I received a message from a doctor in the past couple of days. He stated:

I have luckily had no patients who have died of coronavirus. I have had at least three though who have had delayed cancer diagnoses due to the shutdown of services and the delay in services. These will almost certainly die. I have others who are desperate to be seen by specialists but are hitting a brick wall in trying. The shutdown of the health services is killing people.

That is a startling statement for any doctor to make and it is not an isolated situation.

Around the country many people who are currently cancer symptomatic are facing a brick wall when it comes to reduced and closed services. The consequences of this will be enormous for them. Likewise, the cancellation of cancer screening has seen thousands of abnormalities, precancerous cells and cancers missed this year already. The numbers for cancer screening carried out in this State this year are startling when compared to those for last year. We have a bizarre and confused situation, which demonstrates the priorities of the Government whereby a person can get his or her hair cut and be in the physical space of a barber or go to a beautician and be in their physical space but people cannot attend BreastCheck at the moment. People cannot get a face-to-face consultation with mental health services staff in the majority of counties.

One of the most frustrating aspects of this pandemic has been the refusal of the Government to research the human cost in mortality and morbidity of the shutdown of the health service. I have asked on many occasions. The Taoiseach brought the party leaders together with the heads of NPHET and the HSE only last week and I appreciated the opportunity to be there. However I asked this question again, and again it went unanswered. There is no effort by the Government to understand the actual cost in mortality and morbidity to people throughout the country due to the shutdown and closure of health services.

The truth of the matter is that without that information the health service resource allocation cannot be made on the basis of evidence. Without that information, resource allocation is being made blindly by this Government. I ask that the Government carry out that research and open up critical healthcare services for people in real need across the country.

I thank the Deputy for raising this issue. It has been a core consequence of Covid-19 that normal non-Covid health services have been impacted very severely where activity levels are concerned, particularly in respect of diagnostics and procedures in acute hospitals. The Government is acutely aware of that. The forthcoming winter initiative plan will very much focus on that issue as well as dealing with the impact of Covid throughout the next six months but, critically, it will focus on the resumption of services.

On cancer screening programmes, a number of those services have resumed albeit not at the same levels that obtained prior to the onset of Covid-19. Various conditions and restrictions have been applied to the hospital setting as well to protect healthcare professionals and patients from Covid-19 when patients are going in for various procedures. That has slowed the throughput of patients to a significant degree. Waiting lists have, therefore, climbed since Covid emerged and we are very well aware of that. This came on top of waiting lists that had already been quite significant. Part of the winter initiative is to endeavour to procure capacity separate from Covid to enable more diagnostics and procedures to be done, particularly in regard to cancer, heart disease and areas where we can prevent the onset of serious illness and intervene early to improve patient outcomes from such conditions, along with additional beds and greater throughput in hospitals.

Another element is reducing pressures on trauma centres and accident and emergency centres through having more community diagnostic centres, particularly with regard to respiratory issues. All of this is designed to reduce the pressures on the acute hospital system to enable more procedures to be done in the acute services consistent with the health protection required in a Covid environment.

The Deputy made a valid point on undertaking more comprehensive research on the impact of Covid on a range of conditions or services. Fundamentally, what is required right now is to make sure that over the next six to nine months, the plan is robust enough to manage Covid and enable the resumption of services to as normal a level as possible within the context of the restrictions of Covid-19.

I will give the Taoiseach another example if I can. The National Suicide Research Foundation collects data on self-harm presentation from emergency departments throughout the country. These important data were suspended in the vast majority of these hospitals until the end of June. Even today, self-harm data are still not being collected in all of the emergency departments throughout the country. Face-to-face consultations for serious mental health issues are radically reduced. I understand that as many as 70% of those face-to-face consultations are not happening at present. In the main, these have been replaced by telephone calls. Telephone calls are no substitute for people who are in serious mental health situations. I have heard commentators say the health service is facing breaking point this year due to Covid. The truth of the matter is the health service is at breaking point every year anyway in this particular State. The difference of the situation is we have advance notice of this exceptional circumstance. This gives the Taoiseach an opportunity to prepare properly.

I ask the Taoiseach not to leave 100,000 women in a queue for BreastCheck. Do not set up a hierarchy of illness. Do not pit one patient against another in their pursuit of treatments. Will the Taoiseach provide the necessary resources now to make sure people get the life-saving treatment they need in the coming months?

I fully empathise with the Deputy's presentation. We are with him on the need to respond to these issues. This is why the HSE has developed a draft plan, which contains proposals for health service delivery in the Covid-19 pandemic for the winter and through to 2021, to address the backlog of non-Covid care as a result of the pandemic itself. It is built on a number of pillars, including building capacity, testing and tracing, contact tracing, public health, cancer services, targeting waiting lists and workforce planning because it will require the recruitment of additional personnel. Resources will be provided to enable this to happen. Already, unprecedented resources have been allocated to the health service and will continue to be allocated to the health service given the emergency we are in and the enormous unprecedented challenges that have been presented to the health services by Covid-19.

The Deputy's points on mental health are well made but there have been restrictions in mental health services because of Covid. Again, part of the planning is designed to try to enhance and improve, within the constraints of Covid, mental health services and the overall population health needs of the public, particularly those with chronic enduring illnesses and our senior citizens. Particular attention in the winter initiative plan will be focused on these.