Matt Shanahan demands action on delayed Waterford cardiac lab

Eireann, just again we mark condolences for family members who have been bereaved by COVID and also again give thanks to our frontline health care workers and all our health care sector who are doing so much at this very difficult time. Minister, on the 24th of April in this House you expressed to me your wish to see the second Waterford Cardiac Catlab build developed to a construction tender award as soon as possible. In the House last Thursday, Taoiseach Varadkar also committed himself to seeing this project over the line while acknowledging the inordinate delay it has suffered since first being announced on the 18th of September 2018. I would like to thank you both the senior ministers in government and members of cabinet for your stated public commitments to this project. This development has suffered inexplicable delays since your original order to approve. In fact, 20 months have elapsed and we have yet to approve to a formal build tender for construction. Given, as said, the inordinate unexplained delays, can I ask you, Minister, on behalf of the people of Waterford and the South East, if you will provide to South East Oireachtas members a contact liaison within your department concerning this project development. Your department has issued and circulated completely new timelines for this development, and I believe elected representatives could provide support to ensure that further slippage in proposed delivery schedules are avoided. I believe everyone in this House understands well the significant COVID pressures that are dominating health planning at present minister, but I think appointing a department liaison available to South East Oireachtas members will deliver enormous comfort to the people of Waterford and the South East, while we await the second cardiac catheterisation laboratory and the improved standard of regional care it will help to deliver. To other health matters minister relating to COVID risk and disease management, on April the 23rd, I asked in this House the question as to why senior nursing staff in residential care sittings are not being asked, tasked and trained to take COVID swab tests of residents in their care. I believe it is happening in a small number of centres, but clearly on-site staff managing this activity will help improve turnaround times that are so critical to the safe running of residential care homes. It will also minimise the trauma to vulnerable patients by having invasive swab testing taken by people known to them. As well as taking patient duress into account, faster response times improve the management of isolation needs and possible staff shortages where self-isolation is required. Indeed, faster test turnarounds also reduce the COVID care burden protocols where a negative test result is found. Can we agree, minister, that it should not take weeks of deep analysis to decide if we should let nurses nurse? I know that for some small training may be required, but I believe that every qualified nurse working in the residential, long-stay and short-stay settings are more than capable of managing this task, and would be happy to do so as a proactive infection control measure to safeguard the patients in their care. Can I also highlight another significant headwind to the private nursing home sector minister? Over 100 small nursing homes are facing a renewal of insurance over the coming weeks and months and have been advised that there is no business interruption cover or liability cover on offer for anything COVID-19 related. Lack of liability cover is a major concern as these operations do not have the financial reserves to protect them against a significant COVID-related injury claim. Many of these homes are already losing revenue because of keeping isolation capacity available and allowing them to be further unsupported because of our dysfunctional insurance environment will force many to close their doors permanently. It will be ironic if government action to save residential care lives cannot be harnessed to support these same patients who are at risk of losing their present care facility and their quality of life because of insurable risks. I would ask your department to seriously look at this, Madam Minister. Also, with respect to nursing homes, you recently announced the creation of a COVID-19 nursing home review panel. The panel complement does not have a contributing member from the nursing home sector who would have recent direct and material experience of the challenges that befell nursing homes with the arrival of COVID-19. I personally feel this is a lost opportunity, Minister, to examine and understand fully the sectoral problems and I would ask you to consider the appointment of such a person to this review body. As part of continuing NEFID COVID planning, it appears to me, Minister, your Department of Health may wish to extend the private hospital's contract for a further period. I and members of the regional group are of the opinion that conditions and terms of this contract need to be significantly reviewed and revised before the government commits any further extension. Given the considerable costs involved, €115 million per month, both bed occupancy and service activity at private centres must be maximised where presently they are well below available capacity. Although some elective procedures and day-case services have been decanted from the public hospitals to private hospital settings, these are largely being carried out by public doctors. This is because a significant number of clinicians operating as private subcontractors in the private health care area have found themselves prevented with changed working conditions to which they cannot agree as they have no offer of recompense for the overall cost overheads they are forced to carry. The private hospitals deal secure the facilities minister, but not all of the staff that provide the clinical services. These private consultants operate on a fee per procedure model reimbursed by private health insurers, but since this contract was initiated, insurance fees have not been payable for such activity. This is having a significant effect on both public and private waiting lists, as these doctors could be treating both hospital patient streams under the present arrangement if revised. I as a member of the regional group would ask you minister that if you are minded to extend the private hospitals contract that you sit with the health insurers, VHI, Irish Life and Leia Healthcare and devise a new temporary service contract arrangement to include these subcontracting clinicians. A new arrangement could ensure both our public and private patient streams and can benefit from maximum participation of all medical caregivers. As we welcome the continuation of phased release from required lockdown measures, minister, many of us are cognisant of the possibility of a future observed in COVID infection rates and possible increase in hospital activity. Having said that, I believe it's also fair to say that we have learned a huge amount about the transmission, management and mitigation options to this disease that will hopefully guide us in developing appropriate balance strategies going forward. One of the analytical tools that is required for greater understanding of COVID impact is publication of patient range data by decade of life for COVID infection rates and clinical outcomes. This data, purely for statistical analysis, should record just the gender, the age, the care pathway and the clinical outcome and should not create any data privilege issue. This information is clearly needed to risk assess forward strategy and I would ask you, minister, to prevail on an effort to publish to allow for greater and wider analysis by our national healthcare experts. As we extend into 2020, I believe our society is coming to terms with living with COVID-19 while we await some breakthrough in medical science to overcome this virus. We must now plan and begin again to rebuild our shattered economy with specific attention on our SME component. Having this pertinent data will allow both public and private thought leaders contribute to best planning, mitigation and treatment strategies going forward. It will also allow for more effective public health planning policy into the future and in so doing, hopefully ensure that we have learned from some of the avoidable mistakes of the past and have made adequate provision for the future. Thank you, minister. Thank you very much, Mr Deputy Deputy Sean. Yes, as a short answer, I will arrange for somebody in the department to liaise with the South East deputies. It was quite a good arrangement back when we were all allowed to meet in person in the last Oireachtas and I will be very eager to keep that up where we bring the local representatives together to try and provide us with the benefit of the local knowledge and the local connections that they have on the ground to get this project moving. I want to see the delivery of this cath lab. I do note those new timelines you talk about. I know the contractor selection is underway. The tender is going to be completed during the summer months and then construction commence in the autumn, but there can't be any more slippage. I get that and I know we're all eager to see that delivered. In relation to the issue of testing by nurses and long-term residential care facilities, you'll be glad to know, not only do I now agree with you, but Dr Tony Houlin and others also agree with you as well, as does the HSE. So that will certainly be a part of our testing strategy in relation to nursing homes. The testing strategy, if you like, how do we have all this extra capacity now, how do we best use that, is going to be considered further by NPHET at its meeting tomorrow. In relation to the insurance industry and the renewal of insurance premia, I met with Nursing Homes Ireland on this matter this week, I think, and we asked an official to link with them. They were going to provide examples of nursing homes experiencing challenges in this regard that we were going to then provide to colleagues in the Department of Finance. I'm also conscious the central bank has a role in relation to this from a consumer protection point of view and I would hate to hear or see any price gouging or any attempt by an insurance company to make a quick book off the back of nursing homes and most importantly, the interest of residents in nursing homes during this pandemic. So we should all keep a very close eye on that and I certainly intend to. In relation to the nursing home expert review panel, I take your point about the need for certain expertise. I spoke to the chairperson of the group, Professor Cecily Keller, yesterday, a very eminent public health lead. She'll chair the group. There'll be a geriatrician, a senior nurse and a public advocate. I've made it clear to her, though, if she needs further inputs or further membership that I look very favourably on how she advises that. But one way or the other, there will be significant consultation. On the private hospitals, as I've said already on the record of this House, government will consider this matter further on Friday. We will need extra capacity. But what is the right agreement going forward is something under consideration. And in relation to the issue of data, I'll ask the HPSC to see if we can provide that information. Thank you. Thank you. Thank you.