Mattie McGrath Demands Clarity on Care for Elderly and Disabled

Minister, I want to ask you about your department, can you confirm your department's position in relation to how people with long-term disabilities and the elderly would present to it, should intensive care units have to be rationed, and you have kind of referred to it already, if your department will amend the ethical framework for the decision making in a pandemic to specify, especially to refer to people with disabilities and the elderly, and if you are concerned with the number of facilities, I am sure you are, and we all are, in nursing homes, if you could please, and I also want to ask the Minister on a separate issue, it's very important as well as health and safety and community response, about the community response, rapid response, air ambulance, which has been grounded, a wonderful initiative that was fundraised for, and got some support from the department, yes, but fundraised for, to get up and running and get off the ground, and expert pilots and response time, and a backup that that has been in the southwest, and in my area as well, and in the east, south east, to help with serious incidents, where the first responders called him in, and the fact that they've been grounded due to their inability to fundraise, in this last while, because of the pandemic, and it's a shameful situation, there are only no inferency, but we're proven, and I have the figures and stats, I'm sure you have them yourself, and we have written to you, as many other TDs have written to you, about, you know, the costs, and the fact that they can't fundraise, and it's been grounded, and it's a very valuable service, and the pilots, and the doctors, and the medics that are there, given their time, are now unable to, unable to, to be on the front line, and to help. Also, Minister, the weekly testing capacity, can they give us a definite, and we need clarity on that, and as to the numbers, and if it's affecting the tracing, the fact that we don't have numbers, we said we don't have numbers county by county, and we have all these centres rolled out, up to 50 centres rolled out, test centres, and I said, they would like to go back, and GA, and GA clubs, and other people that have given their facilities, whether there's payment, or what, there, I don't know, but they've given them, and they've drive through, and they're there, but they're not at full capacity, or they even have capacity, and I know we had the difficulties in getting the testing, the reagents, and commodities for the testing, but nonetheless, we have to expedite the testing, and we have to have results of testing, much sooner, and also, the nursing home, I'm also being told, that one, or two people, two persons, if diagnosed, with the pandemic, with the pandemic, if they're diagnosed as a positive, that that's all, we'll be tested in a nursing home, we won't know, and there's also a worrying thing, I think deputies may have referred to, I've been contacted also, that nurses are now being asked to start to, identify, the cause of death, for patients, I think that's wholly unacceptable, and the nursing home sector, you know, can't be treated as the poor relation, and they have been, we've left them behind, and we're playing catch-up now, but we must treat them, with respect to their deserve, and we must give them the facilities, and the tools of the trade, and we must give clarity, as I said, they were told yesterday morning, that they couldn't get any staff, and on the news in last night, it was saying they could get the staff, so, things are not adding up, so, we need total authority there, and they must be supported in every way, with the PPE equipment, but above all, with staff, especially if they have staff that have had to self-isolate, and stay at home, and they need childcare, they have childcare issues as well, but above all, in the nursing homes, the fact that nurses could be asked to, to certify deaths, and the fact that they haven't got, that they're only two in number, and unfortunately, we don't want any numbers, but if there's two, they could be, as we saw in the care home in Leish, we don't want numbers like that, and we want families entitled to know the cause of their illness. Thank you. Thank you, Deputy McGrath, in relation to his questions, I suppose I do just want to say at the outset, that we are operating in a time where we're trying to do so many things at the same time, in real speed, whereas normally a lot of these things we're discussing about, whether you'd redeploy staff from one place to the other, should you say there'd be months of negotiations, we're doing these things day in, day out, and very much with the World Health Organisation's motto or mantra to mind, that speed trumps perfection, and it has to, and that means we're not going to get everything perfectly right, it means we're going to have to go back and retrofit and tweak things and improve things as we go, but I'm determined that we will do that, and my heart, as you know, and I know yours does too, goes out to every single person who's died and their families in relation to this, and sadly more will in our country, and we're all heartbroken by that painful reality, but I do need to say to the Irish people tuned in, and to your own constituents, that thanks to the efforts they're making, they are saving lives, and I just really think that shouldn't be lost in the context of this discussion. The modelling by our experts predicts that there would be 1,700 deaths in our country by this day next week, if the ore rate, the reproductive number, was at 2.7, that we could have seen 12,300 people die in Ireland by 7 May, so people's efforts are working, but that doesn't take away from the devastating tragedy that you rightly allude to. I'm really pleased that you brought up the issue of people with disabilities, and I want to thank you for doing that, because it's a really important issue, and you're right, it's causing a lot of people concern. The National Public Health Emergency Team, doctors, not politicians, approved the publication of what they call the ethical considerations relating to critical care in the context of COVID-19, and they published it on the 3rd of April. And this document deals with issues relating to the provision of critical care interventions in a situation where ICU capacity is exhausted, and not all patients who require intensive care can be admitted. Now, thankfully, that is not where we're at, and we're all working to make sure we don't arrive at that point. We have 127 vacant critical care beds in the Irish Health Service today, so we're all working to avert such a scenario. But the guidance sets out the criteria for ICU admissions, and it stresses that the allocation procedure must be fair, must be justified, and must be transparent. The document recognises that each patient is unique, and that all clinical judgments will be made on a case-by-case basis. It emphasises the requirement for clinical decisions to be based on an objective assessment of the severity of the patient's current illness, in conjunction with several other interconnected clinical factors, such as the likelihood of benefiting from critical care interventions, and the potential for good clinical outcomes. The document also emphasises that no single factor should be taken in isolation when it comes to accessing intensive care. So age is given as one example. However, I want to say on the record of this House, and I've discussed this with the members of the National Public Health Emergency Team, that that statement equally extends to other factors, including disability. So to be very, very clear, and to provide the reassurance that people are looking for, the guidance makes it clear that everyone is morally equal, every life matters, and everyone will receive care, and no one factor should be taken in isolation, be that age or be that disability. On the issue of the air ambulance that you raised, I know that the Irish Community Rapid Response have been working closely with the National Ambulance Service to examine workable solutions, including process efficiencies to ensure continued provision. I was very pleased, therefore, to hear that the Community Rapid Response are in a position to continue with the provision of their service in the short term. The Munster Helicopter Emergency Medical Service is provided by the ICOR under a service level agreement with the HSE, and under the terms of that agreement, the Community Rapid Response commit to fund all maintenance, repairs, fuel, and other expenses incurred in the provision of the transportation element of the service, and the National Ambulance Service in return commits to providing the clinical staff and consumables. It was never envisaged that Exchequer funding would be required to subvent the service, and the decision to proceed with the service was contingent on that ongoing contribution to the cost of running the service. But I am really grateful, as you are and you are right to be, to the work carried out by them to date. I very much welcome the fact that there is ongoing engagement with the National Ambulance Service to try and find solutions to the current funding difficulties. In relation to the issue of testing, finally, just to say, I mean, like every country in the world, we have been challenged in this regard. We have gone from carrying out just a test where the National Ambulance Service had to visit your home, maybe only if you came back from holidays in Italy or China, to a situation where we are testing a broader group of people. We need to expand that definition again. I am pleased now that the number of tests are over almost 91,000, and indeed a figure I have seen now today, 93,715 tests have been carried out in our country. We are amongst the top countries in the world per head of population for the numbers we are testing, consistently in the top five and often in the top three in the European Union and the UK as well. But we want to do more. We want to do better, and we need to keep doing more and better. But I have to be honest, there are a number of pinch points that countries right around the world are competing for reagent, for supplies, for swab tests. So we are continuing to do that. But Paul Reade, the head of the HSE, has said that he now believes he has secured lab capacity for 10,000 tests. That does not mean there will be 10,000 tests every day done. On an average day at the moment, there is only about 3,500 tests, maybe 4,000 tests being ordered. But it is important that we continue to grow that capacity. So particularly when we move to a point post-restrictions or post-partial, post-some of the restrictions, so that we can survey this virus very, very closely.