Marian Harkin urges urgent fixes for nurses, care homes and consultants

Each day as we gather in the Dáil, the numbers who have died from COVID-19 increase and I think it's really important that we remember those people and sympathise with their families, all of whom are grieving in isolation. It's also important that each time I think we recognise the huge efforts made by those in the healthcare sector. And while we have made real progress, both at individual and government level, in containing COVID-19, there are a number of unresolved issues in the healthcare system. First of all, Taoiseach, we hear that nurses have not yet been paid. There are agreed increases. Some hospitals pay, some not. That just needs to be sorted now. Another pressing issue is the fact that, at least from the people I speak to, that in some of our nursing homes, they're still not adequately staffed or have adequate levels of PPE if either their patients or their staff contract the coronavirus. I mean, I've heard the panic in the voices of some of the people in this sector. And while progress is being made, we were slow off the mark in the first place. And I think immediate and urgent efforts are needed. I really want to emphasise that point. Another issue that really hasn't been dealt with, it was mentioned here this morning, but just briefly, and that's the contract that's being offered to private consultants and private hospitals. Now, I fully support the actions taken regarding the takeover of private hospitals, and we can see it as a success that over 2,000 beds are not being used right now. However, I believe there is a need for flexibility in the contract being offered to the consultants. In order to be able to treat their emergency non-COVID patients, they must be insured. And if they don't sign that contract by next Sunday, they don't have insurance. But if they do sign it, they leave all their other patients in limbo. All patients matter. All patients. And that should be the bottom line. Whatever ideological struggles are going on, now is not the time. We need to focus on COVID and non-COVID patients. As you said yourself, Taoiseach, cancer has not gone away. We need a flexible solution, and we can fight our territorial battles later. It's patients that matter now. I also want to briefly mention the issue of domestic violence. We've had a top-class awareness campaign from the Department of Justice, and some really good interagency response. For example, the Gardaí are proactively following up on private COVID calls on domestic violence. And I think that's great reassurance for people. However, Taoiseach, some people still have to leave their homes. In my own constituency of Snagolitrim, there is no emergency refuge accommodation. So people have to access rental accommodation. We need a timely way. We need a timely way of helping those people. And one way is to allow them to avail of short-term rent supplement. And I would ask you to please reconsider this as an emergency solution. A final comment, and it's been brought up already. Refunds or vouchers from airlines. Customers, as you say yourself, are fully entitled to refunds. I think the government should stand on the right side of this issue. And that is with the customers. Yes, I heard what you said, that airlines may need support, and they probably will. But one of the ways that we could do that now is to look again at fifth freedom rights around cargo transport. It should be full refunds for customers. Thank you. Thank you. Thank you. Taoiseach, tomorrow, it's widely anticipated, you'll announce some easing of restrictions. Tomorrow is May Day. It's the start of the Mayfly season on the Corib and Loch Derg. It's something that people have done for generations through the Spanish influenza, which was far more deadly than this has proven to date. And before that, it's a solitary activity by its nature, by its definition. I'd ask you to bear that in mind in easing of restrictions. The idea that on Garda, Sia Khan's time would be taken up with stopping people going out in boats and spaced out across large lakes like Loch Derg and Loch Corib is ridiculous. And I think it calls into question the necessity to make sure that our restrictions are necessary and proportionate. And I'd ask you to look at that issue and how mayfly fishing is treated. I'm not talking about people in jet skis and dangerous activities. I'm talking about something that's happened for generations. Thank you very much, Deputy. That concludes the questions and statements I've asked to Taoiseach now, if you'd like to make a concluding statement. Taoiseach, I'd certainly seek advice from Neffet on the Mayfly fishing. And I know the issue of just solitary fishing in general, people fishing in a local lake or river on their own, has come up on a number of occasions. So it's something that I'll seek advice on. Deputy Harkin mentioned the whole issue of domestic violence. And there is a real concern at the moment that the fact that people are at home so much more than they would normally be is a real risk, both in terms of an increase in domestic violence and also an increase in child abuse as well. And that's something we're very aware of, people being at home and often, I think everyone can understand why those are concerns. And it is something we're very attuned to and the government is attuned to that. In terms of domestic violence, there are two new women's refuges that have opened in recent months in Galway and in Dublin. But the northwest is a very obvious and gaping gap when it comes to the vision of a domestic refuge for women. And I hope that's something we can sort out sooner rather than later. In the meantime, I know hotel accommodation can be used. I don't see why rent supplement couldn't be. So I'll get that checked out. I think that's a good suggestion. In terms of the pay agreement with the nursing unions, I've seen some reports in the media about that, but I will get that checked out this week. The pay increases that were agreed with the nursing unions are linked to a new contract and also reforms and the adoption of more modern work practices in the interests of patients and taxpayers. So there is a linkage there. But I absolutely believe that public bodies should honour the agreement, as unions should do. In relation to capacity in the hospitals, our private hospitals are about 33% occupied, our public hospitals about 80% occupied, our ICUs about half occupied and City West largely unoccupied. That is not necessarily a bad thing. The reason why that is the case is because we want to be prepared to make sure that our hospitals and ICUs were not overwhelmed the way they were in other countries. So it's a good thing that we have that spare capacity. We may need it yet. This could yet go wrong. And I wouldn't like us to make the mistake of relinquishing that capacity only to find out in a few months' time or over the winter that we really need it. It is possible, I think, over the next couple of weeks to use some of that capacity to bring back online some elective healthcare treatments and other interventions that should be happening. But we do need to be wise about it. You know, we would all love to see more orthopaedic operations starting again. But some of those operations can take up an ICU bed for 12 days. And things can change very quickly in 12 days when it comes to this virus. So we just need to be smart about that. It's not a bad thing that we have spare capacity in our health service. It's an unusual experience in Ireland. Not necessarily a bad thing. And we should, I think, retain some spare capacity for as long as we can. Deputy Ryan, I think, spoke very eloquently on the issue of nursing homes, which have been very badly effective. And that is extremely sad and tragic. And we see across Europe between 40 and 60 percent of all deaths are occurring to people who had been residents in nursing homes. And if you think about it, a nursing home is really, really one big household with a lot of staff coming in and out. So it's very hard to keep the virus out. And once it gets in, it's very easy for it to spread. And I think if we were to cocoon people in nursing homes the way we have at home, you'd essentially, as Professor McConkie pointed out, you'd have to put effectively the nursing home into lockdown and have the staff stay overnight and not see their own families. And that would be extremely difficult to do, possibly impossible. So it does raise questions for the future as to what our nursing home model should be and what our elder care model should be. Certainly, I think we'll all agree that we need much more investment in home care so that fewer people have to go to nursing homes as early as they do. The last government was able to increase funding for home care by 40 percent. I doubt the next government will have that kind of money. So we'll have to come up, I think, with a new model for funding home care to make sure that home care is an option for more people for longer. What we've been doing for a long time now is moving towards much more modern nursing homes, replacing nursing homes with 150 or 200 bed single-room occupancy nursing homes. Maybe that wasn't the right answer. We've seen some outbreaks happen in some of the most modern nursing homes. Somewhere like St Mary's in the park, for example, almost all modern buildings, almost all single-room or double rooms under public control, linked with the matter, consultants on site, all of those things. Maybe we need to consider a different model, something similar to what we've done in the disability sector with people in houses of three or four or five rather than big nursing homes of 150, even if they're all single rooms. Maybe I'm wrong. That's the kind of thinking I think we're going to have to think about. And the other issue is the whole issue of clinical governance. It's always been the view up until now that everybody who's a resident of a nursing home is a resident, and they should all be allowed to have their own GP and their own GP of their choice. But the effect of that has been that in a nursing home of 120 or 130 residents, there could be 20 or 30 different GPs, but no one person who's actually in charge as a medical director. There's a person in charge, but they're not a medical person. So we've a lot to think about, I think, across Europe about the future of nursing care and nursing home care as a consequence of this.