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Now, Donegal, as you know, has joined Dublin, uncovered restriction level three as of midnight tonight, the surge in cases there marks a worrying trend of infection rates creeping up in counties outside the capital. This comes as the House has unveiled its 600 million euro plan for a winter like no other to talk about where we are with the pandemic and the key challenges that lie ahead. Minister of Health Stephen Donnelly joins me now.

Minister, good morning. Good morning, Pat. Donegal, we know, has slipped into the situation where it has to be level three because of very high rates in some places, but an overall county rate that pushes it above Dublin's rate at the moment. How many other counties are on the brink?

Well, it is a very difficult day for Donegal, and I know a lot of families and community groups and businesses will have been very disappointed at what happened at the same time, but spoken to a lot of people in Donegal and they were aware of what was happening. The rate, as you say, it's now the highest in the country. And importantly, it rose very, very quickly. So, Tony, Gold's 14 day incident rate is now about twice the national average.

As you say, there's a wide range across the county. So in one electoral district, Kaduna, for example, it's less than five. But then in at Lifford Stranraer, it's three hundred and thirty six at the same time. Importantly, past the positivity rate for the testing is six percent, which is about three times the national average. So why do people in Donegal are going to be very disappointed? I think there is an acknowledgement within the county that this is the right thing to do.

This is how we save lives. This is how we keep the schools open. And ultimately it's how we keep the health services open and protect jobs. There are no other counties being looked at imminently. And Donegal was the one that just rose very, very quickly. But as the chief medical officer has said, he he referenced my own county. He referenced other counties where we can see the rates. I think what we're seeing hopefully is the advantage of having the road map.

If we if we think back to cancellation. Offaly that people were very concerned and very agitated about the measures they felt, which is sort of came out of the blue to the great credit of those three counties. They took on the public health measures and the virus was brought under control very, very quickly. And but we at least now have a road map and we have the level. So people in Donegal are be it anywhere else, can say, look, the level is rising in my county, the positivity rate is going up.

We may need to move to level three, but we know what happens if we go there. And we know that in other counties it has worked and we get the virus back down. We we open up everything again as much as we can.

Now we are using as statistics. We're looking at the numbers of cases per 100000. I'm just wondering whether that's particularly helpful in Ireland's case because of our small population.

I mean, if you had, for example, an outbreak of 200 cases in a country that has only a population of 200000, that would give you an instant level of 100 per 100000, which would be very worrying, but that those cases could be all centred around one meat plant or one particular small area.

Whereas in Britain, if something like that happens, if you've got 200 cases, it's a drop in the ocean and it doesn't really impact at all very much on their cases per 100000.

Yes, it's the great advantage of the approach we're taking, which is we are, we are this is public health led. So what happened was the National Public Health Emergency Team met yesterday morning. They reviewed the data for the whole country. The chief medical officer and I spoke that the issue was raised with the development of the theCIA. And ultimately, the government took a decision the same day. The advantage of this recommendation coming from Nafiz parties is exactly what you've said, that they're not just looking at the 14 day incidents.

So in Donegal, for example, they were looking at the positivity rate. They were also looking at how is this spreading. So, for example, is this one or two big clusters which are very well contained where we can deploy public health teams, mass test, everybody, ask everyone who is involved to stay home and maybe control it that way. In Donegal, that wasn't the case of the majority of cases are actually linked to private households. We've we've a number of doctors in Donegal saying there's a particularly high level of family outbreaks.

We currently have 19. And so part of what Navot are looking at is not only what is the race, but how quickly is the rate moving and where is it happening? Where are people passing this to each other? And think about.

Yeah, without pillorying individual people, can you give us some idea of the kind of outbreaks you're seeing? I mean, is it related to Holy Communion parties, for example? Is it related to house parties? Is it related to, you know, travelling to work across the border? What is the intelligence telling you from Nevitt?

What it's telling us is that there's a very there's a there's an unusually high level between private households. So, for example, 76 percent of the cases in the last fortnight, that fortnight have been close contact with a with a confirmed case. So the unknown community transmission is less. And as I said, what are saying is it's happening within private households the most. That, for example, is why the measure around only having six people over from at one other household is so important right now.

It's why not having a family and social gatherings outside of the family, home or garden is so important right now. And if I could just reemphasize for for people living in Donegal, but really for all of us, the single best and advice I've heard on this was from our chief medical officer about 10 days ago. And he said, look, this or no, we have to get it below zero at the moment. The latest information I have is as of this morning is that it's about 4.5.

And what Dr. Green said was think about the amount of contacts you were planning on having in the next week or two, family, friends, colleagues, sports, whatever it is, and just rearrange the next week or two to have half that number. And the public health doctors tell us, you know, this spreads from from one of us to there. If we just have the number of contacts we were planning on having, they say that's what drives the number down.

That's what suppresses the virus. And really, that's what the road map is all about. It's about identifying those places that the virus spreads and saying we need to limit these interactions in the short term.

OK, so this idea, you have a communion, the bouncy castle, everyone's invited. That's not on. Simply not on.

Not at the moment. Well, sorry, the level three guideline is you can have up to six people from one other household. So you could well have your communion. You could have, you know, your your mom, your dad, your brother, your sister, your friends, whatever it is, up to six people. And there'd be plenty of room on the bouncy castle, unfortunately, because of that limitation. But it's not that you can't do it, it's that you need to limit the number of people coming into your house at six and importantly from one other household.

And then there's the contention, which is backed up by science, that, you know, younger children don't become as infected as easily. They have some sort of resistance, but some do and, of course, remain asymptomatic. This is not to forget those who are seriously ill in hospital. And there are a number of children quite seriously ill from covid-19.

But the idea there, therefore, we can have a sleepover for eight kids. No, you can't.

No, no, you could. You could for six kids if the six kids are from the same households. So we're not differentiating on age. It's up to six people from from one of our household. However, in what I hope will turn out to be good, scientifically verified news, the experience in Ireland to date in terms of the schools, which obviously is something we're watching very, very closely and is supporting the hypothesis that the schools don't appear to be the main drivers of of covid transmission in the community.

So the emerging evidence here and around the world is children do not transmit the virus as well. Obviously, we've only had this virus for for a matter of months. But but the emerging evidence is is positive in terms of children. Could I could I just add to that? If you if I if I may not doesn't fully apply to young adults. And we are now seeing the chief medical officer and I were discussing this yesterday. We are now seeing around Europe and and in a small number of cases in Ireland, younger people say in their 20s, some of them getting very sick and some of them dying.

And it's partly because there has been a bigger transmission amongst younger people. But we really do need to get the message out that being in your 20s does does not make you immune to this virus at all.

Now, when I was talking to Dr Denis McCallie in Sanaullah, I was talking to him about this posting, which you, I'm sure have been told about by your officials. This is the time for truth. Donegal stroked every Facebook page with 1500 members, and it's about a gathering in Letterkenny. And they say it, you know, doesn't offend against the covid rules.

It's a peaceful assembly defended by the Constitution and they're having it tomorrow. And the idea is that the citizens have a right to come on assembly peacefully, unarmed, according to the Constitution. They want to expose the government for spreading fake news. Now, this is an offence to most people that this in a county that's moved to level three, that this kind of assembly should go ahead.

What are you going to do about it? Well, first of all, can can we just address this straight on, because we have lost nearly 1800 people to this virus so far and we are losing more people all the time. On top of that, there are a lot of people that were getting very sick. They don't appear in the fatality numbers, but they're getting very sick. And we don't know. Is this what the long term impact of this is?

So to people who are thinking about this, the people who are thinking about saying this is nonsense, I'm going to meet up with a lot of people, I'm going to do it explicitly against public health at rules, you're putting yourself at risk. You're putting people, you know, who are vulnerable to this virus at risk. You're putting their lives at risk. You're putting the economy and jobs and schools and health care services in Donegal at risk. So what I would say is, please don't.

We are all in this together.

We're trying to save lives or any endorsements. Those that could divert this march, if March, it is off to a field somewhere so they can go off about their business infecting each other, but leave the rest of the people alone.

Yeah, look, it's an operational matter for the guards as to as to exactly what they want, what they want to do. But as far as health minister, I would say very clearly that this is the wrong message. We are all trying to do this together. And I would say to people, if you care about your local schools, if you care about the health of the people in your community, if you care about local jobs, then listen to the public health doctors and please do what everybody else is doing as well.

OK, now the winter health plan, 600 million, 200 to be spent this year, calendar year, and then 400 million in the part of the winter that occurs next year. More beds, more staff. But I got the impression when I heard the announcements yesterday, there's a bit of kind of magical thinking here. I don't see any great hospital construction going on. I don't know where the beds are coming from. We heard from Liam Dawn, former Jen Sack of the Irmo, saying that the process of actually recruiting a nurse, for example, is endless.

Even people who have preregistration here in another hospital, I mean, what's going to change?

Well, the plant itself part of 600 million, it's on top of two billion that is already being spent on PPY testing and tracing another overcapacity.

But what we are doing where are the where are the beds coming from? Because we know the system has so many beds at the moment, whether it's public or private. Where are these extra beds, the intensive care beds, the acute beds and the stepped down beds where they come from?

No building going on, as you can see.

So so there's a variety of things happening. So take the acute beds. The winter plan includes nearly 900 acute 892 acute beds to the great credit of the HSC. Hundred and nine of them have been opened since covid arrived. But on temporary funding, the winter plan is saying we are continuing that funding to keep those 409 going and we're adding another four hundred and eighty three. What the HSC have done is they have scoured the system. They have looked at hospitals where awards were closed.

They have looked at and existing facilities where wards can be opened up. They are hiring according to staffing those wards. As you say, they're looking at modular units. They're looking at repurposing beds. So, for example, you can take a ward bed at a lot of equipment and specially trained staff to and turn it into an ICU. But it's the right protections around. So the HSC, you're right. What we're having to do is react at a pace and at a scale that has never before been asked of our health care system.

I have to say that based on what I have seen from the HSC so far in terms of their ability and our frontline workers and their ability to open beds, repurposed beds, upgrade beds, and if you think of the acute beds, we're saying at about nine hundred and over 400, those have already been done. So we're going to continue that work. Now, what I want to do is Health Minister, on top of that is come out of the budget, hopefully with funding to start bringing this in as permanent capacity in our health care system, because the winter plan that we are putting in place to deal with probably the most challenging winter this the health services will ever have faced, what we're doing is we're accelerating Silajdzic care to do that.

So what we want to do is we want to put this capacity in place, but put it in place in a new and better way, treat people in their communities, treat people in hospitals where they where they need to be to stock that in permanent good change.

Yeah, you talk about acute beds, which require a certain level of staffing, but not as many at all as an ICU bed, which I think it takes more than 20 people for every one that's created recruitment very slow.

The call to Ireland, people thinking they were coming home to get a job with the HSC.

Instead, it turns out they get agency employment and many of them have just gone back saying this is not for me, this was a card. Yeah, I hear you on that and staffing has been a challenge. It's been a challenge in the HSC for many years. The HSC in the winter plan has acknowledged that and said they are now going to launch the biggest recruitment drive they ever had. How we succeed is we make sure that the Houthi and our public hospitals and our community care facilities are a place where our own people, our own graduates, our own clinicians want to work and they want to stay in Ireland and that Ireland has a reputation internationally whereby people people want to come here.

But you are absolutely right. Staffing has been a challenge for years. The nurses and midwives went out on strike last year at just to get to safe staffing levels, which is part of part of what we're doing. It is going to take a lot of work, but we have to be up to the challenge cos we simply have to be the government has now provided the money and we need to work very closely.

I mean, it's great to talk about being up to the challenge and being nimble and all the rest of it. What's changed in terms of the way nurses are recruitment?

I mean, have recruited do nurse managers now have the powers to actually go chase those nurses they want to employ, whether there are people who are retired or who want to work part time, can they do it themselves without going through all the palaver of recruitment, which can take six to seven months to get someone in Ireland to move hospital?

Yeah, well, certainly it's not a system that's fit for fit for purpose, and it has been raised at long before covid arrived here. And I know that locally, nursing managers, hospital managers see how managers have found it very, very frustrating because of the centralized model that they are looking at. We have to find ways of streamlining. I am a great fan of something called subsidiarity, which basically means push authority and control from the center. As much as you can trust your people, you got to make sure that they're doing the right thing.

We need to see more of this. Again, that is in line with Sloan Choucair, which is all about decentralizing, trusting our trusting our staff in the local areas to to do the right thing. And we're going to have to embrace more of that as we deal with this challenge. Now, some of the comments coming in, one asking, are private people with private health insurance, are they going to be screwed as they were the last time because they couldn't get access to the consultants in private care?

I mean, are you about to take over private hospitals again?

Is that, by the way, the possibility that you might buy some of them rather than spend five, six, seven, eight, nine years trying to build a new hospital?

So the private hospitals are short term agreements with the private hospitals are one of the things we have to look at right now, covid has knocked out somewhere between 20 and 40 percent of the capacity in our system. So, for example, in the hospitals, we have to move from 95 percent occupancy to 85 percent occupancy, and that's about 1100 beds you essentially lose. So we have to make sure that public patients get the care that they need. We are negotiating hospital by hospital with the private hospitals.

I was not a fan. You and I have spoken about this at length before. I was not a fan of the block purchase, if you like, and then taking over and controlling the private hospitals. I understand why it was done. It was done in the heat of Colvert spiking in Ireland, but it's I don't believe it's the right way to go. So we're looking at models that are more around paying per procedure and so forth that's being done.

But the other question of buying out as some of the hospitals, private hospitals, we're told some of them are in financial difficulty. You know, they're not breaking even or they're making losses every year.

We know how long it takes the government to build a hospital and they don't do it particularly well if you look at the children's hospital.

So is there a possibility you start buying capacity from these generally very well tech equipped hospitals?

There's certainly a range of options that can be looked at. I think you very correctly say we do not have a good track record when it comes to building our own hospitals on time or on budget. And so we need to look at a range of possibilities, for example. And can you buy existing facilities? They don't have to be health care facilities, but existing facilities that can be repurposed into elective hospitals. One of the big moves in slow and Choucair that I'm very keen that we progress this coming year is having as much standalone elective activity as possible because we have to deal with the waiting lists and then keep the course to keep some of the bigger level for hospitals, for the emergency departments, the on schedule care and so forth.

We need to be creative because certainly the current approach hasn't worked. We need to add two thousand six hundred beds as quickly as we can. Now, some of the comments coming in, the health service was on the floor before covid, it's still on the floor. Staff are exhausted. Where are the call for Ireland people? You know, the agency staff and other one with no beds, no staff, no doctors.

We will run out. I've been working in Edes in Ireland for the last six years. Things have only gotten worse. The agency staff are already working in the health system. Changing them from agency to directly employed does not add a single person. And there's one question I'll throw in before we conclude so you can answer them all and maybe this one first. Why went pubs in Donegal remain open for 15 outside and yet Dublin. It's still food only outside that you can't.

Even if you have a terrorist, you can't buy a pint without a sandwich. Yeah, I'll answer the last one first, and I understand why people would ask that question. The reason is they were they were starting in different places in terms of the risk. So in Dublin, we had a an escalating situation, which we needed to reduce the risk very, very quickly of the virus spreading. The public health experts recommendation was given that the pubs are closed at a time when we are moving Dublin up the level and introducing measures to restrict the virus.

It would not be medically sound or sound from a public health perspective to then open the pubs. Donegal is in in a different situation where the public health advice is the pubs are now open. We need to reduce the risk and therefore we are reducing the contacts that that come from the pubs. So it's only up to 15 people outdoors. That's why in terms of the staff, can I say I, I hear what your listeners are dialing in and it sounds like you've a lot of people working in emergency.

Sounds like you've got doctors and nurses and allied health professionals getting in touch saying we're under pressure. We've been under pressure for years. We're under more pressure from covid and we're done with listening to nice words. I couldn't agree more.

We have six people going to come from no agency staff because if they're turns into full time employed staff, they're still the same people still working in the system. So where are they going to come from? The Philippines?

From India.

Where are these extra people, Irish people, to be lured back somehow in the middle of a covid pandemic to to come to Ireland? Where are these extra people going to come from?

They're going to come from a variety of sources. And the U.S. are putting a very ambitious recruitment plan together. So, for example, we regularly every year have wonderful graduates from medicine, from nursing, from midwifery, from from therapies, graduate and leave the country. We need to keep them here and we need to keep the foreign clinicians coming in and we need to train of more people. So home carers, for example, I think its feet high level five or six.

So we need to work with further education to invest in that to get more people graduated. We do, I believe, need to move people from agency to full time. It may not create an extra body, but anyone working in health care will tell you that having permanent teams who are there all the time, who are committed to their local area, their local hospital, their local clinical team, it's a much better way of running things. So there is still an advantage there.

So there's a lot of different things we need to do, but we have to move beyond promises. It has to happen. The what is different this year is covered. We simply have no choice but to innovate and adapt and to get the people the government is doing what it can. We put six hundred million euro on the table. That's fifteen times more than last year. It's the biggest one ever. And I'll be looking for further supports, more permanent support through the budget process.

But obviously the dreaded fiscal space is very tight. Essentially what we're doing is we're hiring people, but we're hiring them according to a new way of working, which is the Sloan Choucair plan. So, yes, we are adding nine hundred or about nine hundred beds, acute beds, but we're also looking at nearly five million extra homecare hours, access to diagnostics in the community for over 500 community beds.

And how many how many, you know, professional nursing doctors etc staff are you going to employ? And you have to do it quickly because this flu plus the pandemic could be a toxic mix coming up to Christmas. So what's your target? How many people buy when?

So we're looking at approximately two thousand people for the various acute roles across the hospitals. We're looking at about 3000 for the for the community beds, homes and so forth. We're looking at about three thousand six hundred four at home support and we're looking for about two thousand two hundred for testing and tracing as well by when we need to start immediately. The HSC is the HSC is working on this.

They're very aware that there are processes in place which are cumbersome and we are in the middle of a crisis, 1000, 11000 people are there abouts that you're talking about recruiting and jig time. Yes, yes, we are, we are, we are we are facing into the most challenging winter our country has ever faced. As one of your listeners said before covid arrived here, we had the longest waiting lists, didn't have capacity. covid has made that challenge much, much more difficult.

And we have to respond accordingly. You know, and can I just say to people who are who are questioning this, I wouldn't blame anybody for questioning that. And what I would say, look back at the last six months. Look what our health care professionals and managers have managed to achieve, one of the most comprehensive testing and tracing systems anywhere in the world. From standing start, we have E prescribing in place, we were told for years, couldn't be done to complex.

It was achieved in a matter of weeks, hundreds of isolation rooms, rewiring of care pathways, community assessment homes which have never existed before. Our GP's have stepped up in an extraordinary way in terms of clinical leadership from the community. Like our entire health system, our clinicians are frontline workers, everyone working behind them and are working at a pace and a level of innovation and can do that. That simply has never been required before. They have stepped up and walked.

What I'm doing as minister is saying, thank you. We need to keep going. OK, six, OK, targetable. We have a plan. OK, back to the question.

11000 people recruited by when are we talking about the first of December. So was that a good target? It's not a target like that. That's an operational issue for the U.S., which they're working through at the moment, like it will depend, you know, where we need the home care, where we need testing and tracing, where we need the community, that they're putting a detailed plan together on that at the at the moment, it's not a question of having 5000 people by December or anything like that.

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