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Paul Reid: 'I'm certain we'll get back to hugging friends and not wearing masks'

In an interview with TheJournal.ie, the HSE’s CEO said the pandemic highlighted a number of health policy shifts that are needed.

HSE CEO PAUL Reid has said he is confident Ireland will be able to return to ‘normality’ once the pandemic is over, abandoning our masks and hugging friends when we meet them.

“Ireland as a society is one that values engagements and values family and values our interactions with people and I think that’s something you can’t throw out,” he said in an interview with TheJournal.ie.

“Definitely, I’d be certain we’ll get back to that.”

And there is hope now for this return to our old normal, with the likely approval of the Pfizer BioNTech vaccine by the end of 2020. The first shipment to Ireland is contain almost 5,000 doses and the HSE expects to have hundreds of thousands of doses by the end of February.

Reid said he does see some elements of the measures introduced in over the last ten months being maintained in the future.

“Honestly when you look at what we did through the middle of a flu season in the past, we were all coughing and sneezing on the Luas. I think there’ll be greater recognition of transmission. I think we have to take some elements of the good out of all of this.”

He said he doesn’t foresee policy implementations every winter telling people to wear masks, but it may be something people decide to do, knowing it can help.

“Certainly when you think back to a heavy flu season, wouldn’t you rather see everybody jumping on the Luas with a mask? You probably would.”

Nursing homes

If he could go back in time and tell the Paul Reid of February 2020 anything, it would be a warning about Covid-19 transmission in nursing homes.

“The one that breaks my heart, the one I’d really love to be able to tell is about nursing homes and elderly care. That stands out for me as one I’d really like to have known better.

“Because our focus, and not just ourselves … all the scenes [internationally] were in acute hospitals. It was actually sometime later in Spain where it began to emerge around elderly care and nursing home impacts. That would be the one – you’d love to know different.”

Over the course of the year, but particularly in the early part of the pandemic, there were a number of significant outbreaks at nursing homes. In August, an expert panel set up to examine the situation in nursing homes recommended a number of both long and short-term changes. 

This included a recommendation that the health system and nursing homes – the majority of which are privately owned – be more closely aligned.

At the time nursing homes accounted for 56% of all Covid-19 related deaths.

Reid acknowledged a need for a dramatic policy shift in nursing home care – away from congregated settings. 

“From my own local governemnt background, we were dabbling in it a bit, constructing housing schemes for elderly care. I think it’s something we have to up our game on, where you provide integrated care in a very different setting to a nursing home,” he said.

“A congregated setting is not the way to deal with people at that stage of their lives. 

I think it does need a really strong committed governemnt policy change, I don’t think it will naturally change. Personally I’d like to see it in a programme for governemnt, that our strategy direction in the future is different. It will take a long period of time but I think we have to get on a different roadmap.

Another big change required relates to the governance model for the nursing home sector, he said.

“The HSE came under a lot of challenge and criticism, that’s understandable, but at the same time we’re not the oversight [body] and we didn’t have a natural relationship with nursing homes. That was a gap of responsibility and accountability and I think that was a factor, still is a factor,” Reid said.

Through the work of the Covid-19 Nursing Homes Expert Panel, he said there had been an “interim solution” to get the HSE and the private nursing home sector working better together.

That’s something that should be clarified in time – what’s Hiqa’s role, what’s the HSE’s role, what’s private nursing home’s and owner’s roles and responsibilities? I think we’re still seeing some of the impact of that gap.

“Even recently, Hiqa went into a nursing home, Oaklands nursing home [in Listowel, Co Kerry], they say it’s not fit for purpose, we take it over, the owner backs away. It just seems an odd process.”

Outbreaks in meat plants

Another sector that experienced significant levels of transmission was food manufacturing – again with some significant outbreaks, particularly in meat plants.

Last month reports released by the Health and Safety Authority detailed a number of issues identified during inspections of these plants, including staff working “face-to-face” with ill-fitted masks, a lack of social distancing and tightly-spaced locker rooms. 

“We have to look at the meat plants from two points. One is the technical aspect of how the virus spreads and the situation within the plant itself. But we also have to look at the wider societal [part], and the workforce and their living arrangements or transport arrangements.”

He said public health teams who went into plants saw “congested workspace” in some cases, with a lot of shouting because of the loud machinery. Air circulation in the plants is also believed to be a factor in transmission.

“Now I should say, the meat plants responded quite well with us. It was a learning for them too,” he said.

But I think it would be remiss to step back from some of the wider implications for workforce and for society because many of the staff lived in high congested settings, many of them transported to work together, many of them couldn’t afford to take days off work in terms of pay issues.

“And many of them were reluctant to stay out of work so [they were] going to work symptomatic. And indeed many were reluctant to pass on contacts or even make contact with others, potentially putting someone else out of work.”

Concerns about Christmas

Covid-19 case numbers continued to rise over the last week, with the government warning it is likely the country will face new restrictions before the New Year.

Taoiseach Micheál Martin has said he is “very minded” to accept NPHET advice for a pre-New Year closure of the hospitality sector. This morning, government sources gave indications that restaurants and gastro pubs would be asked to close their doors again on 30 December. 

The exact restrictions are to be decided by Cabinet when it meets this coming Tuesday.

Reid said he is worried about the knock-on impact on the healthcare system in January.

“The impact of one positive case is in complete disproportion to normal events, so it has the capacity to close a ward very quickly, it certainly will close a bed very quickly for a period of time.

So looking right now, we’re beginning to see rising trends at a time when we’re going to have more reduced restrictions. In normal times, I’d be concerned about post-December anyway for the hospital system.

“Now we have to layer in normal concerns, people come forward with chronic illnesses, people with COPD effects, and layer onto that positive Covid cases,hospitalisations and impact on some of our bed capacity, that would be a concern.”

He said the health service is in a stronger position going into the new year than it normally would be, with the trolley count down 55% on last year.

Future pandemics

Reid said Ireland has to build a “national pandemic capacity capability” that can dial up or down as needed.

“That means, public health and the role of public health teams and doctors, that needs to be strengthened. There’s plenty of other roles they can do when there isn’t a pandemic so public health doctors will always have value. We have to strengthen and value more that workforce.”

He said an operating model for testing and tracing will also need to remain in place.

“It’s hard to imagine that will always be a fixed workforce. My direction on it would be something you scale up and scale down as needed, but you need to keep a base level. So that can be a fully HSE in-house system or something you can build and contract in future,” he said.

The health system will also have to strengthen its ‘pandemic skills’, he said.

So, where do we go for ventilators, where do you go for supplies of testing reagents kits, how do you build up resilience on the island for PPE, how do we invest so that companies can recalibrate their business?  It would be a very wise investment to be able to produce PPE here, as opposed to buying it overseas or China.

Reid said he believes there has been a “huge recognition” of the investment needed in the healthcare system in Ireland.

“But it’s not just about money,” he added. “It’s about where the money is invested and I think we need to make a step change in care outside the hospital so that the emergency department is not the first port of call.”

“A number of people have said to me over the last year ‘has it set back the reform plan for the health service?’ but I actually think it’s strengthened it hugely. It’s given the system confidence to be able to make changes, and do them, and not having to design them to the nth degree.”

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    Mute Maurice O Neill
    Favourite Maurice O Neill
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    Dec 19th 2020, 10:38 AM

    Reid said he believes there has been a “huge recognition” of the investment needed in the healthcare system in Ireland. Well I would say more than enough money has been given to that runaway train over the last few years and they still can not run it properly. Look at the Children’s hospital and the overspend there

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    Mute Gere
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    Dec 19th 2020, 11:25 AM

    @Maurice O Neill: Very true Maurice. Bed capacity down 50% from this time last year & the hospitals still cannot cope. People are dying at home from other ailments because they know if they go into hospital they will die alone. The one thing this has taught me is, if you can look after elderly relations at home do so, because if they go into a nursing home you may not be able to make sure they are been cared for correctly & you may never see them again.

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    Mute Dave Barrett
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    Dec 19th 2020, 1:23 PM

    @Maurice O Neill: And Martin wants to build one in Cork.

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    Mute Fred the Muss...
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    Dec 19th 2020, 1:57 PM

    @Maurice O Neill: You try and deal with the HSE as a supplier, they are the absolute pits. We had a better product that would have saved millions and they blocked us every step of the way.

    11
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    Mute Maurice O Neill
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    Dec 19th 2020, 2:15 PM

    @Dave Barrett: Will never happen.

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    Mute seamus toomey
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    Dec 19th 2020, 3:28 PM

    @Fred the Muss…: any proof to go along with this?

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    Mute Fred the Muss...
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    Dec 19th 2020, 3:53 PM

    @seamus toomey: Loads of proof but I’m not making it public on the Journal. I still have to deal with the HSE

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    Mute Damien Grogan
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    Dec 19th 2020, 4:17 PM

    @Fred the Muss…: unless you are an event management company like Roqu. Then they’ll give you €14m up from for ventilators that don’t work

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    Mute Maurice O Neill
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    Dec 19th 2020, 10:36 AM

    And just wait until this is all over and the trolley numbers will be up at around 800 a day. You will not see him or his buddies in NEPHET for love or money come out and comment on that scandal.

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    Mute Capax
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    Dec 19th 2020, 10:52 AM

    @Maurice O Neill: Fully agree, massive inequalities, incompetence and wanton greed in the management of the Healthcare system. Reflects very badly in the great people that work within it.

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    Mute Capax
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    Dec 19th 2020, 10:54 AM

    @Capax: reflects badly on the great people that work within the healthcare system. (Auto type error)

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    Mute ed w
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    Dec 19th 2020, 12:36 PM

    @Maurice O Neill: huge amounts of waste in the system. poor management and too much management. not enough focus on the frontline

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    Mute Maurice O Neill
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    Dec 19th 2020, 10:34 AM

    Statement of the century. Who elected him to anything. Go back and do your job like you are supposed to do and let the elected people run the Country.

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    Mute Denis Ryan
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    Dec 19th 2020, 11:17 AM

    @Maurice O Neill: A guy who is employed in public health commenting on public health, shock horror. ” Go back and do your job”….. you must be one of those freedumb fighters. Hows Donnie and Gemma these days?

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    Mute Fionn Darland
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    Dec 19th 2020, 10:37 AM

    Cometh the hour, cometh the man (or woman). Paul Reid has been a rock throughout this pandemic. Well done Paul. Thank you for your hard work in these trying times.

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    Mute Maurice O Neill
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    Dec 19th 2020, 10:40 AM

    @Fionn Darland: Ya right

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    Mute David Geraghty
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    Dec 19th 2020, 12:19 PM

    @Fionn Darland: I can confirm he is a man.

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    Mute ed w
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    Dec 19th 2020, 12:37 PM

    @Fionn Darland: really ? is doing your next pay review

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    Mute emer daly
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    Dec 19th 2020, 11:44 AM

    You say you would really like to have known better about the nursing homes… Well you know now…. so put the highest measure of care and protection there now.

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    Mute Derdaly
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    Dec 19th 2020, 3:30 PM

    @emer daly: how could he not have known? 2 to 3 weeks beforehand the Spanish Army had to go into a nursing home in Madrid. This was international news. https://www.npr.org/sections/coronavirus-live-updates/2020/03/24/820711855/spanish-military-finds-dead-bodies-and-seniors-completely-abandoned-in-care-home

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    Mute Brian Ó Dálaigh
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    Dec 19th 2020, 5:07 PM

    @Derdaly: not just Spain. The whole world knew as nursing homes in Korea, China, Italy, Spain were being overrun. NPHET knew this and actively encouraged the spread of the virus through nursing homes killing hundreds of residents. So many NPHET hole-lickers here and not one of them is interested in holding NPHET to account. They would rather there were hundreds more dead residents than admit – maybe, just maybe – that NPHET is composed primarily of HSE careerists rather than actual experts. The CMO is guilty of the Cervical Scandal and attacking the victims of such, and those victims continue to die and will do for several years, yet Holohan is a God to some on here.

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    Mute Peter Bell
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    Dec 19th 2020, 11:04 AM

    A wannabe T.D.

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    Mute Jonnie Marre
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    Dec 19th 2020, 12:25 PM

    Who are you anyway??? Paul Reid who?? Shut down the HSE quango! Not fit for purpose!!

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    Mute ed w
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    Dec 19th 2020, 12:39 PM

    @Jonnie Marre: problem with shutting down the hse is they create another layer of management without dismantling the old one. we are paying the price for that when the regional boards were abolished (in name only)

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    Mute Niall Hickey-Horan
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    Dec 19th 2020, 4:00 PM

    Well Paul you don’t really need to tell us this. There is NO way we will continue with this madness indefinitely! Mid 2021 you have your deadline vaccine or no vaccine. Dr Tony is Holohan is god, judge, jury and it’s about time someone pointed that out to him! Get the HSE up to scratch none of this would be needed

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    Mute Jim Lingk
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    Dec 19th 2020, 12:45 PM

    The masks are here to stay.

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    Mute Tommy Berry
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    Dec 19th 2020, 1:13 PM

    @Jim Lingk: That wouldn’t be a bad thing. The flu virus, wouldn’t be so prevalent every year.

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    Mute Jim Lingk
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    Dec 19th 2020, 3:28 PM

    @Tommy Berry: I disagree and believe it will be a bad thing.

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    Mute Joseph Duggan
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    Dec 19th 2020, 2:03 PM

    Sounds like trump it will go away but in the meantime it’s a mess deaths etc

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    Mute Vanessa
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    Dec 19th 2020, 1:40 PM

    In case of a future pandemic I’m going to sell my house.

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    Mute Damien Grogan
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    Dec 19th 2020, 4:15 PM

    Already there Paul. Already there…

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    Mute Fiona Fitzgerald
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    Dec 20th 2020, 1:30 PM

    A bit shocked at the statement blaming unfortunate meat factory workers. They had a paid job and depended on it to buy the most basic groceries and essentials. Why on earth put out a statement that anyone “was reluctant to” live on air? Who wouldn’t be “reluctant” to give up work with zero support and sick pay? How were they supposed to buy food and medicine?

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    Mute Kev Mak McClean
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    Dec 19th 2020, 8:53 PM

    Dumb obvious statement….tomorrow is another day…soon be xmas….another year older…..m

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