heard three or four from his own party before that. It is a disgrace. In the two minutes I have left I will say this: the Minister questioned some of the Opposition over pointing to the inconsistencies in the guidelines and the messages and he says that we have the information, we know and we should not be pointing things out. That is not true. We do not know what NPHET thinks. More important, we do not know what the experts and scientists on the expert advisory group, which advises NPHET, think. I have been saying this since March. Fianna Fáil were backing us in this point beforehand when I asked for the expert advisory group, that is, the actual scientists, to publish their minutes. They eventually published a few of them. Does the House know how far behind they are behind on those minutes so that we know what they are thinking about all these measures? The latest minutes were published at the end of June. That is how much of a gap there is between the considerations of the scientists and experts and our knowledge. The latest NPHET minutes were published on 12 August.

We, therefore, have no clue what the experts think and whether it bears any relationship whatsoever to the ham-fisted, contradictory, inconsistent guidelines, communications and statements from the Minister. The result is we are losing faith and the people are losing faith in the Covid-19 strategy of the Government as infections rise. Let us consider even the publication of information today about private houses. This information states that we can open the pubs and do not need to worry because it is all in private houses. I thought: how did it get into the private houses? Did it come through the walls? Did it magically appear? No. As Professor Sam McConkey helpfully pointed out on the news, it probably came from work or whatever. Are we gathering that information? No.

The HSE's data hub has next to no information. We have no clue where the community transmissions are coming from because we do not gather the information. That suggests that the contact tracing system is a mess because we are not gathering the data that would allow us to track and trace the virus.

Paul Murphy (Dublin South West, RISE)
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It is no offence to the Minister of State but it is scandalous that we are here to discuss health and the Minister for Health was present for the statements of a number of the other Opposition groups and backbenchers but then will not be there for a whole load of groups. I have a question that I will pose to the Minister of State and she might not know the answer because she is not the Minister for Health but the Government has chosen to put her in this position so I will ask her the question and leave her time to answer it.

Will the Tallaght Hospital paediatric emergency department be fully reopened as has been promised? Last week, staff at Tallaght Hospital were shocked to find out that the children's emergency department was being downgraded to an urgent care centre and all acute paediatric services were stopped. The nurses union has gone on record to say that this decision is simply unsafe. Back in March, when the services were temporarily closed, we were promised that they would reopen. It was even announced last week that they would reopen but then at the last minute, members of staff were told it would not be reopening at all and instead the service would be downgraded. This decision will pile extra pressure on Crumlin hospital and Temple Street Hospital, which are already struggling to cope. It is bad news for families in Tallaght and for children across Dublin. Will the Minister of State and the Department intervene to reverse this decision to ensure the hospital's children's services are fully restored as was promised?

Catherine Connolly (Galway West, Independent)
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I call Deputies Cahill and Higgins, who are sharing time.

Paul Murphy (Dublin South West, RISE)
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I left time for an answer.

Catherine Connolly (Galway West, Independent)
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These are statements.

Paul Murphy (Dublin South West, RISE)
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It was allowed earlier.

Catherine Connolly (Galway West, Independent)
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I did not allow it earlier on.

Paul Murphy (Dublin South West, RISE)
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Maybe the Leas-Cheann Comhairle did not but it was allowed earlier.

Catherine Connolly (Galway West, Independent)
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I am afraid it is not allowed in this session.

Paul Murphy (Dublin South West, RISE)
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It was allowed when a Sinn Féin speaker was speaking.

Catherine Connolly (Galway West, Independent)
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It was not allowed in this session.

Paul Murphy (Dublin South West, RISE)
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It was.

Catherine Connolly (Galway West, Independent)
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Not since I chaired the session. I chaired the session from the beginning and it was not part of the rules for this session. The Minister was here, he made a statement and we clarified that he would come in at the end for ten minutes, including statements. It was not an interactive session. The Deputy will have to take this back to the Business Committee if he wants an interactive session but I took this over from the beginning and it has not been an interactive session.

Paul Murphy (Dublin South West, RISE)
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Sessions such as this have been carried out interactively. It is said that if time is left over then answers can be given.

Catherine Connolly (Galway West, Independent)
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That was not the case with this session. If the Deputy wants to take up the minute that he left over I will allow him to do so because he stopped short.

Paul Murphy (Dublin South West, RISE)
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I hope I will get an answer from the Minister, Deputy Stephen Donnelly, at the end and he has time to get the answer because it is a huge issue and it has received relatively little coverage. The issue is that there is a plan to downgrade the children's department in Tallaght University Hospital to an urgent care centre as part of the national children's hospital but that is not open. It seems that the coronavirus has been used to speed up that process and that the children's department was closed because of the coronavirus but then it has not been fully reopened and it is a huge problem.

Catherine Connolly (Galway West, Independent)
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We will move on to Deputies Cahill and Higgins.

Jackie Cahill (Tipperary, Fianna Fail)
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I want to start by immediately raising the case of Alan Clifford, which has been brought to my attention by his mother Kathleen. Alan attends an adult day service in Nenagh, run by the Daughters of Charity. Since 3 March of this year, Alan has had no access to services whatsoever as a result of the Covid-19 lockdown. His mother Kathleen is Alan's sole carer and she was left in a situation of having to seek out different sorts of help from friends and leave from work to take care of her son, while also trying to juggle her job commitments. At this stage, all of Kathleen's leave has diminished and there is still no sign of a service resuming for Alan. I have corresponded with the Minister and had phone calls and different correspondence with Kathleen. It is noteworthy that there are a lot of families in Kathleen's situation and it is upsetting to see that the budget that was to be used for day services and residential services is now exclusively being used for residential services. This is not right. Day service users are in desperate need of this facility reopening and in order to ease the pressure on families such as the Cliffords, this has to happen. It is of vital importance in my constituency that the adult day service on Stafford Street in Nenagh opens as soon as possible and that families, carers and service users need clear communication on this matter and a clear roadmap for reopening.

It is vital that Shannondoc services are resumed in the areas of Templemore, Thurles and Roscrea as soon as possible. This is an issue about which I am being contacted daily in my constituency. As it stands, my constituents have to travel from different parts of north Tipperary to Nenagh. I also spoke to an ambulance driver who is based in Thurles who stated their calls have increased dramatically as a result of the lack of Shannondoc services in Thurles or Roscrea. We need this full service to be restored as a matter of urgency.

I mention Nenagh General Hospital and the 24-7 accident and emergency services there. As it stands, University Hospital Limerick is serving north Tipperary also, outside of the hours of 9 a.m. to 5 p.m. As we enter what will be a unique winter for us with unique challenges and with Covid-19 still present in our community, I urgently request that the accident and emergency department in Nenagh General Hospital would be open on a 24-7 basis. This is essential to take some of the huge pressure off University Hospital Limerick. This needs to happen as a matter of urgency.

I welcome the common-sense approach that has been adopted in Cashel to use Our Lady's Hospital again. This is something I talked about in this House many times and thankfully the advent of Covid-19 has got Our Lady's Hospital back into use. It has been used to ensure that patients can isolate with Covid-19 if needed and it is up to HIQA standards for the patients who were in St. Patrick's Hospital. St. Patrick's Hospital has been promised a capital development and I urgently ask for a roadmap for that development. Our Lady's Hospital can then be used as a respite, palliative care and step-down facility for South Tipperary General Hospital. It is urgent that St. Patrick's Hospital gets the capital investment that is needed.

I mention Dean Maxwell community nursing unit. I know the Taoiseach spoke about this matter in this House in recent weeks. This facility urgently needs to be brought up to Covid-19 standards and it needs urgent investment. Whether a greenfield site is the most appropriate solution or not is up to others to decide but we need a firm roadmap for the investment and timeframe for the Dean Maxwell unit in Roscrea.

Emer Higgins (Dublin Mid West, Fine Gael)
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Back in March, the message from the World Health Organization to all countries was to test, test and test. The Government has moved mountains to follow this advice to the letter. In the last week alone, 68,000 people have been tested. That is the equivalent of the population of Sligo now being tested every single week. That is what is needed to hunt down the virus, to keep it out of our nursing homes and to keep it away from our vulnerable people. Countless lives have been saved by swift and determined action by this Government but as we have seen over the past two weeks, numbers have steadily increased, predominantly in the Dublin area. This increase has led to a high-risk delay in getting a test.

As I know this is of great concern to the Government, I would like to take this time to highlight a specific case that came to my attention today. One of my constituents in Lucan was confirmed as a close contact of a colleague who received a positive Covid-19 test on Sunday. Many of his colleagues were also deemed close contacts. They were contacted on Monday by the contact tracing team, which confirmed they were being referred for a Covid-19 test and should receive appointments within 24 hours. When my constituent did not receive his appointment on Monday, he called the HSE live helpline that day. He was advised he should receive the appointment by Tuesday. He was added to an escalation list and was informed he would definitely receive an appointment by 8 p.m. that evening. No text, phone call or appointment came through. He phoned the HSE helpline again this morning and was advised that no referral was to be found on the system and he would have to be added again, thus starting the process all over from the beginning. It has now been three days since he was first notified that he was a close contact and was being referred for a test. His colleague, who was tested in Tullamore, has already received his result but my constituent has not yet received his appointment.

7 o’clock

Both were identified as close contacts at the same time. Another person, also based in Lucan, has not yet received his appointment either. By the time that my two constituents receive their results, a week will have lapsed since they were identified as close contacts. If they are diagnosed as positive cases, so much time will have been lost in tracing their contacts from last weekend. Since then, as we all know, the figures in Dublin have given us great cause for concern, and the situation here has been described as being on a knife-edge.

That is why it is critical that people in Lucan get tested as quickly as people in Tullamore. It is not fair, it is not right and it is not safe that when two people are referred at the same time, the person in Tullamore receives his or her result before the person in Lucan even receives his or her appointment. Delays such as this will have a domino effect in allowing Covid-19 to spread across the capital city. We need to get testing and tracing back under control. We have seen the system being challenged before and we saw a concerted Government response to get it back under control, and that is what we need to see again.

Specifically, I ask the Minister to commit to providing mobile testing units in Lucan and Clondalkin as the first step to achieving this outcome. We did it before, it worked and so let us do it again. The virus is so contagious that it is a major challenge to meet our targets when our infection rate rises. We have, however, met that challenge before and we need that same level of determined focus to meet that challenge again.

Chris Andrews (Dublin Bay South, Sinn Fein)
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I congratulate the Minister of State on her appointment. I have not had an opportunity to do so before now and I wish her well in that journey. It is going to be a challenging one and it is very important for us all that she succeeds. Earlier, the Minister for Health, Deputy Stephen Donnelly, mentioned the words "solidarity" and "confidence". Not too far from here, however, St. Mary's nursing home, on the Merrion Road, is being closed. The closure was announced in June and at present, 20 very vulnerable individuals with disabilities live there. Many of the residents have been there for up to 50 or 60 years. They are surrounded by friends and the staff have, effectively, become family. The staff recently received a Covid-19 hero award from the former Lord Mayor, Tom Brabazon. The nursing home is free from Covid-19.

In the middle of a pandemic and with all the issues concerning nursing homes, it seems bizarre to be closing a nursing home that is free of Covid-19. St. Mary's should not be closed but kept open and invested in. The nursing home is already 80% funded by the State and the HSE. The State must intervene and invest in these vital facilities. I was visited the nursing home on the Merrion Road today and I met the staff and residents. Several of the residents had one request, and that was for the Minister for Health to meet them. I noticed earlier that the Minister for Education and Skills met some sexual abuse survivors. I ask that the same courtesy be afforded to the residents of St. Mary's nursing home by the Minister for Health. Will the Minister meet the staff and residents of St. Mary's nursing home? It is not much to ask for and it is important that St. Mary's is funded and not closed.

Peter Fitzpatrick (Louth, Independent)
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First, I again put on record my complete admiration and support for all our front-line workers. In recent weeks, we have seen more than 1 million students return to school and we must pay tribute to the teaching, caretaker, administrative and special needs assistant, SNA, staff who made this possible. Unfortunately, we are seeing Covid-19 numbers on the rise again and we must ensure that our front-line health staff get all the support they need. They have been through a traumatic time in the past six months and we cannot expect them to simply react as normal should this second wave of the virus get any worse. The best way for the public to support our front-line staff is to heed the simple advice to wash our hands regularly, wear face masks when in public and in places where it is not possible to socially distance and limit social contacts. If we heed this advice, then we will suppress this horrible virus and give everyone a chance to return to a normal way of life.

I will raise several issues. Nursing homes suffered an extraordinary number of deaths during the first wave of the pandemic. In my home town of Dundalk, Dealgan House nursing home suffered, like many more. I have said before that we need to hold a full public inquiry into the circumstances of why so many residents died in nursing home settings. Such an inquiry would not be about finding scapegoats, a blame game, or an opportunity for some to use as a political football. It would simply be a mechanism to allow us to find out where the systems failed in nursing homes, what measures we need to take to ensure that it never happens again and to help those in nursing homes understand better how the system failed.

The many families who lost loved ones in nursing homes, such as in the Dealgan House nursing home, deserve answers to the many questions they have about the circumstances in which their loved ones died. It is the least that they deserve. I call once more, therefore, for a full public inquiry into the circumstances of why so many residents died from Covid-19 in nursing homes like Dealgan House nursing home. The process should be open and transparent, it should get the facts and result in the publication of real and sustainable solutions for nursing homes in future.

We cannot have a situation where questions remain unanswered. We must get to the truth and act on it to ensure that all nursing homes are safe and friendly environments that offer a real quality of life for their residents. It is important to put on the record that my own mother was a resident of the Dealgan House nursing home and that her time there was excellent and she was treated with the utmost respect and dignity.

Staying on issues regarding Covid-19, I note that more than 120 health workers have been diagnosed with the virus during the past week and according to the INMO, this figure could be even higher because asymptomatic cases are not being picked up. Beaumont Hospital has been forced to close wards after patients and staff contracted the virus. I find this alarming. My understanding is that healthcare workers are not required to quarantine for 14 days when returning from a country listed as requiring quarantine. It is also my understanding that when a positive case is identified in an acute hospital, not all staff are tested. Surely, we must examine this situation. Healthcare workers must be protected but so do their patients. How can a situation arise where a healthcare worker does not need to quarantine for 14 days when returning from a listed country? Why are all staff not tested in an acute hospital when there is a positive case?

We saw how quickly this virus could spread in hospitals and other care settings during the first wave. What is most worrying is that the number of cases among older people is starting to increase, with 21 people over the age of 65 testing positive in the past week alone. I would like to hear the Minister of State's views on healthcare workers not being required to quarantine when returning from a listed country.

On a related matter, our ability to care for critically-ill patients in intensive care units, ICUs, has been highlighted during this pandemic. When researching this aspect, I found that Germany and Italy had similar rates of Covid-19, but dramatically different death rates. In Germany, 4.7% of patients died, while in Italy that figure was 14.5%, more than three times higher. A simple explanation for this was that Germany had more ICU beds than Italy. Germany had more than 48 beds per 100,000 people, while Italy had just under seven beds per 100,000 people. If we look at Ireland, we can see that we have only six beds per 100,000. My point is that the provision of ICU beds in Ireland is inadequate. If a second wave of the pandemic hits us, I fear for the ability of our ICUs to cope. I appeal to the Minister for Health to look seriously at the situation regarding ICU capacity. We need to invest now and ensure that we are prepared for any eventuality.

While the Covid-19 pandemic has, rightly, seen most of the resources of our healthcare system devoted to combating it, we must not forget that people are suffering from other illnesses. New figures have revealed that cancer screening is down 60% for the first six months of 2020 compared with 2019. To put this in perspective, between January 2019 and June 2019, some 248,223 people were screened across the three screening programmes, while in the same period in 2020, that figure was 99,286. This is a decrease of 148,937. I find this extremely worrying.

The three cancer screening programmes, namely, BreastCheck, BowelScreen and CervicalCheck, were all shut down due to Covid-19. BreastCheck is still shut down, while the other two programmes are operating at a reduced capacity. My biggest fear is that we will see a large number of people who are suffering from cancer go undiagnosed.

As a matter of urgency, I appeal to the Government that we must immediately introduce a programme to catch up and deal with this backlog. The Minister needs to make a comprehensive statement on this matter and outline to the House what measures the Government is introducing to ensure that all three screening programmes are brought up to date.

On a related matter, more than 600,000 people are now on outpatient waiting lists. What is most alarming is the number of patients who have been waiting more than 18 months for an appointment. There are 73,101 people waiting for an orthopaedic appointment, of which 17,138 have been waiting more than 18 months. That means that more than 23% of people awaiting orthopaedic appointments are waiting more than 18 months. There are 22,456 people on the waiting list for a neurology appointment, of which 6,455 have been waiting more than 18 months. That means that 29% of people awaiting neurology appointments have been waiting more than 18 months. It is time to stop such waiting times once and for all. We must make the necessary resources available and implement the necessary changes to ensure that we have a healthcare system that is fit for purpose. The bottom line is that people should be assured that they will get the required treatment and healthcare in order for them to receive the possible treatment and outcomes. It is time that we take a long, hard look at healthcare to see what is needed to make it world class in its delivery and outcomes.

Kieran O'Donnell (Limerick City, Fine Gael)
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I want to speak in this debate and I will obviously start with the context of Limerick city and county. A glimmer of good news emerged today when no additional cases of Covid-19 were recorded in Limerick. That is the first time that has happened for 24 days, since 17 August. This is a worrying time for the public but it is not a time to panic. We very much need to continue this trend. Limerick had 19 new cases yesterday but has none today. That is very positive.

What we need to do in Limerick is to heed the advice of the Department of Health, which is worth repeating. People should reduce their social contacts, take a step back and keep their distance from others. People should not drop their guard because they know someone to whom they are talking. On feeling any symptoms, people should isolate, contact their GP, not go to work and remember to take a free Covid test. People should wash their hands regularly throughout the day, wear a face covering and download the Covid tracker application.

My view at this point is that our policy around Covid must aim to live with the virus, as distinct from extinguishing it in the short term. I wish to start on a couple of areas. It is important that we continue the momentum in Limerick where there were no new cases today. That is to be welcomed and is a tribute to the people of Limerick and the health services. I note that additional test centres have now been established, which is to be welcomed. We must get back to being able to exist and that is one of the reasons that I supported the call for the reopening of the pubs. We must ensure that we have implemented strict conditions in pubs and I know that publicans are willing to adhere to that. Hotels are going through an equally difficult time. I met some hoteliers on Monday who want to see what can be done to ensure their businesses will continue to be viable.

The message I have for the people of Limerick city and county is that we must ensure that we continue this downward trend. The rate of infection was 66.2 persons per 100,000 of population yesterday. That will be brought down with the news that were no new cases today and that is to be welcomed.

I want us to look at the business sector and ensure that businesses are sustainable through supports to publicans, restaurateurs and retailers. We must ensure that we continue those welcome supports and the Brexit supports that were announced today.

I also want to touch on a topic in which the Minister of State is interested, namely, the area of disabilities. In Limerick, we have the Daughters of Charity, the Brothers of Charity, St. Gabriel's and St. Joseph's Foundation will also be coming into the area. We have been in touch with the Minister of State about funding to be provided for day services to ensure that people with disabilities are able to attend those services on a regular basis. The disability sector has been the most exponentially impacted area of all. The individuals who attend these services, their families and parents have been affected. We must ensure that those people can start to go to their day services. There is obviously a funding issue for the various organisations that I mentioned earlier, including the Daughters of Charity, the Bawnmore facility, St. Gabriel's and St. Joseph's Foundation. I know that the Minister of State is working on the winter initiative and she might give us an update on where that is. Many parents have been in touch with me and we must ensure that their children get back to day services in the Limerick area as quickly as possible.

The big challenge for us in Limerick over the short term is to get a downward trend in the spread of the deadly coronavirus. Today has been a step forward in meeting that challenge because there have been no new cases in Limerick for the first time in more than three weeks, since 17 August. We need to continue that progress, which is down to the vigilance of the Limerick public and health services in the city, county and region. We must continue to ensure that we can battle through this and that businesses and individuals can continue to function. That is important and I pay tribute to the Limerick public.

John Lahart (Dublin South West, Fianna Fail)
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I thank the Deputy. I call on Deputy Richard O'Donoghue.

Alan Farrell (Dublin Fingal, Fine Gael)
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There are two minutes left on the clock.

John Lahart (Dublin South West, Fianna Fail)
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Is the Deputy taking that time? He is not listed here.

Alan Farrell (Dublin Fingal, Fine Gael)
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I will take that time.

John Lahart (Dublin South West, Fianna Fail)
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I apologise to the Deputy.

Alan Farrell (Dublin Fingal, Fine Gael)
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That is quite all right. I thank Deputy O'Donnell for sharing his time. I want to address two matters that I think NPHET, the Minister for Health and the public should be considering about the current phase of where we are with Covid-19. These issues have raised their heads since the schools reopened, as businesses are opening more prevalently and more people are in our towns, villages and cities. I strongly urge the public to wear masks outside schools. I have dropped my children to school on a number of occasions, as I am sure many other Members have. Even with staggered start times for our primary schools, the areas outside of most school gates are awash with parents. Some of those parents have not seen one another in a number of months and it is inevitable that chats happen. It is important that NPHET and the Minister for Health make a statement to parents asking them to wear masks, where possible.

The same goes for our busy streets. I have been in and around the city since the Dáil resumed in early September. I was also in the city centre in August and, of course, all Members were here in June and July. The city is slowly starting to get busier and there are places where a large number of people congregate, for example at lights as they wait to cross the street, etc. We have to start giving consideration to the transmission rates that are there in the community and we must recognise that those transmission rates will be dramatically reduced if people wear masks in the right setting. I appreciate that is outdoors but I still think people need to make the right choices. I just wanted to take two minutes to say that.

John Lahart (Dublin South West, Fianna Fail)
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I call Deputy O'Donoghue, who is sharing time.

Richard O'Donoghue (Limerick County, Independent)
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How do we support settled communities in our schools? I will give a few facts about schools.

In our area, children who have not isolated after having returned from abroad are presenting at school. They are expected to go into pods with other children who have been isolated with their families since March. Where is the sense in that in our fight against Covid?

Children are presenting to schools having been away for months in a red zone. They are travelling into a green country and returning home. The rights of both sets of children are being violated, that is, the rights to an education and to safety. I raised this in the Dáil earlier this year. If people are travelling back from abroad in clear violation of Covid regulations, we need to have something in place to protect the children who are here.

There are children coming here who went back to school in September. Between September and Christmas, the size of a class could increase from five to 30 students within a couple of months. When our children went back to school, they all started at the same time. If people are returning to this country, they are entitled to an education the same as everyone else. However, if they come into this country, they have to present themselves at a school and must ensure there is a safe environment for a child who is now back in the country. From that date, people should have to isolate for two weeks before being allowed into a school.

The passports of those coming into the country should be shown to the authorities and schools notified that they have re-entered the country, and that they need to isolate for two weeks before going back to school. We have to look after all children, settled or otherwise. We have to put in place something that protects all children.

Michael Healy-Rae (Kerry, Independent)
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I wish to discuss some questions in the short time I have available. It was beyond belief that the 100% capacity on buses was reduced to 50% at the last moment. I can agree with why it had to happen, namely, to ensure the health of students travelling on buses to school but why was it done at such a late stage? We had the whole year to get our act together and that decision was brought upon us at the last minute. I take grave exception to that decision. It has led to confusion, upset and families not having transport for their children to go to school. That is why it is such an important issue.

We should be able to get to the stage of spontaneous testing and results. Surely in the world we are living in today we should be able to achieve that. The more we can speed up testing and results, the more we will be able to open up all possibilities.

We should be doing other simple and straightforward things. For instance, in the county I represent there are two excellent hospitals in Tralee, the Bon Secours, which is private, and University Hospital Kerry. I am very proud of the management and staff of the hospitals and the efforts made with regard to healthcare, not least during this pandemic.

Other things need to be done. I refer to the dialysis unit in University Hospital Kerry. Due to social distancing, a proper canopy to protect people from the weather outside of the unit is urgently required and would not break the bank. If I only asked the Minister of State for one thing on the floor of this Chamber, it would be to ask her whether such a canopy could be provided. I know of a man whose two legs were amputated and is on dialysis who has to go out in all weathers to an area where there is no canopy. That is horrific.

Could the Department of Health please stop praising our healthcare workers? They do not want praise. Our nurses do not want praise. The people working in catering do not want praise. They want proper pay. Pay and conditions were agreed a number of years ago. They want their money. They want us to keep our word to them, and I ask the Minister of State to please do that and to provide a canopy over the dialysis unit in University Hospital Kerry. I would be eternally grateful for that.

Joan Collins (Dublin South Central, Independents 4 Change)
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I will make a short contribution. I agree that we are at a crucial point and it will be one of many crucial points we will face over the next period in our war against the virus. We will have rearguard skirmishes, battles and everything else thrown into the mix over the next period of time. The Minister called it chapter 2. I do not know whether that is the correct term, but that is how he described it.

The public know the danger. If people are told what is going on, they will react and do what is necessary. People know that this virus can kill. A small fringe element is trying to say differently, but people generally know and have seen what is happening.

People will respond to clear communication and logic. It is when things start getting confusing that people get frustrated and angry. I can understand why people get angry, because it has been a long and difficult six months and we have another long and difficult six months ahead of us. When one hears Dr. Ronan Glynn, Dr. Tony Holohan and other experts talking, it is crystal clear why the measures are necessary healthwise. Politicians have to respond to that and make clear points as well.

There is a conflict between when a message comes from NPHET and when it is taken up by politicians. Lobby groups come out and pressure is put on to reopen sectors. That is okay. Many medical experts have said the economy has to open up but it has to be safe for workers and their families, social distancing has to be in place and handwashing has to happen. People are in difficult circumstances and workers should be protected in many ways. The clear message that we have to get out is that we are protecting people. I do not think that message has got out, particularly in meat factories. The message has been confused and people are concerned about it.

There were outbreaks in April and again more recently. Advice was not listened to. The workers were not tested enough and were not separated when they went home to their families and communities. The situation has to be examined. We know from a migrant rights group that this is still a problem.

Another key point is the need for a robust test, trace and isolation system that includes testing contacts. Dr. Gabriel Scally and Professor Paul Moynagh spoke on a radio programme today and said this is crucial. I am scared about what we are facing into because I have an underlying illness. No matter how much I try to protect myself, when I am out I am taking risks. Testing has to be robust. Professor Moynagh made the point that there were no cases in meat factories at the beginning of July but by the middle of the month, 80 people tested positive in a Kildare meat plant.

Only 4,000 people a day were tested, of whom 2,000 were hospital workers. Some six days later, only 2,000 people a day were being tested. If we have capacity for 15,000 tests a day, that is what we should do. We should be testing hospital workers, crèche workers, healthcare workers, teachers and those working in meat factories. University students come from different communities and they should be tested, and there should be follow-up tests if the system can manage that.

I heard in the echo chamber that the character of NPHET could change over the next period of time. Proposals or talks are happening in the background. I heard that the committees around NPHET may be eliminated. If that happens, the Minister has to come into the Dáil and explain exactly why that is happening. I heard a proposal that a NPHET team would include representatives from industry and agriculture. NPHET is a public health committee, not a mixture of industry, vested interests and all of that.

That is going to confuse the message again. If that is going to happen, the Minister has to come in here and explain that.

My final point is that people in the community must be advised, particularly with the rise now in Dublin that we are told is at a knife-edge, as to where the cases are and the areas they are in. I do not mean pointing at people in particular but to general areas. We found out today that five pubs caused an infection cluster, as had restaurants. We have to be told because then people can and will be careful and will make the extra effort to look after themselves, their families and friends. There has to be more detail provided as to where those clusters are coming from and the communities involved.

Anne Rabbitte (Galway East, Fianna Fail)
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I thank all the Deputies for their contributions to the vital debate here this evening on the Government’s response to Covid-19. While I was sitting here for a number of minutes after the Minister, Deputy Stephen Donnelly left, I took notes and would like to respond with some of these before I go into the rest of the speech that the Minister, Deputy Donnelly, has prepared for me, and which I will then read out.

As to my colleague across the floor, Deputy Andrews, who spoke about a visit to St. Mary’s, I will liaise with the Minister, Deputy Donnelly, on that issue and if he is not able to attend I will certainly go there myself to meet the residents.

Deputy Cahill spoke about a particular case. I will not discuss individual cases on the floor of the Dáil but when it comes to adult day services reopening, if anybody is listening in here this evening who has a member of their family who has not returned to one day of service yet in any of the adult day services, I would like them to make contact directly with my office. That is not where we would want our adult day services to be. My understanding is that all adult day services are open and that there is, at a minimum, a 40% return to capacity. If anyone is not receiving at least two days a week in any of their adult day services, please let me know.

While I acknowledge that there is a significant issue around transport at present, I need to know that the adult day services have reached out to all our vulnerable people to ensure that a pre-Covid-19 service is available to them. That also addresses the issue raised by Deputy O’Donnell in Limerick.

As to the issues raised by Deputy Quinlivan, this is not the first time he has raised these issues on the floor of the Dáil. He has repeatedly raised these issues and I know that the Minister is acutely aware of every single one of them.

Deputy O’Donoghue, also from Limerick, has raised an issue about schools and spoke about a particular school and area. This needs to be red-flagged with the Minister for Education and Skills and not just for the cases in one area. Where children who are returning to a particular school have left our jurisdiction and have been in a red zone, the principal and the authorities need to be aware of that because public health is there to protect all families.

Finally, in response to Deputy Joan Collins, clear communication has to be the piece. Members of the public have been amazing in their response in taking on board everything that has been asked of them over the past number of months. When there is clear communication, they will respond accordingly and will react in the same way.

As we go forward into the next phase, whether that be chapter 2 as the Minister, Deputy Stephen Donnelly has said, clear, concise, communication must continue. It is important for us as elected representatives to continue with that clear line of communication and not to muddy the waters.

Our overall goal is to reopen our society and economy as safely as possible, given our current knowledge of Covid-19, the causes of the transmission and the pattern of the disease in our community. It is a challenge facing governments the world over. In developing our response we are guided by NPHET and by the advice of Departments and Government agencies. Collectively, our objective is to strike a balance between what is safe and what may risk increasing transmission of the disease. The greater the degree of reopening and the more contact people have with one another, the higher the risk that we will see an increase in the transmission of the virus. This requires careful consideration as to the best course of action. We all want to return to normal but it is not possible for each sector to return to normal at the same pace. Therefore, we are prioritising certain sectors of society at this time in the hope that we will all be able to return to normality at some stage.

The key message is that maintaining virus transmission levels at the lowest possible level is key to maintaining progress with Covid-19. We continue to see a combined effort by everyone living in Ireland to maintain the solidarity that has marked the past number of months, with people continuing to do the difficult work of remembering to keep apart, to keep washing one’s hands, appropriate coughing and sneezing etiquette and more recently, the wearing of face coverings on public transport and in shops. I know all Deputies will join with me to thank the individuals for their hard work and resilience. It is clear from the experience of this disease both in Ireland and abroad that an extremely cautious approach is required.

We are still waiting at this stage for effective treatments for the disease. While a huge amount of progress has been made and a number of drugs have been shown to have an effect on Covid-19, we are still without a definite treatment. We are also still without a vaccine although there continues to be encouraging progress reported in the development of new vaccines.

For now, the public health advice remains our best defence against Covid-19. However, it is important to record the progress that has been made. Much of our society and economy has now reopened. What has changed in many respects is how we interact with others in these situations. It is important now to think of how we do something and not just what we do. New public health measures were agreed on 18 August in response to an increase in case numbers. These measures remain in place until 13 September. In the meantime, our public health teams, the HSE and NPHET continue to monitor very closely the prevalence of the disease within Ireland and are endeavouring to suppress it as quickly as possible wherever it appears.

The Government has also agreed that it will set out a roadmap for resilience and recovery in order to guide the next stage of our approach.

Finally, I extend again my sympathies to the families and friends of those who died in recent months due to contracting Covid-19. I also acknowledge the contribution of the front-line workers in the national effort to combat this disease.

It is also important to say that we sometimes forgot to acknowledge certain sectors when we moved from phase 1 to phase 3, one of which was the adult disability sector. It played a phenomenal role on 13 March, when many of the adult day services just closed down and the service users were returned to family members where these families no longer had the access or opportunity for respite and where their loved ones put the last stroke on the calendar on the wall on 13 March. Some have only begun again to mark their calendar in the past number of weeks. Those families became very frustrated in the latter weeks because they felt that they had been forgotten about and that their services were not going to open. There was poor communication. The most important thing we have to remember is that during Covid-19, the Department of Health, the HSE, the front-line workers, families and service users all worked so hard together to protect the most vulnerable. There was serious cohesion among all. It is important as we go into our next chapter to ensure that this cohesion remains. At the same time, as we reopen economies and society we do not want to leave anyone behind. As Minister of State with responsibility for disabilities, I certainly do not want to see any of my service users left behind. Yet again, I say to any family member watching in tonight that if his or her loved one has not returned to an adult day service I need to know and would like to know. Please communicate with me because I will need to know why this is so.