theirishtimes--2020-05-14--Coronavirus: Report warns over ‘financial sustainability’ of childcare sector

The childcare sector is facing significant financial , logistical and public health challenges associated with reopening in the coming months , according to a confidential Department of Children and Youth Affairs document .
It comes as Minister Katherine Zappone cancelled a scheme designed to give healthcare workers childcare in the home , after just six providers applied to join the programme .
“ It has become clear that the low uptake is unlikely to change , ” the department said .
“ While the home-based approach met public health requirements , the provision of this type of model raised other @ @ @ @ @ @ @ generally about potential health impacts amidst continued strict social distancing rules.
” A document , prepared in the department , which has been seen by The Irish Times , says many businesses could be threatened due to public health considerations limiting their capacity to earn income , while parents are unable to cover costs associated with higher fees .
Concerns have also been raised around poor working conditions in the sector and the impact of illness and self-isolation associated with Covid-19 , with a risk that there may not be sufficient numbers of @ @ @ @ @ @ @ are lifted .
This is despite Taoiseach Leo Varadkar saying on Wednesday that reopening childcare facilities is “ among the safest things that we can do over the next couple of months ” .
The warnings are contained in draft terms of reference prepared for a group examining the phased reopening of the sector , which met for the first time on Wednesday .
It flags concerns around “ maintaining social distancing among young children and those caring for them ” , as well as meeting parental demand for childcare from families as @ @ @ @ @ @ @ while restricting capacity and thereby reducing adult-child ratios ” .
On financial risk , the document identifies “ financial sustainability of the sector when capacity restrictions limit income and parents can not afford to cover any higher costs with higher fees ” .
There are also concerns around ensuring there are sufficient staff in the sector “ given ongoing likelihood of sickness and self isolation , reduced adult-child ratios , low wages and poor working conditions ” .
The failure of the long-planned healthcare scheme to get off the ground was blamed on @ @ @ @ @ @ @ the home based approach met public health requirements , the provision of this type of model raised other difficulties , ” the department said .
Despite the failure of the scheme and challenges to the sector , operators are considering ideas from elsewhere in Europe to aid reopening , include the concept of “ bubbling ” , where children from the same set of families are educated together in the same group , or “ bubble ” every day , therefore minimising the risk of widespread infection throughout a creche if one of @ @ @ @ @ @ @ increased use of outdoor facilities is also possible .
Operators in the sector who have sufficient physical space are also looking at how that could be subdivided further .
However , some believe regulations may have to be changed in order to permit new arrangements .
The closure of creches , as part of one of the first raft of measures introduced to slow the spread of Covid-19 , affected more than 200,000 children and their parents .
The reopening of the sector is seen as key to facilitating the return to work @ @ @ @ @ @ @ securing the future of 31,000 workers and thousands of businesses in the sector .
Under the reopening road map , special childcare arrangements for healthcare workers will begin on May 18th .
On June 29th , creches are due to open in a phased manner for children of essential workers .
On July 20th , they are due to open for children of all other workers “ on a gradually phased basis ” .
Sources in the childcare sector said there are mounting concerns about the future viability of many businesses , as @ @ @ @ @ @ @ going back to work while maintaining public health standards .
Under a special Covid-19 scheme , the vast majority of wages in the sector are currently being paid by the State , over and above the level granted in the general income support scheme , thanks to top-ups provided by the Department of Children and Youth Affairs .

The closure of creches, as part of one of the first raft of measures introduced to slow the spread of Covid-19, affected more than 200,000 children and their parents. Photograph: Frank Perry/AFP/GettyImages
The childcare sector is facing significant financial, logistical and public health challenges associated with reopening in the coming months, according to a confidential Department of Children and Youth Affairs document.
It comes as Minister Katherine Zappone cancelled a scheme designed to give healthcare workers childcare in the home, after just six providers applied to join the programme.
“It has become clear that the low uptake is unlikely to change,” the department said.
“While the home-based approach met public health requirements, the provision of this type of model raised other difficulties, and the sector were concerned generally about potential health impacts amidst continued strict social distancing rules.”
READ MORE
A document, prepared in the department, which has been seen by The Irish Times, says many businesses could be threatened due to public health considerations limiting their capacity to earn income, while parents are unable to cover costs associated with higher fees.
Concerns have also been raised around poor working conditions in the sector and the impact of illness and self-isolation associated with Covid-19, with a risk that there may not be sufficient numbers of qualified professionals in the sector as restrictions are lifted.
This is despite Taoiseach Leo Varadkar saying on Wednesday that reopening childcare facilities is "among the safest things that we can do over the next couple of months".
The warnings are contained in draft terms of reference prepared for a group examining the phased reopening of the sector, which met for the first time on Wednesday.
It flags concerns around “maintaining social distancing among young children and those caring for them”, as well as meeting parental demand for childcare from families as the economy reopens, “all the while restricting capacity and thereby reducing adult-child ratios”.
On financial risk, the document identifies “financial sustainability of the sector when capacity restrictions limit income and parents cannot afford to cover any higher costs with higher fees”. There are also concerns around ensuring there are sufficient staff in the sector “given ongoing likelihood of sickness and self isolation, reduced adult-child ratios, low wages and poor working conditions”.
Healthcare scheme
The failure of the long-planned healthcare scheme to get off the ground was blamed on insurance and other issues. “While the home based approach met public health requirements, the provision of this type of model raised other difficulties,” the department said.
Despite the failure of the scheme and challenges to the sector, operators are considering ideas from elsewhere in Europe to aid reopening, include the concept of "bubbling", where children from the same set of families are educated together in the same group, or "bubble" every day, therefore minimising the risk of widespread infection throughout a creche if one of them falls ill with Covid-19. An increased use of outdoor facilities is also possible.
Operators in the sector who have sufficient physical space are also looking at how that could be subdivided further. However, some believe regulations may have to be changed in order to permit new arrangements.
The closure of creches, as part of one of the first raft of measures introduced to slow the spread of Covid-19, affected more than 200,000 children and their parents. The reopening of the sector is seen as key to facilitating the return to work for many parents, as well as securing the future of 31,000 workers and thousands of businesses in the sector.
Under the reopening road map, special childcare arrangements for healthcare workers will begin on May 18th. On June 29th, creches are due to open in a phased manner for children of essential workers. On July 20th, they are due to open for children of all other workers “on a gradually phased basis”.
Mounting concerns
Sources in the childcare sector said there are mounting concerns about the future viability of many businesses, as well as how they can realistically handle going back to work while maintaining public health standards.
Under a special Covid-19 scheme, the vast majority of wages in the sector are currently being paid by the State, over and above the level granted in the general income support scheme, thanks to top-ups provided by the Department of Children and Youth Affairs.


theirishtimes--2020-05-14--New plan for Covid-19 testing commits to 72-hour turnaround time

A new plan for Covid-19 testing is to be published on Thursday committing to a 72-hour turnaround time for the the completion of test and contact tracing , as well as the long-promised target of 100,000 tests per week .
The Health Service Executive plan will form a core part of new safeguards that will support the process of gradually easing restrictions from May 18th .
The HSE testing arrangements will contain a series of key performance indicators , including the number of tests per week , the turnaround time for results and targets for contact tracing .
It comes @ @ @ @ @ @ @ from when a test is taken to results returning to the patient .
Most experts recommend a 72-hour timeframe .
Health officials have promised improvements , and have highlighted a range of technical issues including data-entry errors , a lack of automation and systems that can not interact with each other which are delaying the issuing of results .
The State claimed in March that it could achieve as many as 15,000 tests each day , later revised to 100,000 a week .
However , until recent weeks the number of tests carried @ @ @ @ @ @ @ , which has contributed to the delays .
Taoiseach Leo Varadkar said on Wednesday he accepted some targets had not been met , but he said the HSE was now in a position to carry out 100,000 tests per week .
He was confident the HSE could achieve a 72-hour turnaround time for test results and tracing .
“ I absolutely accept criticisms from anyone that says we should have done that sooner , but I can also guarantee that absolutely everyone across the system is pulling out all the stops to get @ @ @ @ @ @ @ is absolutely to have a test result turnaround time of 72 hours , but it ’ ll never be 100 per cent , you know .
There isn ’ t a test that I ’ m aware of where you get the results within 72 hours 100 per cent of the time.
” Fianna Fáil health spokesman Stephen Donnelly said the median turnaround for test results was currently five days , far short of the target of three days .
He said the figures supplied to him by the HSE were “ hugely @ @ @ @ @ @ @ it is taking so long.
” His Sinn Féin counterpart , Louise O ’ Reilly , said it was more than six weeks since the target of 15,000 per day was announced .
“ They missed it and there is nothing to suggest that another target will help .
The target is meaningless without the necessary tracing and isolation facilities.
” The HSE said on Wednesday evening that the median time from referral for testing to the completion of contact tracing was “ circa four days when you consider hospitals and community together @ @ @ @ @ @ @ taken in hospitals or residential settings – take a median time of five days to complete the process , whereas hospital cases take a day to complete testing and another day for tracing , although this can be longer in complex cases .
Such complex cases are more common in hospitals and care homes or direct provision centres as there may be more contacts , or there may be language barriers or complications arising from a person ’ s illness or even death .
“ The recent testing of residential care facilities was @ @ @ @ @ @ @ of results as there were thousands of residents and staff across over 600 settings .
This process obviously pushes out the average time for contact tracing , ” the HSE said .
It said that it had no accurate figures on the split between complex and non-complex cases at the moment , but prior to the mass testing of nursing homes , “ approximately 80 per cent of cases were marked as routine ” .
A senior HSE source told The Irish Times that the majority of tests would be turned around in @ @ @ @ @ @ @ always be outliers for more complex cases ” .

The HSE testing arrangements will contain key performance indicators, including the number of tests per week, the turnaround time for results and targets for contact tracing
A new plan for Covid-19 testing is to be published on Thursday committing to a 72-hour turnaround time for the the completion of test and contact tracing, as well as the long-promised target of 100,000 tests per week.
The Health Service Executive plan will form a core part of new safeguards that will support the process of gradually easing restrictions from May 18th.
The HSE testing arrangements will contain a series of key performance indicators, including the number of tests per week, the turnaround time for results and targets for contact tracing.
It comes after criticism of the nine-day average turnaround from when a test is taken to results returning to the patient. Most experts recommend a 72-hour timeframe.
READ MORE
Health officials have promised improvements, and have highlighted a range of technical issues including data-entry errors, a lack of automation and systems that cannot interact with each other which are delaying the issuing of results.
The State claimed in March that it could achieve as many as 15,000 tests each day, later revised to 100,000 a week. However, until recent weeks the number of tests carried out has fallen well short of targets, which has contributed to the delays.
Taoiseach Leo Varadkar said on Wednesday he accepted some targets had not been met, but he said the HSE was now in a position to carry out 100,000 tests per week. He was confident the HSE could achieve a 72-hour turnaround time for test results and tracing.
“I absolutely accept criticisms from anyone that says we should have done that sooner, but I can also guarantee that absolutely everyone across the system is pulling out all the stops to get to this point.
“The target is absolutely to have a test result turnaround time of 72 hours, but it’ll never be 100 per cent, you know. There isn’t a test that I’m aware of where you get the results within 72 hours 100 per cent of the time.”
Three days
Fianna Fáil health spokesman Stephen Donnelly said the median turnaround for test results was currently five days, far short of the target of three days.
He said the figures supplied to him by the HSE were “hugely underwhelming… It is very disappointing to hear it is taking so long.”
His Sinn Féin counterpart, Louise O’Reilly, said it was more than six weeks since the target of 15,000 per day was announced. “They missed it and there is nothing to suggest that another target will help. The target is meaningless without the necessary tracing and isolation facilities.”
The HSE said on Wednesday evening that the median time from referral for testing to the completion of contact tracing was “circa four days when you consider hospitals and community together”.
Community tests – those not taken in hospitals or residential settings – take a median time of five days to complete the process, whereas hospital cases take a day to complete testing and another day for tracing, although this can be longer in complex cases.
Such complex cases are more common in hospitals and care homes or direct provision centres as there may be more contacts, or there may be language barriers or complications arising from a person’s illness or even death.
Challenging
“The recent testing of residential care facilities was particularly challenging in ensuring the timely notification of results as there were thousands of residents and staff across over 600 settings. This process obviously pushes out the average time for contact tracing,” the HSE said.
It said that it had no accurate figures on the split between complex and non-complex cases at the moment, but prior to the mass testing of nursing homes, “approximately 80 per cent of cases were marked as routine”.
A senior HSE source told The Irish Times that the majority of tests would be turned around in 72 hours, but there would “always be outliers for more complex cases”.


theirishtimes--2020-05-13--Covid-19: Testing and tracing delays will not defer lifting of restrictions, says Holohan

Delays in reducing the time it takes to test and trace the contacts of new Covid-19 cases will not affect the decision on whether to ease lockdown restrictions next Monday , the State ’ s chief medical officer has said .
Technical issues have delayed the time it takes to test infected people and trace their contacts , but Dr Tony Holohan insisted that this would not be a factor in the decision of the State ’ s National Public Health Emergency Team on sanctioning the first wave of lockdown relaxations .
“ I am not anticipating that we will @ @ @ @ @ @ @ is going to limit us in terms of easing restriction , ” he said at the Department of Health Covid-19 briefing on Wednesday .
The department announced that 10 more people have died in the State from Covid-19 , the lowest daily death toll since late March , and that there were 159 new cases of the virus .
These latest figures brought overall coronavirus-related fatalities here to 1,497 , of which 55 per cent , or 818 people , were nursing home residents .
There are now 23,401 confirmed cases of the @ @ @ @ @ @ @ has proposed allowing up to four people not from the same household to meet outdoors from Monday and the reopening of some retail outlets such as garden centres , but health officials will make a final decision on sanctioning this based on infection rates and hospital figures .
Dr Holohan pointed to continuing improvements in relation to testing and contact tracing over the coming days and that the “ trajectory ” of improvement will continue “ all the way up to Monday ” .
In a setback to the Government ’ s Covid-19 @ @ @ @ @ @ @ and Youth Affairs Katherine Zappone on Wednesday night announced the scrapping of a scheme to provide temporary childcare to healthcare workers – launched just last week to provide childcare at home for front-line medics – due to the low take-up by childcare providers .
Only six providers signed up to be part of the service , with owners citing difficulties with insurance cover and concerns over possible transmission of the virus for the low number .
The HSE will pledge in a new plan to be unveiled on Thursday that Covid-19 test results @ @ @ @ @ @ @ within 72 hours – down from a nine-day average turnaround time that health specialists say is not fast enough to fight the pandemic .
The plan , aimed at supporting the process of gradually easing restrictions from Monday , will set out a series of key performance indicators , including the number of tests per week , the turnaround time for results and the targets for faster contact tracing .
Dr Holohan dismissed the possibility of schools reopening earlier than planned , playing down the Taoiseach ’ s enthusiasm that this could happen @ @ @ @ @ @ @ on Wednesday that reopening schools for children “ over the next couple of months ” was “ among the safest things ” that the State could do in light of latest medical research .
Dr Holohan said that there was “ a very small number of studies ” on the issue involving “ small numbers of children ” , but insufficient evidence to change official advice on reopening schools .
No consideration had yet been given to the wearing of face coverings in classrooms when schools are due to reopen in September , @ @ @ @ @ @ @ Taoiseach ’ s intention had been to put the education system on notice that schools would reopen in September and to combat claims that this may not be possible .
Sources suggested schools could reopen earlier , by about a week or so , to allow children with special needs to reacquaint themselves with the school setting before term starts , while teachers and staff could be allowed back in the opening phases to prepare for the school year .
Dr Holohan said he was still advising against non-essential travel in or out @ @ @ @ @ @ @ pushing for borders to reopen in order to revive travel in the June-August holiday season .

Delays in the testing and tracing system for Covid-19 will not affect the decision on whether to ease lockdown restrictions next Monday, the State’s chief medical officer has said. File photograph: Olivier Douliery/AFP via Getty Images
Delays in reducing the time it takes to test and trace the contacts of new Covid-19 cases will not affect the decision on whether to ease lockdown restrictions next Monday, the State’s chief medical officer has said.
Technical issues have delayed the time it takes to test infected people and trace their contacts, but Dr Tony Holohan insisted that this would not be a factor in the decision of the State's National Public Health Emergency Team on sanctioning the first wave of lockdown relaxations.
"I am not anticipating that we will be in a situation whereby that performance is going to limit us in terms of easing restriction," he said at the Department of Health Covid-19 briefing on Wednesday.
The department announced that 10 more people have died in the State from Covid-19, the lowest daily death toll since late March, and that there were 159 new cases of the virus.
READ MORE
These latest figures brought overall coronavirus-related fatalities here to 1,497, of which 55 per cent, or 818 people, were nursing home residents. There are now 23,401 confirmed cases of the virus in the country.
The Government has proposed allowing up to four people not from the same household to meet outdoors from Monday and the reopening of some retail outlets such as garden centres, but health officials will make a final decision on sanctioning this based on infection rates and hospital figures.
Dr Holohan pointed to continuing improvements in relation to testing and contact tracing over the coming days and that the “trajectory” of improvement will continue “all the way up to Monday”.
Childcare scheme
In a setback to the Government's Covid-19 response, however, Minister for Children and Youth Affairs Katherine Zappone on Wednesday night announced the scrapping of a scheme to provide temporary childcare to healthcare workers – launched just last week to provide childcare at home for front-line medics – due to the low take-up by childcare providers.
Only six providers signed up to be part of the service, with owners citing difficulties with insurance cover and concerns over possible transmission of the virus for the low number.
The HSE will pledge in a new plan to be unveiled on Thursday that Covid-19 test results and contact tracing will be turned around within 72 hours – down from a nine-day average turnaround time that health specialists say is not fast enough to fight the pandemic.
The plan, aimed at supporting the process of gradually easing restrictions from Monday, will set out a series of key performance indicators, including the number of tests per week, the turnaround time for results and the targets for faster contact tracing.
Schools reopening
Dr Holohan dismissed the possibility of schools reopening earlier than planned, playing down the Taoiseach’s enthusiasm that this could happen sooner.
Leo Varadkar had said earlier on Wednesday that reopening schools for children "over the next couple of months" was "among the safest things" that the State could do in light of latest medical research.
Dr Holohan said that there was “a very small number of studies” on the issue involving “small numbers of children”, but insufficient evidence to change official advice on reopening schools.
No consideration had yet been given to the wearing of face coverings in classrooms when schools are due to reopen in September, he said.
Government sources suggested the Taoiseach’s intention had been to put the education system on notice that schools would reopen in September and to combat claims that this may not be possible.
Sources suggested schools could reopen earlier, by about a week or so, to allow children with special needs to reacquaint themselves with the school setting before term starts, while teachers and staff could be allowed back in the opening phases to prepare for the school year.
Dr Holohan said he was still advising against non-essential travel in or out of the country, despite the EU pushing for borders to reopen in order to revive travel in the June-August holiday season.


theirishtimes--2020-05-15--Child sex abuse in scouts ‘tolerated’ at top level

Child sexual abuse was “ tolerated ” at the highest levels of former scouting organisations , with the crimes of those who preyed on children covered up to protect the reputation of the movement , a damning report has concluded .
There is evidence that groups of sex offenders operated at the top of Scouting Ireland ’ s legacy organisations to protect each other and “ facilitate ” child abuse , a report by child protection expert Ian Elliott found .
The Government is to consider the findings of the report and decide whether a statutory inquiry into the historic @ @ @ @ @ @ @ there are concerns over whether such an inquiry would be able to uncover substantially more information , according to sources .
Scouting Ireland made a full organisational apology on foot of the report ’ s publication on Thursday .
The historic abuse relates to the Catholic Boy Scouts of Ireland ( CBSI ) and the Scout Association of Ireland , which merged to form Scouting Ireland in 2004 .
The report said one of the legacy bodies was a “ seriously dysfunctional organisation ” , with “ sex offenders dominating the leadership for @ @ @ @ @ @ @ former organisations were defined by “ cronyism ” and poor governance , which led to a consistent failure to report child abuse to authorities , it said .
There was an “ almost complete absence of any concern for the young people who were abused ” , the report found .
Scouting Ireland has now identified 356 alleged victims of historic abuse , and 275 alleged perpetrators , who primarily operated between the 1960s and 1990s .
Mr Elliott had been investigating the scale of the historical abuse on behalf of Scouting Ireland @ @ @ @ @ @ @ work was limited due to current Garda investigations into several alleged abusers , and a “ systematic failure ” of the former organisations to maintain records on abuse allegations , the report said .
In one case an alleged abuser who held a senior position kept child abuse case files at his home , to prevent the incidents being investigated , it said .
The “ negligence ” of Scouting Ireland in failing to secure records related to abuse cases upon the merger of the two former bodies meant the “ full extent @ @ @ @ @ @ @ be known , the report said .
There was a “ close link ” between CBSI and the Catholic Church , and the report said some clerical sex offenders found “ acceptance of their practices ” in the scouting body , particularly during the 1980s and 1990s .
“ Some people who were not themselves offenders were complicit in the cover-up of credible allegations of abuse , with the intention of protecting the scouting movement , ” the report said .
Even in cases where volunteers were facing multiple abuse allegations , “ @ @ @ @ @ @ @ being acted upon ” , it said .
There is evidence that sex offenders operated in groups at the top level of the legacy organisations , “ preventing any attempts to hold an alleged offender accountable for their actions if they were part of their group ” , the report said .
This culture of cronyism resulted in individuals facing abuse allegations being moved “ sideways ” or promoted within the organisations , rather than removed .
This occurred to the extent abuse was “ known about and tolerated ” in some situations @ @ @ @ @ @ @ the report said .
Individuals facing child abuse allegations were permitted to move between scout troops , or between the two legacy organisations , it said .
Minister for Children Katherine Zappone said the report “ lays bare the horrors of what happened when sex offenders gained positions of power and became untouchable ” , Adrian Tennant , chairman of Scouting Ireland ’ s board , said the organisation apologised unreservedly “ to the victims and survivors of abuse in scouting who were failed ” .
Mr Tennant said sexual predators had “ @ @ @ @ @ @ @ young people and “ destroy lives ” .
The youth organisation accepted the findings of Mr Elliott ’ s report in full and would implement its recommendations , he said .

Child sexual abuse was “tolerated” at the highest levels of former scouting organisations, with the crimes of those who preyed on children covered up to protect the reputation of the movement, a damning report has concluded. Photograph: The Irish Times
Child sexual abuse was “tolerated” at the highest levels of former scouting organisations, with the crimes of those who preyed on children covered up to protect the reputation of the movement, a damning report has concluded.
There is evidence that groups of sex offenders operated at the top of Scouting Ireland's legacy organisations to protect each other and "facilitate" child abuse, a report by child protection expert Ian Elliott found.
The Government is to consider the findings of the report and decide whether a statutory inquiry into the historic abuse may be required. However, there are concerns over whether such an inquiry would be able to uncover substantially more information, according to sources.
Scouting Ireland made a full organisational apology on foot of the report's publication on Thursday. The historic abuse relates to the Catholic Boy Scouts of Ireland (CBSI) and the Scout Association of Ireland, which merged to form Scouting Ireland in 2004.
READ MORE
The report said one of the legacy bodies was a “seriously dysfunctional organisation”, with “sex offenders dominating the leadership for decades”.
The culture of the former organisations were defined by “cronyism” and poor governance, which led to a consistent failure to report child abuse to authorities, it said. There was an “almost complete absence of any concern for the young people who were abused”, the report found.
Scouting Ireland has now identified 356 alleged victims of historic abuse, and 275 alleged perpetrators, who primarily operated between the 1960s and 1990s.
Mr Elliott had been investigating the scale of the historical abuse on behalf of Scouting Ireland for more than a year. His work was limited due to current Garda investigations into several alleged abusers, and a “systematic failure” of the former organisations to maintain records on abuse allegations, the report said.
In one case an alleged abuser who held a senior position kept child abuse case files at his home, to prevent the incidents being investigated, it said.
The “negligence” of Scouting Ireland in failing to secure records related to abuse cases upon the merger of the two former bodies meant the “full extent” of the past abuse cannot be known, the report said.
Church links
There was a "close link" between CBSI and the Catholic Church, and the report said some clerical sex offenders found "acceptance of their practices" in the scouting body, particularly during the 1980s and 1990s.
“Some people who were not themselves offenders were complicit in the cover-up of credible allegations of abuse, with the intention of protecting the scouting movement,” the report said.
Even in cases where volunteers were facing multiple abuse allegations, “attempts were made to suppress these allegations being acted upon”, it said.
There is evidence that sex offenders operated in groups at the top level of the legacy organisations, “preventing any attempts to hold an alleged offender accountable for their actions if they were part of their group”, the report said.
This culture of cronyism resulted in individuals facing abuse allegations being moved “sideways” or promoted within the organisations, rather than removed. This occurred to the extent abuse was “known about and tolerated” in some situations, and abusers “protected”, the report said.
Individuals facing child abuse allegations were permitted to move between scout troops, or between the two legacy organisations, it said.
Minister for Children Katherine Zappone said the report "lays bare the horrors of what happened when sex offenders gained positions of power and became untouchable",
Adrian Tennant, chairman of Scouting Ireland's board, said the organisation apologised unreservedly "to the victims and survivors of abuse in scouting who were failed".
Mr Tennant said sexual predators had “used the movement” to prey upon young people and “destroy lives”. The youth organisation accepted the findings of Mr Elliott’s report in full and would implement its recommendations, he said.


theirishtimes--2020-05-15--Up to 600 meat-plant workers have Covid-19

As many as 600 meat processing workers have tested positive for Covid-19 , according to Siptu .
The claim comes as concerns mount that the pattern could follow nursing homes .
In the Dáil on Thursday , Fianna Fáil leader Micheál Martin said the situation was now “ gravely serious ” .
Siptu says up to 15 workers in the Republic have been hospitalised by the illness and there has been one fatality in Northern Ireland .
On Thursday , the Dáil was told of reports that about 60 employees at Rosderra Meats ’ Edenderry plant in Co Offaly had @ @ @ @ @ @ @ test results due .
Earlier this month the Dáil was told of about 100 confirmed cases at its plant in Roscrea , Co Tipperary .
The company has not yet responded to the claims but said the safety and welfare of employees is of the utmost importance and that it is being extremely vigilant with protective measures for infection control .
While the industry itself has said it has taken a number of steps to address the problems , the matter received considerable attention in the Dáil .
Independent TD Carol Nolan said @ @ @ @ @ @ @ in the Rosderra Irish Meats plant in Edenderry have now been confirmed as having Covid-19 .
Rise TD Paul Murphy said a complaint had been made to the HSE in relation to Moyvalley Meats “ that sick workers were working and living alongside other workers ” .
Moyvalley could not be reached for comment .
Chief Medical Officer Tony Holohan has put the latest official number of confirmed cases at 500 , a rise of 133 , with 12 hospitalised by the illness .
In total , there are 12 clusters across the @ @ @ @ @ @ @ a lack of transparency on the issue and that officials needed to visit factory floors to assess the issue .
“ Without calling for the shutting down of the sector , it seems very surprising that the blanket testing of a facility is followed by no interruption of work until the results are returned , ” he said .
“ Would it not be reasonable to halt production for a deep clean and putting in place of new control measures while waiting for the results ?
Simply sending workers back to work and @ @ @ @ @ @ @ does not make sense , particularly given the Minister ’ s assurance that testing capacity is not an issue.
” Siptu has renewed its calls for mandatory temperature checks for staff .
It said processing plants are predominantly staffed by migrant workers from eastern Europe , South America and South Africa in particular and because of relatively low wages – typically about €12 per hour – many of the workers shared accommodation and transport .
The physical conditions of many plants also pose difficulties in the context of Covid-19 in terms of proximity @ @ @ @ @ @ @ been made for a cessation of operations in what is considered a vital service , demands are growing for increased controls across the sector .
“ No matter what you do , it ’ s practically impossible to stop the spread of it , ” said one person familiar with the layout of processing plants .
Siptu organiser Greg Ennis said while some processors have worked well with it in terms of providing safety measures , staggered breaks among staff and personal protective equipment , there was a need for temperature checks .
@ @ @ @ @ @ @ but it ’ s something that will help stop the spread of the virus , ” Mr Ennis said , but that such pleas had “ fallen on deaf ears ” in Government .
In a statement , Meat Industry Ireland ( MII ) , the representative body , said its members had introduced “ a very substantial suite of protective measures in processing plants ” .
“ They are working with the HSE and authorities in the particular plants affected and the meat processing industry is following the HSE guidance and advice @ @ @ @ @ @ @ preventative measures and procedures around testing .
”

Fianna Fáil leader Micheál Martin said there was a lack of transparency on the issue and that officials needed to visit factory floors to assess the issue. Photograph: Dara Mac Donaill
As many as 600 meat processing workers have tested positive for Covid-19, according to Siptu. The claim comes as concerns mount that the pattern could follow nursing homes.
In the Dáil on Thursday, Fianna Fáil leader Micheál Martin said the situation was now "gravely serious".
Siptu says up to 15 workers in the Republic have been hospitalised by the illness and there has been one fatality in Northern Ireland.
On Thursday, the Dáil was told of reports that about 60 employees at Rosderra Meats' Edenderry plant in Co Offaly had tested positive for the virus with more test results due. Earlier this month the Dáil was told of about 100 confirmed cases at its plant in Roscrea, Co Tipperary.
READ MORE
Protective measures
The company has not yet responded to the claims but said the safety and welfare of employees is of the utmost importance and that it is being extremely vigilant with protective measures for infection control.
While the industry itself has said it has taken a number of steps to address the problems, the matter received considerable attention in the Dáil.
Independent TD Carol Nolan said she had been told that 60 workers in the Rosderra Irish Meats plant in Edenderry have now been confirmed as having Covid-19.
Rise TD Paul Murphy said a complaint had been made to the HSE in relation to Moyvalley Meats "that sick workers were working and living alongside other workers". Moyvalley could not be reached for comment.
Chief Medical Officer Tony Holohan has put the latest official number of confirmed cases at 500, a rise of 133, with 12 hospitalised by the illness. In total, there are 12 clusters across the country.
Mr Martin said there was a lack of transparency on the issue and that officials needed to visit factory floors to assess the issue.
“Without calling for the shutting down of the sector, it seems very surprising that the blanket testing of a facility is followed by no interruption of work until the results are returned,” he said.
“Would it not be reasonable to halt production for a deep clean and putting in place of new control measures while waiting for the results? Simply sending workers back to work and, indeed, not testing their families does not make sense, particularly given the Minister’s assurance that testing capacity is not an issue.”
Siptu has renewed its calls for mandatory temperature checks for staff. It said processing plants are predominantly staffed by migrant workers from eastern Europe, South America and South Africa in particular and because of relatively low wages – typically about €12 per hour – many of the workers shared accommodation and transport.
Difficulties
The physical conditions of many plants also pose difficulties in the context of Covid-19 in terms of proximity of working.
While no calls have been made for a cessation of operations in what is considered a vital service, demands are growing for increased controls across the sector. “No matter what you do, it’s practically impossible to stop the spread of it,” said one person familiar with the layout of processing plants.
Siptu organiser Greg Ennis said while some processors have worked well with it in terms of providing safety measures, staggered breaks among staff and personal protective equipment, there was a need for temperature checks.
“Temperature testing is not the panacea but it’s something that will help stop the spread of the virus,” Mr Ennis said, but that such pleas had “fallen on deaf ears” in Government.
In a statement, Meat Industry Ireland (MII), the representative body, said its members had introduced "a very substantial suite of protective measures in processing plants".
“They are working with the HSE and authorities in the particular plants affected and the meat processing industry is following the HSE guidance and advice on all aspects related to Covid-19 including preventative measures and procedures around testing.”


theirishtimes--2020-05-15--Coronavirus: Private hospitals threaten to pull out of State deal

Private hospitals may pull out of the agreement which has seen the State take over their facilities during the Covid-19 crisis , if the HSE does not increase the number of patients it is sending them .
The hospitals suggested they would look for an alternative arrangement with the Government to provide care to patients , similar the National Treatment Purchase Fund ( NTPF ) .
The HSE is currently reviewing whether the three-month agreement should be extended .
The deal has been criticised over its reported €115 million cost per month and the relatively few patients treated in these @ @ @ @ @ @ @ not signed up to public contracts during the crisis .
They maintain they have been shut out of their traditional private hospitals .
Minister for Health Simon Harris said there was a “ bit of a myth ” that private hospitals were empty .
He said in April the Bon Secours Hospital in Cork had 82 per cent occupancy , UPMC Whitfield in Waterford 55 per cent , the Mater Private Hospital Cork 57 per cent and the Mater Private Hospital in Dublin 60 per cent .
However , a group of fully @ @ @ @ @ @ @ State contract o work only in the public system maintained that across the private hospitals on May 12th , occupancy levels were 34 per cent and some had no in-patients .
On Thursday , private consultants said they could no longer have histopathology samples for possible cancers processed in private hospitals as they had not signed the State contract .
The consultants said they were seeking to arrange options for their patients outside of the private hospital procedures including urgent intravitreal injections and infusions for multiple sclerosis and potentially for cancer patients as @ @ @ @ @ @ @ , the National Public Health Emergency Team ( NPHET ) is investigating whether all hospitals have fully reported cases of Covid-19 , after it emerged that one has reported hundreds of cases late .
The late-reported cases account for more than half of the 426 new cases of the disease reported by NPHET on Thursday.The deaths of another 10 patients were announced .
The Government has to inform private hospitals by the end of May as to whether it wants to extend the agreement .
Health sources maintained that it might be premature @ @ @ @ @ @ @ deal by the end of May given that non-Covid care in public facilities are only resuming .
The Private Hospital Association said : “ PHA members recognised at the outset the unprecedented challenge that the Covid-19 pandemic presented to the country and in good faith offered the private hospital network in order to plan for the expected surge in demand for additional capacity .
This was the right decision for that time and that facility currently remains in place .
Thankfully the curve has flattened considerably in the interim period .
The requirement @ @ @ @ @ @ @ review by the HSE and we await the outcome of that process .
While private hospitals are getting busier , activity levels are dependent on cases being sent to them by the HSE .
If these do not increase , it may be preferable at a point to revert to the NTPF model whereby services and elective procedures can be procured and contracted based on precise levels of demand at any given time and thereby delivering better value for money .
” The Cabinet is meeting on Friday to discuss the easing of @ @ @ @ @ @ @ has given the green light .
Public health officials have recommended to the Government that face-coverings should be worn indoors where social distancing can not be practised .
Measures will include allowing four people from different households to meet outside , but the Government may move to clarify that people only meet in groups of four once a day .

Private hospitals may pull out of the agreement which has seen the State take over their facilities during the Covid-19 crisis.
Private hospitals may pull out of the agreement which has seen the State take over their facilities during the Covid-19 crisis, if the HSE does not increase the number of patients it is sending them.
The hospitals suggested they would look for an alternative arrangement with the Government to provide care to patients, similar the National Treatment Purchase Fund (NTPF).
The HSE is currently reviewing whether the three-month agreement should be extended. The deal has been criticised over its reported €115 million cost per month and the relatively few patients treated in these facilities. About 300 private consultants have not signed up to public contracts during the crisis. They maintain they have been shut out of their traditional private hospitals.
Minister for Health Simon Harris said there was a “bit of a myth” that private hospitals were empty. He said in April the Bon Secours Hospital in Cork had 82 per cent occupancy, UPMC Whitfield in Waterford 55 per cent, the Mater Private Hospital Cork 57 per cent and the Mater Private Hospital in Dublin 60 per cent.
READ MORE
However, a group of fully private consultants who have not signed a State contract to work only in the public system maintained that across the private hospitals on May 12th, occupancy levels were 34 per cent and some had no in-patients.
On Thursday, private consultants said they could no longer have histopathology samples for possible cancers processed in private hospitals as they had not signed the State contract.
The consultants said they were seeking to arrange options for their patients outside of the private hospital procedures including urgent intravitreal injections and infusions for multiple sclerosis and potentially for cancer patients as well as for histopathology samples.
Late reports
Separately, the National Public Health Emergency Team (NPHET) is investigating whether all hospitals have fully reported cases of Covid-19, after it emerged that one has reported hundreds of cases late. The late-reported cases account for more than half of the 426 new cases of the disease reported by NPHET on Thursday.The deaths of another 10 patients were announced.
The Government has to inform private hospitals by the end of May as to whether it wants to extend the agreement.
Health sources maintained that it might be premature for the HSE to recommend ending the deal by the end of May given that non-Covid care in public facilities are only resuming.
HSE CEO Paul Reid and HSE clinical lead for testing Niamh O’Beirne during a briefing at DCU Glasnevin campus in Dublin on Thursday. Photograph: Leon Farrell/Photocall Ireland/PA Wire
The Private Hospital Association said:“PHA members recognised at the outset the unprecedented challenge that the Covid-19 pandemic presented to the country and in good faith offered the private hospital network in order to plan for the expected surge in demand for additional capacity. This was the right decision for that time and that facility currently remains in place. Thankfully the curve has flattened considerably in the interim period. The requirement for private hospital capacity is currently under review by the HSE and we await the outcome of that process. While private hospitals are getting busier, activity levels are dependent on cases being sent to them by the HSE. If these do not increase, it may be preferable at a point to revert to the NTPF model whereby services and elective procedures can be procured and contracted based on precise levels of demand at any given time and thereby delivering better value for money .”
The Cabinet is meeting on Friday to discuss the easing of restrictions from Monday, to which NPHET has given the green light. Public health officials have recommended to the Government that face-coverings should be worn indoors where social distancing cannot be practised. Measures will include allowing four people from different households to meet outside, but the Government may move to clarify that people only meet in groups of four once a day.


theirishtimes--2020-05-15--Damning report reveals child abuse was ‘tolerated’ in scout bodies

The sexual abuse of vulnerable children was both “ facilitated ” and “ tolerated ” at the highest levels of Scouting Ireland ’ s legacy organisations , with abuse covered up in order to protect the reputation of the scouting movement .
Serial child abusers were protected by a culture of “ cronyism ” , and evidence now shows groups of sex offenders operated at the top levels of the legacy organisations to protect each other .
The historic abuse relates to the Catholic Boy Scouts of Ireland and the Scout Association of Ireland , which merged to form Scouting @ @ @ @ @ @ @ there are 356 alleged victims of past abuse , with 275 alleged perpetrators operating at times with impunity to prey on children , primarily between the 1960s and 1990s .
Child protection expert Ian Elliott ’ s comprehensive report into the scandal found one of the legacy bodies was a “ seriously dysfunctional organisation ” with “ sex offenders dominating the leadership for decades ” .
But it is not simply the fact that the abuse took place .
The most damning revelations are the extent to which former senior figures in the @ @ @ @ @ @ @ failed to act , at times actively covering it up .
The report shines a light into another dark corner of Ireland ’ s past , and goes some way towards providing truth to those who were betrayed as children , and have been living with the damage in the decades since .
The scouting movement in Ireland is more than a century old and holds honour and loyalty among its core tenets .
The report laid bare how the trust of parents to place their children in the care of the two @ @ @ @ @ @ @ themselves had in scout leaders in positions of authority , was broken in the most grievous manner .
Loyalty was shown by senior figures not to the victims , but often to the perpetrators .
To protect the reputation of the institution above the children within it .
In that sense this report and its harrowing details , will likely prove to be the movement ’ s darkest hour .
Scouting Ireland has issued a full apology over the past abuse , and repeatedly stressed that reforms over the past two years have @ @ @ @ @ @ @ has more than 12,000 adult volunteers and 40,000 youth members , many who will attest to its huge value to their own lives .
The youth organisation has been beset with controversies for much of the past two years , following revelations first reported in The Irish Times over the flawed handling of a rape allegation concerning two adult volunteers .
The question will now shift to whether the Government should launch a statutory inquiry into the historic abuse scandal , which it previously stated it was considering .
Such an inquiry would @ @ @ @ @ @ @ against during his investigation , such as a lack of historic records on abuse cases .
Elliott ’ s report stated that some individuals who he interviewed provided “ only a limited amount of information ” and in his opinion “ had more to tell but did not see fit to do so within this process ” .
Here a statutory inquiry would have stronger powers of investigation to potentially delve deeper .
While we now for the first time have a damning picture of the extent children were failed in the legacy @ @ @ @ @ @ @ some further questions remain – that only a full State inquiry can try to answer .

Evidence now shows groups of sex offenders operated at the top levels of the legacy organisations to protect each other.File Photograph: Aidan Crawley
The sexual abuse of vulnerable children was both “facilitated” and “tolerated” at the highest levels of Scouting Ireland’s legacy organisations, with abuse covered up in order to protect the reputation of the scouting movement.
Serial child abusers were protected by a culture of “cronyism”, and evidence now shows groups of sex offenders operated at the top levels of the legacy organisations to protect each other.
The historic abuse relates to the Catholic Boy Scouts of Ireland and the Scout Association of Ireland, which merged to form Scouting Ireland in 2004.
We now know there are 356 alleged victims of past abuse, with 275 alleged perpetrators operating at times with impunity to prey on children, primarily between the 1960s and 1990s.
READ MORE
Child protection expert Ian Elliott’s comprehensive report into the scandal found one of the legacy bodies was a “seriously dysfunctional organisation” with “sex offenders dominating the leadership for decades”.
Betrayed
But it is not simply the fact that the abuse took place. The most damning revelations are the extent to which former senior figures in the legacy organisations knew about the crimes but failed to act, at times actively covering it up.
The report shines a light into another dark corner of Ireland’s past, and goes some way towards providing truth to those who were betrayed as children, and have been living with the damage in the decades since.
The scouting movement in Ireland is more than a century old and holds honour and loyalty among its core tenets.
The report laid bare how the trust of parents to place their children in the care of the two former organisations, and the trust children themselves had in scout leaders in positions of authority, was broken in the most grievous manner.
Loyalty was shown by senior figures not to the victims, but often to the perpetrators. To protect the reputation of the institution above the children within it. In that sense this report and its harrowing details, will likely prove to be the movement’s darkest hour.
Scouting Ireland has issued a full apology over the past abuse, and repeatedly stressed that reforms over the past two years have improved current safeguarding standards. It currently has more than 12,000 adult volunteers and 40,000 youth members, many who will attest to its huge value to their own lives.
Challenges
The youth organisation has been beset with controversies for much of the past two years, following revelations first reported in The Irish Times over the flawed handling of a rape allegation concerning two adult volunteers.
The question will now shift to whether the Government should launch a statutory inquiry into the historic abuse scandal, which it previously stated it was considering.
Such an inquiry would likely face similar challenges Elliott ran up against during his investigation, such as a lack of historic records on abuse cases.
Elliott’s report stated that some individuals who he interviewed provided “only a limited amount of information” and in his opinion “had more to tell but did not see fit to do so within this process”. Here a statutory inquiry would have stronger powers of investigation to potentially delve deeper.
While we now for the first time have a damning picture of the extent children were failed in the legacy organisations, abuse survivors may justifiably feel some further questions remain – that only a full State inquiry can try to answer.


theirishtimes--2020-05-15--Covid-19: Three private hospitals took no patients

Three of the private hospitals taken over by the State to help deal with the Covid-19 epidemic accommodated no patients during April , at the height of the crisis .
Overall , two inpatient beds out of three remained empty for the month in the almost 20 private hospitals covered by the deal , which is costing the State €115 million a month .
The Health Service Executive ( HSE ) says occupancy rates have increased since then .
There was 0 per cent occupancy at St Francis Hospital in Mullingar , Co Westmeath , which has 77 beds ; @ @ @ @ @ @ @ ; and Bon Secours Limerick , which has more than 50 beds , according to figures provided by the HSE to The Irish Times .
Kingsbridge and the Bons Limerick had a large outpatient caseload , according to the HSE .
Another private hospital , the Sports and Surgery Clinic in Santry , Dublin , had a 6 per cent occupancy in April .
It carried out just 44 day case and 120 diagnostic tests during the month , an average of fewer than 10 appointments per working day .
The occupancy across @ @ @ @ @ @ @ the HSE at 36 per cent , with data for early May showing a rise to 48 per cent , it says .
The hospitals with the highest occupancy were the Bons Tralee , Co Kerry at 86 per cent and St Vincent ’ s Private in Dublin at 82 per cent .
Other hospitals with low occupancy rates included the Galway Clinic ( 23 per cent ) ; Aut Even in Kilkenny ( 21 per cent ) ; and the Bons Dublin ( 25 per cent ) .
In Dublin , the @ @ @ @ @ @ @ ; the Blackrock Clinic had 45 per cent occupancy ; and the Beacon was 34 per cent .
In total , private hospitals discharged 2,654 inpatients during the month , with the highest figure treated at the Bon Secours group of hospitals ( 860 ) .
There were 59 inpatient discharges from the Blackrock Clinic and 57 from the Mater Private Cork .
The private hospitals also dealt with a total of 8,585 day cases , 1,071 new outpatients , 2,109 returning outpatients and carried out 7,887 diagnostic tests .
The work performed @ @ @ @ @ @ @ urgent cardiac treatment , according to the HSE .
Some hospitals also supported the delivery of emergency care and two supported nursing homes through the provision of a geriatrician or nursing service .
In April , only “ critical essential work ” was undertaken in the private hospitals , “ as per National Public Health Emergency Team guidance ” , according to the HSE .
This was loosened after May 5th to allow more work to be carried out , it says , and hospital groups have been tasked with drawing up plans @ @ @ @ @ @ @ at “ optimising ” capacity .

Three of the private hospitals taken over by the State to help deal with the Covid-19 epidemic accommodated no patients during April, at the height of the crisis.
Overall, two inpatient beds out of three remained empty for the month in the almost 20 private hospitals covered by the deal, which is costing the State €115 million a month.
The Health Service Executive (HSE) says occupancy rates have increased since then.
There was 0 per cent occupancy at St Francis Hospital in Mullingar, Co Westmeath, which has 77 beds; Kingsbridge Hospital in Sligo with 19 beds; and Bon Secours Limerick, which has more than 50 beds, according to figures provided by the HSE to The Irish Times.
READ MORE
Kingsbridge and the Bons Limerick had a large outpatient caseload, according to the HSE.
Another private hospital, the Sports and Surgery Clinic in Santry, Dublin, had a 6 per cent occupancy in April. It carried out just 44 day case and 120 diagnostic tests during the month, an average of fewer than 10 appointments per working day.
The occupancy across all sites in April was estimated by the HSE at 36 per cent, with data for early May showing a rise to 48 per cent, it says.
The hospitals with the highest occupancy were the Bons Tralee, Co Kerry at 86 per cent and St Vincent’s Private in Dublin at 82 per cent.
Other hospitals with low occupancy rates included the Galway Clinic (23 per cent); Aut Even in Kilkenny (21 per cent); and the Bons Dublin (25 per cent).
In Dublin, the Mater Private was 60 per cent occupied; the Blackrock Clinic had 45 per cent occupancy; and the Beacon was 34 per cent.
Patient numbers
In total, private hospitals discharged 2,654 inpatients during the month, with the highest figure treated at the Bon Secours group of hospitals (860). There were 59 inpatient discharges from the Blackrock Clinic and 57 from the Mater Private Cork.
The private hospitals also dealt with a total of 8,585 day cases, 1,071 new outpatients, 2,109 returning outpatients and carried out 7,887 diagnostic tests.
The work performed included cancer surgery, chemotherapy services and urgent cardiac treatment, according to the HSE. Some hospitals also supported the delivery of emergency care and two supported nursing homes through the provision of a geriatrician or nursing service.
In April, only “critical essential work” was undertaken in the private hospitals, “as per National Public Health Emergency Team guidance”, according to the HSE.
This was loosened after May 5th to allow more work to be carried out, it says, and hospital groups have been tasked with drawing up plans up to the end of June aimed at “optimising” capacity.


theirishtimes--2020-05-15--What will private hospitals do for us in Covid era partnership?

“ We feared Armageddon , ” says Debbie O ’ Neill , the clinical nurse manager of the intensive care unit in the Blackrock Clinic .
“ One of my colleagues put it very aptly ; she said she felt she was standing on the beach , with her back to the wall , and could see the tsunami [ coming ] .
” Whatever else it is , the Blackrock Clinic on a Thursday afternoon in early May does not feel like Armageddon .
Theatres and wards are sparsely populated , although not empty .
Under the new deal @ @ @ @ @ @ @ infection control guidelines , occupancy is down to 45 per cent , far below the usual 80 and 90 per cent .
Describing the run-in to the State ’ s temporary takeover of private hospitals , Michele McCormack , the clinic ’ s chief operations officer , said Blackrock “ started talking ” to the Health Service Executive in March .
Everything was based on fears that the State would have a fifth of the ICU beds it needed , framed against the backdrop of footage emerging from Italy and Spain , of @ @ @ @ @ @ @ doctors battled with air disaster-style numbers every day .
For Margaret O ’ Donnell , a plastic surgery consultant at the clinic , and its director of clinical governance , the atmosphere at the time was one of “ national emergency – shoulder to the wheel ; what do we have to do ” .
Under the deal , the Blackrock Clinic was detailed to “ decompress ” the public system – to carry out complex and pressing surgeries that could not be done in public hospitals .
Since then , it has @ @ @ @ @ @ @ cardiac and other urgent procedures .
In a second phase of the plan , Blackrock would have taken in Covid patients .
However , the surge , and the associated pressure on Irish hospitals , never came , or at least not to the same extent as elsewhere .
Now , as the country faces months – perhaps years – of living with Covid-19 , critical questions are being asked about how the healthcare system can operate .
For all parties , the issues are multiplying , and there are no easy solutions @ @ @ @ @ @ @ her predecessor , Prof Gregor Shanik , had a term for conundrums like this .
He called them “ wicked problems ” .
As it faces into an era of seismic and unpredictable change , how will Irish healthcare solve its wicked problem ?
Launching the agreement , Taoiseach Leo Varadkar said private hospitals were not being nationalised .
The move , he said , represented a “ public-private partnership ” for the common good .
However , the Government has faced calls to do precisely that .
There is not a lot @ @ @ @ @ @ @ confidential joint HSE/Department of Health paper given to the National Public Health Emergency Team last week made clear pointing to the scheduled end-May contract review .
Such a review will assess the agreement ’ s effectiveness in supporting the public system set against prevalence of the disease .
Pointedly , it said Minister for Public Expenditure Paschal Donohoe would be responsible for approving any extension , given the costs involved .
Some senior health figures believe a review at the end of May comes too quickly .
It should assess the delivering of @ @ @ @ @ @ @ .
Care should be given , too , to all those patients who have not contracted the virus , but who have had their own treatments delayed .
According to the paper , private hospitals “ will be used in support of the resumption of more routine scheduled care in order to tackle the increasing waiting lists for such care ” .
It said this “ may be dependent on the decision on whether or not to extend the arrangement ” .
Inside the Department of Public Expenditure and Reform , however , @ @ @ @ @ @ @ of keeping costs under control while keeping access that may be needed in the event of a future surge of the virus .
Options could include , for example , a “ less demanding ” version of the current deal that would retain flexible access to ICU beds , or the National Treatment Purchase Fund ( NTPF ) could be given a greater role .
The aim may be to extend , but with lower capacity , and less cost , sources say .
Alongside surge planning , Covid-19 will also have a @ @ @ @ @ @ @ .
Patients will be processed more slowly , infection controls will be more onerous , affecting the speed at which everything can be done .
The HSE/Department of Health paper said private hospitals will be used to support the resumption of routine , but delayed scheduled care to tackle longer waiting lists .
The paper said this “ may be dependent on the decision on whether or not to extend the arrangement ” .
The HSE has to inform private hospitals by May 31st on whether it intends to extend the agreement to @ @ @ @ @ @ @ to extend until July , then either hospitals or the HSE can subsequently terminate the arrangement with 30 days ’ notice .
For consultants temporarily relocated to the Blackrock Clinic , the sense is things aren ’ t going back to normal .
As she prepares to go into theatre , gynaecological oncologist Dr Noreen Gleeson , normally of St James ’ s Hospital , says : “ I think things will never go back quite to the way they were on account of Covid ; I think it will be with us @ @ @ @ @ @ @ have to work our health systems around it.
” A decision by the HSE to extend the deal until July will impact on everyone in the health system .
The private hospitals are making their position clear .
Michele McCormack , the Blackrock Clinic executive , is forthright .
While she is committed to the deal , and providing capacity if needed , once it is concluded , she is adamant the clinic “ will return to its normal business as before ” .
“ The current agreement… is an emergency measure put @ @ @ @ @ @ @ pandemic .
Like most of the emergency measures put in place , it is not financially sustainable beyond that point for the State , the private hospitals , the health insurers and the thousands of consultants working in the private hospitals , ” she said .
The Private Hospitals Association ( PHA ) , the industry group for the sector , is also sending a clear signal to the Government .
In a statement to The Irish Times , a spokesman said the deal was “ the right decision for that time ” @ @ @ @ @ @ @ are getting busier , activity levels depend on cases being sent to them by the HSE .
“ If these do not increase , it may be preferable at a point to revert to the NTPF model whereby services and elective procedures can be procured and contracted based on precise levels of demand at any given time and thereby delivering better value for money.
” The deal has cast a shadow over the business model of the institutions , but also over medical consultants and insurers .
Private healthcare is a €2 billion @ @ @ @ @ @ @ Nearly 2.276 million people had in-patient insurance at the end of last year .
Medical consultants receive about €600 million collectively from the private system .
Senior figures in the sector say that about 30 specialists receive more than €1 million , although this is not just salary – private medical practices can be micro economies employing technicians , nurses , business managers .
Some specialists purchase suites in private hospitals , costing from several hundred thousand euro to more than €1 million .
Fears such practices could become unviable form part of @ @ @ @ @ @ @ public contract , on a salary of between €141,000 and €195,000 .
Some 320 of the 600 fully-private sector consultants have signed up .
The Department of Health last Friday told doctors it would not offer them a contract that allowed them to charge fee-paying patients .
Essentially , they could take or leave what is on the table .
Some doctors have argued that the original basis of the agreement was to have capacity to deal with the pandemic , not to tackle public waiting lists .
They argue the State has @ @ @ @ @ @ @ patients on waiting lists without ever having to take over hospitals or to make doctors employees of the State .
Doctors are concerned about the fate of their existing private patients .
Already there are murmurings of legal action .
Insurers have seen their business model disrupted as subscribers lost access to the private hospitals .
Private maternity , psychiatry and diagnostics are still available as are some out-patient consultations and procedures , but insurers have introduced premium waivers , cashback arrangements and rebates for customers .
There are concerns that if the @ @ @ @ @ @ @ for example , into the autumn that a question about the “ relevance ” of insurance cover will arise .
Already , the industry is bracing for a fall in subscribers , as the recession bites .
In a Covid-19 world , the way forward is far from clear .
It is a densely interwoven patchwork of financial , logistical , tactical and strategic questions , shot through with ethical and philosophical dilemmas , not to mention the vested interests and turf wars common in Irish healthcare .

"We feared Armageddon," says Debbie O'Neill, the clinical nurse manager of the intensive care unit in the Blackrock Clinic. "One of my colleagues put it very aptly; she said she felt she was standing on the beach, with her back to the wall, and could see the tsunami [coming]."
Whatever else it is, the Blackrock Clinic on a Thursday afternoon in early May does not feel like Armageddon.
Theatres and wards are sparsely populated, although not empty. Under the new deal with the State, and rigorous Covid-era infection control guidelines, occupancy is down to 45 per cent, far below the usual 80 and 90 per cent.
Describing the run-in to the State's temporary takeover of private hospitals, Michele McCormack, the clinic's chief operations officer, said Blackrock "started talking" to the Health Service Executive in March.
READ MORE
Everything was based on fears that the State would have a fifth of the ICU beds it needed, framed against the backdrop of footage emerging from Italy and Spain, of makeshift ICU beds in hospital corridors as doctors battled with air disaster-style numbers every day.
For Margaret O’Donnell, a plastic surgery consultant at the clinic, and its director of clinical governance, the atmosphere at the time was one of “national emergency – shoulder to the wheel; what do we have to do”.
Under the deal, the Blackrock Clinic was detailed to “decompress” the public system – to carry out complex and pressing surgeries that could not be done in public hospitals. Since then, it has done 400 cancer surgeries, along with cardiac and other urgent procedures.
In a second phase of the plan, Blackrock would have taken in Covid patients. However, the surge, and the associated pressure on Irish hospitals, never came, or at least not to the same extent as elsewhere.
Now, as the country faces months – perhaps years – of living with Covid-19, critical questions are being asked about how the healthcare system can operate. For all parties, the issues are multiplying, and there are no easy solutions in sight.
O'Donnell says her predecessor, Prof Gregor Shanik, had a term for conundrums like this. He called them "wicked problems". As it faces into an era of seismic and unpredictable change, how will Irish healthcare solve its wicked problem?
Contract review
Launching the agreement, Taoiseach Leo Varadkar said private hospitals were not being nationalised. The move, he said, represented a "public-private partnership" for the common good. However, the Government has faced calls to do precisely that.
There is not a lot of time to decide, as a confidential joint HSE/Department of Health paper given to the National Public Health Emergency Team last week made clear pointing to the scheduled end-May contract review.
Such a review will assess the agreement's effectiveness in supporting the public system set against prevalence of the disease. Pointedly, it said Minister for Public Expenditure Paschal Donohoe would be responsible for approving any extension, given the costs involved.
Some senior health figures believe a review at the end of May comes too quickly. It should assess the delivering of Covid and non-Covid care in public hospitals. Care should be given, too, to all those patients who have not contracted the virus, but who have had their own treatments delayed.
According to the paper, private hospitals “will be used in support of the resumption of more routine scheduled care in order to tackle the increasing waiting lists for such care”. It said this “may be dependent on the decision on whether or not to extend the arrangement”.
Inside the Department of Public Expenditure and Reform, however, the goal is to find a way of keeping costs under control while keeping access that may be needed in the event of a future surge of the virus.
Options could include, for example, a "less demanding" version of the current deal that would retain flexible access to ICU beds, or the National Treatment Purchase Fund (NTPF) could be given a greater role. The aim may be to extend, but with lower capacity, and less cost, sources say.
Alongside surge planning, Covid-19 will also have a profound impact on the Irish health system. Patients will be processed more slowly, infection controls will be more onerous, affecting the speed at which everything can be done.
The HSE/Department of Health paper said private hospitals will be used to support the resumption of routine, but delayed scheduled care to tackle longer waiting lists. The paper said this “may be dependent on the decision on whether or not to extend the arrangement”.
The HSE has to inform private hospitals by May 31st on whether it intends to extend the agreement to July 30th. If it does decide to extend until July, then either hospitals or the HSE can subsequently terminate the arrangement with 30 days’ notice.
Michele McCormack, Blackrock Clinic executive, is adamant the clinic will return to its normal business once the deal is concluded with the State. Photograph: Nick Bradshaw / The Irish Times
For consultants temporarily relocated to the Blackrock Clinic, the sense is things aren't going back to normal. As she prepares to go into theatre, gynaecological oncologist Dr Noreen Gleeson, normally of St James's Hospital, says: "I think things will never go back quite to the way they were on account of Covid; I think it will be with us for a long time and we will have to work our health systems around it."
‘Normal business’
A decision by the HSE to extend the deal until July will impact on everyone in the health system. The private hospitals are making their position clear.
Michele McCormack, the Blackrock Clinic executive, is forthright. While she is committed to the deal, and providing capacity if needed, once it is concluded, she is adamant the clinic “will return to its normal business as before”.
“The current agreement… is an emergency measure put in place to deal with the Covid-19 pandemic. Like most of the emergency measures put in place, it is not financially sustainable beyond that point for the State, the private hospitals, the health insurers and the thousands of consultants working in the private hospitals,” she said.
The Private Hospitals Association (PHA), the industry group for the sector, is also sending a clear signal to the Government. In a statement to The Irish Times, a spokesman said the deal was "the right decision for that time", but added that while private hospitals are getting busier, activity levels depend on cases being sent to them by the HSE. "If these do not increase, it may be preferable at a point to revert to the NTPF model whereby services and elective procedures can be procured and contracted based on precise levels of demand at any given time and thereby delivering better value for money."
The deal has cast a shadow over the business model of the institutions, but also over medical consultants and insurers. Private healthcare is a €2 billion industry in Ireland, employing thousands. Nearly 2.276 million people had in-patient insurance at the end of last year.
Medical consultants receive about €600 million collectively from the private system. Senior figures in the sector say that about 30 specialists receive more than €1 million, although this is not just salary – private medical practices can be micro economies employing technicians, nurses, business managers. Some specialists purchase suites in private hospitals, costing from several hundred thousand euro to more than €1 million.
Fears such practices could become unviable form part of the objections to the Government’s public contract, on a salary of between €141,000 and €195,000. Some 320 of the 600 fully-private sector consultants have signed up. The Department of Health last Friday told doctors it would not offer them a contract that allowed them to charge fee-paying patients. Essentially, they could take or leave what is on the table.
The Blackrock Clinic: Under the new deal with the State, and rigorous Covid-era infection control guidelines, occupancy is down to 45 per cent, far below the usual 80 and 90 per cent. Photograph: Nick Bradshaw / The Irish Times
Some doctors have argued that the original basis of the agreement was to have capacity to deal with the pandemic, not to tackle public waiting lists. They argue the State has used the NTPF to buy care for patients on waiting lists without ever having to take over hospitals or to make doctors employees of the State.
Doctors are concerned about the fate of their existing private patients. Already there are murmurings of legal action.
Insurers have seen their business model disrupted as subscribers lost access to the private hospitals. Private maternity, psychiatry and diagnostics are still available as are some out-patient consultations and procedures, but insurers have introduced premium waivers, cashback arrangements and rebates for customers.
There are concerns that if the State takeover of private hospitals continues, for example, into the autumn that a question about the “relevance” of insurance cover will arise. Already, the industry is bracing for a fall in subscribers, as the recession bites.
In a Covid-19 world, the way forward is far from clear. It is a densely interwoven patchwork of financial, logistical, tactical and strategic questions, shot through with ethical and philosophical dilemmas, not to mention the vested interests and turf wars common in Irish healthcare.
Truly, a wicked problem.


theirishtimes--2020-05-15--Covid-19: ‘All my perceived certainties of life were thrown into disarray’

In October 2017 , Gerry Kenneally was diagnosed with bladder cancer .
“ All my perceived certainties of life were thrown into disarray –all that remained for me was a black hole full of uncertainty and despair , ” he says .
Throughout this time , and the eight surgeries it has encompassed , he says his “ ally in the struggle to stay positive and stay alive ” has been consultant Dr Hubert Gallagher .
When the deal was announced , Kenneally says the prospect of losing access to his consultant was deeply traumatic .
“ I was dealing @ @ @ @ @ @ @ stress put on by Covid-19 .
.
.
all of a sudden , to add to the tsunami , I have someone telling me we can ’ t carry out your procedure or , if we do , it could be with someone I ’ ve never met before.
” Dr Gallagher says he will continue seeing Kenneally in his clinics during the crisis , but there is uncertainty over what will happen if he needs more procedures .
Others , like Eileen Brady , are also facing uncertainty .
She suffers from @ @ @ @ @ @ @ disease which means the adrenal glands , which power the muscles , don ’ t work .
It affects , among other things , heart function .
“ Because of this deal , my consultant can ’ t look after me .
I have a very rare condition which needs to be looked after by someone who knows me.
” Her team has been taking care of her for 20 years , and her care involves changing doses and medicines depending on whether she comes across a situation which causes an “ adrenal @ @ @ @ @ @ @ worried about me because the stress of not knowing where I ’ m to go or how I ’ m to be looked after could actually bring on a crisis , ” she says .
“ I have spent 20 years organising my care ; my life is well regulated and I have a healthy life .
I don ’ t want to , at my age , go to a new doctor and explain the last 20 years of my care .
”

In October 2017, Gerry Kenneally was diagnosed with bladder cancer. "All my perceived certainties of life were thrown into disarray –all that remained for me was a black hole full of uncertainty and despair," he says. Throughout this time, and the eight surgeries it has encompassed, he says his "ally in the struggle to stay positive and stay alive" has been consultant Dr Hubert Gallagher.
When the deal was announced, Kenneally says the prospect of losing access to his consultant was deeply traumatic. “I was dealing with the stresses of cancer and the stress put on by Covid-19 . . . all of a sudden, to add to the tsunami, I have someone telling me we can’t carry out your procedure or, if we do, it could be with someone I’ve never met before.”
Dr Gallagher says he will continue seeing Kenneally in his clinics during the crisis, but there is uncertainty over what will happen if he needs more procedures.
Others, like Eileen Brady, are also facing uncertainty. She suffers from a condition called Addisons, an auto-immune disease which means the adrenal glands, which power the muscles, don't work. It affects, among other things, heart function.
READ MORE
“Because of this deal, my consultant can’t look after me. I have a very rare condition which needs to be looked after by someone who knows me.” Her team has been taking care of her for 20 years, and her care involves changing doses and medicines depending on whether she comes across a situation which causes an “adrenal crisis”.
“My consultant is worried about me because the stress of not knowing where I’m to go or how I’m to be looked after could actually bring on a crisis,” she says. “I have spent 20 years organising my care; my life is well regulated and I have a healthy life. I don’t want to, at my age, go to a new doctor and explain the last 20 years of my care.”


theirishtimes--2020-05-15--Elliott Report: Four case studies of abuse

Subject A was a member of a scouting organisation and seemingly held in high regard .
He rose to be a senior volunteer within that organisation before he left of his own accord and in good standing .
The members of scouting with whom he socialised were mainly individuals against whom several other credible allegations of abuse are also on record .
A phone call was received at the national office of the scouting organisation requesting to speak to someone involved in child protection .
This call was received in 1995 .
The call was from a person who said @ @ @ @ @ @ @ A over a three-year period from the time he was 10 years old .
He said he could recall at least eight sexual assaults committed by Subject A in different locations .
The alleged abuse had taken place 20 years before the victim had made the telephone call in 1995 and had been prompted by the victim seeing Subject A in full scout uniform attending a scout event .
The allegation was discussed with named people who held senior positions in the scouting body , all of whom are reported as having ignored @ @ @ @ @ @ @ it on to someone else to deal with .
The picture that was presented as a result of that report , was of someone who was an active sex offender within scouting , and who was using scouting as his means of accessing sexual partners who were children .
Senior people in the scouting body took no immediate action against the alleged offender .
The volunteer persisted and , some weeks later , succeeded in having the issue brought to hearing .
Subject A did not deny any of the allegations against him @ @ @ @ @ @ @ something was being done about his “ problem ” .
Subject A stated that it was known he was not able to control his sexual impulses when among young people .
He also stated that he had spoken of this previously and had asked to be allowed to resign his commission .
This had been refused .
A request for help was received at the headquarters of Scouting Ireland during 2018 .
It came from a person who said he was a survivor of sexual abuse that he suffered when he was a @ @ @ @ @ @ @ abuse he described was shocking and involved the use of force and was associated with alcohol .
He described how he was given alcohol when attending camps before being raped by his scout leader , Subject B .
This person was a senior volunteer in scouting and rose to be a member of the board of directors in one of the legacy scouting bodies .
A records search was undertaken on Subject B , and an old file was located .
He was described as a difficult person .
However , there was @ @ @ @ @ @ @ or suspected risk to children and young people .
Subject B eventually of his own volition chose to stand down from his position and left scouting .
He left in good standing .
It was reported to the reviewer that when Subject B died , the chief scout at the time asked that a guard of honour be formed for the funeral .
However , when he approached people to participate , none would agree .
A senior volunteer who was involved at the time was spoken to by the reviewer and asked @ @ @ @ @ @ @ known that Subject B was an alleged offender at the time .
He replied that it was and that he was tasked with keeping an eye on him when he attended camps .
Subject C was a scout leader and played a part in setting up a new scout group which was based in a college .
He was a priest and it later emerged that his interest in young boys involved a desire to have a sexual involvement with them .
His sexual activities were eventually brought to the attention of his @ @ @ @ @ @ @ detailed letter to the headquarters of a scouting organisation .
Included with the letter were written statements from five of Subject C ’ s victims .
They were all young teenage boys .
They described his sexual assaults on them , most of which took place at scouting camps .
The letter from Subject C ’ s superior , who was also a priest , appears to have been held outside of any official filing system when it was received .
There is no record of it being filed .
Subject C was @ @ @ @ @ @ @ no record of him having done so .
After a period of 20 years , Subject C was complained of to the gardaí and charged with several counts of alleged abuse .
He was never tried for these as he took his own life .
Subject D became involved in scouting through his son .
He offered to help as a volunteer with a thriving scout group .
His behaviour presented as concerning particularly during camps when he would spend an inordinate amount of time close to the tents of the boys .
@ @ @ @ @ @ @ group leader who challenged him and asked him to stop doing this .
Subject D joined the training team and continued to contribute well to a range of scouting activities such as helping when the boys went swimming .
A parent reported a child being disturbed and distressed through his involvement in scouting .
This led on to an allegation being made against this volunteer of sexual abuse .
This was reported to gardaí immediately by the scout leader , and after discussion with them , it was agreed that Subject D should @ @ @ @ @ @ @ while the matter was investigated .
As the investigation by the gardaí progressed , it emerged that Subject D had been previously convicted of two charges of sexual assaults on young people .
He was prosecuted for the offences he committed on the young boys in scouting .
It was revealed in the court proceedings that he had 32 victims , four of whom were from within the scout group .
The above are four historic abuse cases outlined in the Elliott report

Case Study A
Subject A was a member of a scouting organisation and seemingly held in high regard. He rose to be a senior volunteer within that organisation before he left of his own accord and in good standing.
The members of scouting with whom he socialised were mainly individuals against whom several other credible allegations of abuse are also on record.
A phone call was received at the national office of the scouting organisation requesting to speak to someone involved in child protection. This call was received in 1995.
The call was from a person who said they had been sexually abused by Subject A over a three-year period from the time he was 10 years old. He said he could recall at least eight sexual assaults committed by Subject A in different locations.
READ MORE
The alleged abuse had taken place 20 years before the victim had made the telephone call in 1995 and had been prompted by the victim seeing Subject A in full scout uniform attending a scout event.
The allegation was discussed with named people who held senior positions in the scouting body, all of whom are reported as having ignored it, or having tried to pass it on to someone else to deal with.
The picture that was presented as a result of that report, was of someone who was an active sex offender within scouting, and who was using scouting as his means of accessing sexual partners who were children.
Senior people in the scouting body took no immediate action against the alleged offender. The volunteer persisted and, some weeks later, succeeded in having the issue brought to hearing.
Subject A did not deny any of the allegations against him and is noted as appearing relieved that something was being done about his “problem”.
Subject A stated that it was known he was not able to control his sexual impulses when among young people. He also stated that he had spoken of this previously and had asked to be allowed to resign his commission. This had been refused.
Case Study B
A request for help was received at the headquarters of Scouting Ireland during 2018. It came from a person who said he was a survivor of sexual abuse that he suffered when he was a young person involved in scouting.
The abuse he described was shocking and involved the use of force and was associated with alcohol. He described how he was given alcohol when attending camps before being raped by his scout leader, Subject B.
This person was a senior volunteer in scouting and rose to be a member of the board of directors in one of the legacy scouting bodies.
A records search was undertaken on Subject B, and an old file was located. He was described as a difficult person. However, there was no mention of him being a known or suspected risk to children and young people.
Subject B eventually of his own volition chose to stand down from his position and left scouting. He left in good standing.
It was reported to the reviewer that when Subject B died, the chief scout at the time asked that a guard of honour be formed for the funeral. However, when he approached people to participate, none would agree.
A senior volunteer who was involved at the time was spoken to by the reviewer and asked the question as to whether it was known that Subject B was an alleged offender at the time. He replied that it was and that he was tasked with keeping an eye on him when he attended camps.
Case Study C
Subject C was a scout leader and played a part in setting up a new scout group which was based in a college.
He was a priest and it later emerged that his interest in young boys involved a desire to have a sexual involvement with them.
His sexual activities were eventually brought to the attention of his superiors, one of whom wrote a detailed letter to the headquarters of a scouting organisation. Included with the letter were written statements from five of Subject C’s victims.
They were all young teenage boys. They described his sexual assaults on them, most of which took place at scouting camps. The letter from Subject C’s superior, who was also a priest, appears to have been held outside of any official filing system when it was received. There is no record of it being filed.
Subject C was asked to leave scouting but there is no record of him having done so.
After a period of 20 years, Subject C was complained of to the gardaí and charged with several counts of alleged abuse. He was never tried for these as he took his own life.
Case Study D
Subject D became involved in scouting through his son. He offered to help as a volunteer with a thriving scout group.
His behaviour presented as concerning particularly during camps when he would spend an inordinate amount of time close to the tents of the boys. This eventually led to intervention by the group leader who challenged him and asked him to stop doing this.
Subject D joined the training team and continued to contribute well to a range of scouting activities such as helping when the boys went swimming.
A parent reported a child being disturbed and distressed through his involvement in scouting. This led on to an allegation being made against this volunteer of sexual abuse.
This was reported to gardaí immediately by the scout leader, and after discussion with them, it was agreed that Subject D should be asked to stand back from scouting while the matter was investigated.
As the investigation by the gardaí progressed, it emerged that Subject D had been previously convicted of two charges of sexual assaults on young people.
He was prosecuted for the offences he committed on the young boys in scouting. It was revealed in the court proceedings that he had 32 victims, four of whom were from within the scout group.
The above are four historic abuse cases outlined in the Elliott report