I call the leader of Aontú, Deputy Tóibín.

Information given to Aontú by the HSE shows that well over 40% of Covid-19 deaths in Ireland are linked to hospital or nursing home outbreaks. That is 3,500 people who died because they contracted Covid-19 in a nursing home or hospital. For example, these are people who went into hospital with a broken leg and came out in a coffin.

It is a human disaster of enormous proportions and, incredibly, the people who were most vulnerable during the Covid crisis were actually the people who were most exposed. Throughout Covid the Government was focused on restricting people to 2 km from their homes, preventing people from going to funerals, to school and to work, when in reality the most dangerous place one could be was in a nursing home or in a hospital, the two locations run or regulated by the State. We accept that no Government could get everything right but there were serious and disastrous mistakes made during Covid.

Documents released to Aontú by the National Treatment Purchase Fund show that 10,000 people were discharged from hospitals into nursing homes at the start of Covid. Many of those who were discharged were not tested for Covid. This had the effect of seeding those nursing homes with Covid. Staffing was chaotic in those nursing homes. Indeed, the current Minister for Health, when he was an Opposition Deputy at the time, stated in this Chamber that the HSE was intercepting staff and PPE from going into nursing homes. The head of Nursing Homes Ireland actually tried to get a meeting with then Minister for Health, Deputy Simon Harris, to draw attention to this crisis but none was forthcoming for weeks. Nursing homes were so short staffed that they were phoning relatives and asking for help. Nursing homes were going onto Facebook looking for help. In one case I recall a nursing home manager went on the radio in tears to discuss how two staff were left in charge for 48 hours in a nursing home when five people died around them. They could not get the necessary staff to help them out. The Minister of State, Deputy Mary Butler, wrote to the HSE head, Mr. Paul Reid, as did Mr. Phelim Quinn, then chief executive officer of HIQA, urging for more staff. There was no reply for weeks, but finally Mr. Paul Reid wrote back saying that everything was fine and that there was no pressure. Shockingly, at the time, the Minister, Deputy Simon Harris, created the Be on Call for Ireland initiative where 73,000 people signed up, including medics and nurses who came home from abroad to do their civic duty for this country. How many people were ever recruited from that? It was around 450 people. Only 10% of that database of people were ever contacted by this Government, which is a tiny fraction.

The Government is now saying that it is carrying out a review. Is the Taoiseach for real? Is the Taoiseach saying that the deaths of 3,500 people only warrants a review? Why does the Government oppose a public investigation that would find out the truth and provide justice for families who have lost loved ones so tragically in the Covid crisis?

I thank the Deputy. I remember the pandemic very well. I remember it almost on a day-to-day basis and I remember the very difficult decisions and the different judgment calls that had to be made at different points in time, often without much information. At the very start we knew very little about the virus, as the Deputy will recall. It was not even clear at the start whether asymptomatic transmission was even possible. That became clearer later in the pandemic. It will always be the case that with hindsight things will look differently than at the time when we had so little information.

I remember something that Paul Reid, the head of the HSE at the time, said at the start of the pandemic. He said that there was no roadmap, no playbook and no lived experience as to how one deals with a pandemic of this nature. He said we would probably get about 70% of things right and 30% of things wrong. That is probably correct, but it is important that we find out what we got right and what we got wrong. This is why there will be a public inquiry. A public inquiry will be established this year to examine how the pandemic was handled in Ireland, not just healthcare aspects such as what happened in hospitals and nursing homes, but also around testing, the public health advice that was given around masks and antigen tests and all those things that became controversial, and also the economic response. All of these things need to be inquired into. I am committed to having that inquiry up and running this year.

With regard to there being a lack of staff, there was a lack of staff at various points during the pandemic. It was often the case that staff were just unavailable. In some cases, staff were unwilling to go into nursing homes for fear of getting the virus themselves. I can understand that. In other cases, when people were contacted because they had offered their services, they were not available when they were contacted. That was the real experience I had during that period of time. The Deputy will also recall that during that time I re-registered as a doctor and took part in the vaccination programme and the occupational health programme prior to that.

The characterisation the Deputy mentioned at the start was not particularly accurate. I am sure it was the case that there were people who went into hospitals who were in very good health but perhaps had, for example, a broken leg and who contracted the virus and died from it. Unfortunately, this does happen in healthcare. It is never something that anybody wants to see happen but the vast majority of people who died from Covid in Ireland were people who were elderly or had an underlying medical condition. That is how viruses work. That would have been the case in the community as well as in hospitals and nursing homes. Out of respect to the relatives of the thousands of people who did die in hospitals and nursing homes we should not create the impression that all or most of those deaths were preventable. Some of them might have been, but nobody dies of natural causes. There is always a reason. Very often it is a respiratory infection or urinary tract infection. For people who are elderly or who have comorbidities that is the thing they get at the end and that is the cause of death. It is not the case that those deaths were all or even mostly preventable. Out of respect for those families, many of whom are still grieving, it is important that we do not create a false impression in that regard.

It is important to repeat that the information we received is characterised that these 3,500 people who died contracted Covid in a nursing home or in a hospital. Out of respect to those people who have lost loved ones, they should be entitled to the truth and entitled to justice in relation to what happened them. They want information here. They do not want a nebulous review or inquiry. They want a commission of investigation that happens in a public fashion. If we do not do this for them, then they will not get to the bottom of what happened to their loved ones and they will not get justice for what happened to their loved ones. Right now, the information we have shows that 44 families are currently starting legal action against the State as a result of what happened. If there is not a full public investigation I worry that we will have the time-honoured example of this Government aggressively litigating against those families who have lost loved ones, in the same manner the Government has done on numerous occasions, so that families spend years tied up in the justice system expending massive amounts of their own resources in trying to achieve justice. Will the Taoiseach go on the record to say that we will have a full commission of investigation into this tragedy?

We will have a full public inquiry into how the pandemic was handled in Ireland. This will include what happened in nursing homes, in hospitals and in the community, along with the wider economic and social response. We have not yet decided on the exact format of that. I do want it to be done properly, whether that is using the commission of investigation mechanism, which has pros and cons, or a tribunal mechanism or another mechanism. I am open to that being considered. There are pluses and minuses to all of these mechanisms. I do not believe it can be done quickly. It will take time and it will take time to do it properly. I am determined to have this up and running this year, and ideally by the middle of the year.

Again, it is important we are honest with people that with the best will in the world and even with the best infection control procedures, it is not always possible to keep viruses out of hospitals and out of nursing homes. If it is not brought in by the staff it is brought in by visitors or brought in by the patients. That is just the reality of it. If one looks at the same statistics the world over one will see a similar profile, which is sadly that a high proportion of people who died from Covid would have picked it up in a healthcare setting or in a nursing home. That is the nature of a virus. We need to be serious about looking into the issues the Deputy has raised, and he is right to raise these issues, but we also need not to create the false impression as to how viruses work and what was possible and what was not possible.