Minister of State at the Department of Health (Deputy Frankie Feighan) - I welcome this opportunity to update the House on the important policy areas that fall under my remit as Minister of State with responsibility for public health, well-being and the national drugs strategy. My opening statement will deal with how these policy areas support the response to the Covid-19 pandemic. My closing statement will set out my policy priorities for the remainder of 2020 and into 2021.

Covid-19 is having a major impact on every aspect of our society both in Ireland and across the globe. Real progress has been made in suppressing the virus thanks to the great efforts of our healthcare workers and our citizens. By working together, we have saved lives and limited the impact of this disease on our society. However, we must all do everything to avoid the virus spreading further as we head into winter. The Covid-19 pandemic has put public health and well-being centre stage in Government policymaking and the lives of our citizens. Physical and mental well-being have always been important, but are now more vital than ever as we adapt to living with the changed world caused by the Covid-19 pandemic.

As outlined in the programme for Government, the State has a major role to play in promoting good physical and mental health. I believe that a healthy lifestyle is a key foundation for a better quality of life and is key to reducing the risks from infectious and chronic disease. Empowering people and communities to shift our focus more towards prevention is a key element of the Sláintecare strategy delivered through Healthy Ireland, a framework I am proud to head up.

Healthy Ireland is our national action plan to help people to live healthier and longer lives, prevent illness, and reduce health inequalities. Since Healthy Ireland was launched in 2013, further policies have been developed under its umbrella to address specific public health priorities and reduce the risk of ill-health. These include the national obesity policy and action plan, the national physical action plan and the national sexual health strategy. Further support for implementation also includes a national Healthy Ireland citizen engagement and communications campaign, the Healthy Ireland fund, and support for our evidence base through the outcomes framework and Healthy Ireland survey.

Most important, we have built strong networks with a wide range of collaborators, encompassing other Departments, Government agencies, local authorities and the research sector to further Healthy Ireland's aims and objectives. Over recent months the communications and citizen engagement campaign was repurposed as a wider cross-Government well-being campaign, In This Together, to promote resources and initiatives from across Government to support health and well-being during the pandemic. This campaign and activity of support in the context of the pandemic will continue in the months ahead to help maintain our individual and collective well-being.

During this pandemic, we have learned that it is within our power to protect ourselves and others from Covid-19 if we follow public health advice. It has been widely reported that the risks of serious illness from Covid-19 are increased substantially if we have certain health conditions, including heart disease, diabetes, respiratory diseases or cancers. The personal actions we take to reduce the risk of developing these conditions are well known and include quitting smoking and keeping our alcohol consumption low. These are simple actions, but I appreciate they are not easy. The fear, worry and uncertainty felt by many in the recent difficult months may have made it even more difficult to look at our tobacco and alcohol use. However, it has never been more important to do so. That is why it is now more urgent than ever that the Government and I, as Minister of State, do whatever we can to help people make healthier choices in their everyday lives.

Smoking remains the biggest single cause of addiction, ill-health and death in Ireland, with an estimated 6,000 people dying each year from tobacco-related diseases. One in every two smokers will die of a disease that is attributable to smoking, such as cancer, heart disease or respiratory disease. This dark reality cannot be highlighted enough and it is why I have chosen to discuss it again in our national Parliament today. The World Health Organization, WHO, has warned that smokers are more likely to develop severe disease with Covid-19 than non-smokers. This is because those with impaired lung function due to smoking find it harder to fight off the virus. Now is the time to quit smoking and now is the time to do what we can to help those who want to quit.

Ireland has a reputation as a world leader in tobacco control and has set a target to have a smoking prevalence of less than 5% by 2025. The two principles underlying the tobacco-free Ireland policy are protection of children and the denormalisation of smoking. The public health tobacco and nicotine-inhaling products Bill, currently being drafted, is designed to further deliver on those promises. I look forward to the day it is brought before the House. I hope we can work together to enact it and ensure the harmful effects of cigarettes are kept from our children and that smoking is viewed by all as the serious health risk that it is.

The health harms attributed to alcohol consumption include diabetes, cardiovascular disease and some cancers. Like the diseases associated with smoking, these illnesses were highlighted by the Covid-19 pandemic. The Public Health (Alcohol) Act 2018 is beginning to take effect in Ireland. Shops are already separating their alcohol from other groceries to be ready for the November deadline for that change. I pay tribute to retailers for their willingness to take on these actions at a time so many other changes are affecting their businesses financially.

I reaffirm to the House that I am strongly committed to introducing minimum unit pricing so that the cheapest and yet stronger alcohol will no longer be available at such low prices to our younger people and to those who drink to harmful excess. I am working hard on this issue and I look forward to working with our colleagues in Northern Ireland to share the experience of enacting this very important health measure on both sides of the Border without further delay.

Covid-19 has reinforced the need to treat drug and alcohol misuse as a public health issue. The national drugs strategy, Reducing Harm, Support Recovery, provides the roadmap to a health-led approach to drug and alcohol misuse, which supports harm reduction and treating people with compassion and respect.

Covid-19 posed a major threat for people with drug addiction, especially those who are homeless and not in treatment. I recently met staff from the HSE's addiction services to hear at first hand about the changes in the delivery of opioid-substitution treatment during Covid-19. Specific resource documents were developed to ensure that all people in receipt of opioid-substitution treatment could continue safely on the treatment during the pandemic and that anyone who required such treatment would receive it. I am pleased to report that existing patients continued the opioid-substitution treatment throughout the pandemic and an additional 755 people were brought into the treatment, an increase of 7%.

As a result, the impact of Covid-19 on people who use drugs has been greatly minimised. HSE addiction services have saved lives, although perhaps not in hospitals, by ensuring that people with underlying health conditions did not end up in intensive care in the first place.

The programme for Government contains a commitment to retaining the specific actions taken to support increased and improved access to opiate substitution treatment during the Covid-19 pandemic. I am determined to mainstream the gains that have been achieved within the health services.

One of the downsides of Covid-19 has been the circulation and use of new drugs throughout the county. One such drug that worries me is called nitrous oxide. The HSE and drug and alcohol task forces have been proactive in communicating to parents and youth workers the dangers associated with nitrous oxide. I have also confirmed that the sale of nitrous oxide is prohibited under existing legislation. My colleague, Deputy Higgins, has also been proactive in promoting the risks associated with this drug. As Minister of State with responsibility for this area, I am conscious that more action may be required. This is why I have asked the HSE to commence greater research on this drug to enable my Department to make evidence-based choices.

I am aware that drug and alcohol services have had to adapt in new ways to continue working to support people affected by substance misuse. My Department is currently undertaking an assessment of the impact of Covid-19 on drug and alcohol services to identify lessons for policy and practice. This assessment will be presented to the national oversight committee, which I chair, for discussions with all stakeholders in the strategy, including the Department of the Taoiseach. Work is under way to prepare for the restoration of drug and alcohol services in a planned and appropriate manner in line with public health advice. This includes guidance on one-to-one and group supports. My Department has established a working group with drug and alcohol service providers to identify the guidance and supports required. I have also approved emergency funding to offset the costs of delivering drug and alcohol services in a Covid environment.

I am aware of concerns that recently introduced regulations that restrict indoor events to no more than six attendees would impact on the operation of drug and alcohol support groups. These groups provide a key lifeline for people struggling with addiction and support their recovery and rehabilitation. As announced earlier this week, it has been clarified to me that drug and alcohol support group meetings are not impacted by the restrictions and can continue to operate, subject to adherence to public health guidance relating to physical distance and other protective measures. I advise that these support groups proceed with an extra degree of caution and put in place strict protective measures as individuals with addiction problems are more vulnerable to the risks of Covid-19.

Responsibility for the health needs of socially excluded groups such as people who are homeless, Travellers, the Roma community and residents of direct provision centres also comes under my ministerial brief. Covid-19 has brought into focus the significant health inequalities faced by these groups due to social and housing conditions. At the beginning of the pandemic, a range of preventative and precautionary measures were introduced, which were aimed at minimising the risk of infection among service users and staff in congregated settings. The impact of Covid-19 was greatly minimised by an intensive and collaborative response from Departments, the HSE and civil society. A good example of this approach is the measures adopted for people who are homeless. As a result of these efforts, the number of outbreaks of Covid-19 in homelessness services has been minimised, with only 15 cases associated with four clusters. We need to maintain these supports for homeless people and other socially excluded groups as Covid-19 remains a threat to public health.

I hope that the Deputies present now have a deeper appreciation of the increased importance of public health policies as a result of Covid-19 and of how these policies, Healthy Ireland, tobacco and alcohol policies, the national drugs strategy and Inclusion Health have helped to minimise the impact of Covid-19 on the population, especially those who are socially excluded. I look forward to the contributions to this debate....

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