Dáil Éireann debate – Thursday, 21 Jan 2021
This morning, many people’s hearts sank on hearing level 5 restrictions are going to continue for at least another month. Infection figures remain stubbornly high. Throughout this pandemic, hospitals have consistently been to the fore regarding new outbreak figures. Not only are hospitals reservoirs for infection of vulnerable people, but they are also sources of new infection in our communities. These outbreaks are taking large numbers of vital front-line medical staff out of our hospitals, leaving the remaining staff struggling to provide care to patients.
As I have said for months on Leaders’ Questions, we must analyse all the available data on Covid infections and make our decisions on what those data are telling us. The data indicate that we need to take a completely new approach to managing infection outbreaks in our hospitals. Last week, I pleaded with the Minister for Health to address the situation with regard to the management of contaminated personal protective equipment, PPE, in our hospitals. I pointed out that hospitals have complained that they do not have enough bins available to them for the amount of PPE waste that is being created. With such a high rate of infections in our hospitals, it gives rise to very significant risks of infection.
This week, we see from the minutes of NPHET’s meeting on 10 December that the team expressed concern and sought clarity as to why mass testing was not being carried out in our hospitals where outbreaks had been detected. The HSE response to these concerns pointed out that decisions on mass testing are being taken locally by hospitals, which seek advice from the local public health department, and with involvement nationally from senior HSE management only where necessary. In plain English, the buck stops with nobody. When there is no one in charge, there is stagnation, leading to hospitals being a reservoir for Covid infection. We will never get our infection figures down unless we address this lack of leadership. This is a position supported by NPHET, which suggested in early December that the HSE establish a national outbreak control team to ensure consistency of approach nationally to addressing hospital outbreaks and engaging in mass testing. Is there anyone in charge of controlling and minimising Covid outbreaks in our hospitals? Where does the buck stop? Can the Tánaiste confirm whether the national outbreak control team has eventually been put in place?
Obviously, the buck stops with the HSE in this regard. I do not know whether the national outbreak team has been established yet. I will find out for the Deputy.
In general, we all appreciate the Covid situation is very serious. We are still seeing more than 2,000 cases per day. More than 200 people are in intensive care, and about 2,000 are in hospital. Case numbers and the number of hospitalisations are starting to fall slightly but not at the pace we would like. While no decision has yet been made on restrictions – a decision will be made by the Cabinet next week – it is fair to say we are nowhere near where we need to be to ease level 5 restrictions. Of course, that does not mean that schools cannot open in February. There is, of course, the possibility of opening more construction sites because they are not supposed to be closed normally in level 5.
The Deputy rightly raises concerns about hospital clusters. We are aware that nursing home and hospital clusters are numerous. Sadly, most deaths occur in nursing homes and hospitals. Indeed, it seems that as many as one third of patients in hospital got Covid in hospital. They did not go in Covid-positive; they picked up Covid while in the hospital. Some may not be sick as a result of it. They may be sick for a different reason but it is still a matter of genuine concern that so many people are acquiring Covid in our hospitals.
Regarding what has been done, the HSE is responsible, as I said earlier. It seeks advice from local public health departments on what to do when there is an outbreak in a hospital. Generally what happens is that there is testing in outbreak areas. If there is an outbreak in a ward, an intensive care unit or another part of the hospital, testing is done there. Mass testing has been done on occasion, as in both University Hospital Limerick and Letterkenny University Hospital, but it is very labour intensive and can divert from the vaccine programme, patient care and other things that need to be done.
On 3 November I asked a parliamentary question on the need for the establishment of a co-ordinated response team to ensure a consistent approach to Covid outbreaks, but when I received a reply on 21 December in advance of the current surge in infections, the HSE was silent on its establishment. In the first week of January, there were 158 outbreaks in our hospitals. Last week, we had a further 37 new outbreaks. Our hospitals should be about making people better, not about picking up a virus that could be deadly.
The Tánaiste will recall that as a result of my persistent highlighting of the Covid infection problems in our meat plants during the first wave of infection, a national outbreak control team was put in place to ensure we would have a consistent national approach to managing Covid outbreaks in those facilities. Regular testing of all staff is now taking place in our meat plants. Surely if we can do this in the meat plants, we should be able to do it for patients, front-line staff and those who will, sadly, need our hospitals over the weeks and months to come.
I will check the position on the national outbreak control team. I am not sure whether it has been established yet, but it is fair to say the settings in question are healthcare settings. Many people in healthcare settings will have Covid and many will have other illnesses. They are very susceptible to Covid, and that is why infection control is so important. Hospitals, nurse managers and doctors are very well trained in infection control and have the support of microbiology teams, for example, to advise them.
When it comes to mass testing, I am not sure how practical it would be to do mass or serial testing in hospitals given the number of them and the number of tests that would have to be done. However, it has been done in Letterkenny University Hospital, where there were major outbreaks. What tends to be done is that testing is done in the outbreak areas within the hospital because it might be in a particular part, ward or department of the hospital. That is done on the advice of the local public health department.