Paula Bradshaw of Alliance asks if £6.5m of funding from the department has gone to care homes yet.

Ms Shepherd says "yes it would have went through into account possibly last Friday or the Friday before".

"I do believe that money has been allocated," she adds.

The IHCP representative adds that the body has put in a proposal to the department regarding additional costs to care homes resulting from Covid but has been advised by the department that the proposals can't be seen as independent.

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Ms Shepherd continues that she is aware "the department are considering additional funding" but says it is unclear "what shape that is or what it looks like".

Mrs Bradshaw then makes a declaration that she has a family member who worked in a care home.

Gerry Carroll of People Before Profit asks if it’s been the case that owners of care home have been buying their own PPE, or accessing it from the trust.

He asks how many care homes are only paying statutory sick pay.

Ms Shepherd says of PPE, "it's a mixed approach".

"The department and trusts have really stepped up and are providing PPE and replenishing PPE," she adds.

Ms Shepherd says the IHCP also purchased PPE on behalf of providers.

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Turning to statutory sick pay, or SSP, she says there is an issue but that it has been resolved with the department in relation to home care services and that there is an agreement to "fund the gap".

For staff in care homes, she says the department is "currently looking at a proposal" and she says it is something that needs to be rectified but is "under active consideration".

Colin McGrath of the SDLP says during the pandemic outbreak "it felt that every week there was a different priority".

He says the "proper emphasis wasn't placed on the care home sector but the knowledge was there" that the virus could spread there.

He asks Ms Shepherd if she believes a lack of PPE provision for care home workers had an impact on lives.

Ms Shepherd says "in relation to care homes being left behind" there have been a number of reports in recent years which she says outline how the "social care sector is thought of latterly".

She says that when the outbreak started, the "priority at the time as thought to be in the acute services because of the estimation of the number of people that were going to be impacted".

Ms Shepherd refers to action taken in relation to the social care sector as being "reactive" and says she doesn't know "whether that would translate to things not being done on time".

"There was a lot of work put into acute care as that was deemed to be where the pandemic would present," she adds.

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Turning to PPE, Ms Shepherd "we did have to struggle and argue about PPE early on".

"As to whether that has led to any adverse impact on residents, I don't know the answer to that.

"That would have to be picked up at a later stage," she says and outlines that at the beginning the virus didn't appear to be in care homes, but as soon as it was apparent the issue was raised.

"Early on in the process we were told it was normal infection control processes that were needed," she adds.

Committee chairperson Colm Gildernew asks Ms Shepherd what steps she believes could "improve or reduce the ability for Covid-19" to enter care homes.

Ms Shepherd says "testing is obviously the key issue" - "testing all staff and testing all residents".

She emphasises there need for "a repetition of that test" and says that the virus can be difficult to identify.

There is a "real challenge in trying to ensure to ensure the virus doesn't come into a care home or round it," she says.

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Mr Gildernew turns to the issue of testing for residents coming out of hospital.

Ms Shepherd says “we were having to accept people from hospital without being tested in the past” - something she says was asked to be resolved.

She says “it’s too late to apply that retrospectively” and that Covid-19 is already in care homes.

"We can't go back in time for that."

“Anyone coming into a care home must have a pre-admission test,” she explains, but adds that the test does not guarantee that people are clear of the virus.

"People may develop the virus a number of days after that," she adds.

Ms Shepherd says the health minister's announcement of 13 May regarding "ramping up the testing" is very welcome.

"The priority now is that we need to reduce the potential for the transmission of the virus within care homes" that have Covid and to reduce the possibility of it entering homes that don't have it.

"There needs to be urgent consideration of antibody testing," she adds.

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Ms Shepherd says that "the testing will need to be repeated on a regular basis" as it will only give a picture at a moment in time.

There are also human rights issues concerning the carrying out "a quite intrusive test" on people who are unable to consent or understand what the test is about.

Under the Safe at Home project, the Department of Health has asked care homes to take part in a pilot scheme that would see some staff live-in the home.

She says that the unions will not support the staff live-in options.

Ms Shepherd welcomes the possibility of the Ambulance Service and nurses being made available for mobile testing.

And she also welcomes the health minister's proposal that the independent care sector is in need of reform for the future.

Returning from their break, the members proceed to the next briefing, with Pauline Shepherd of Independent Health and Care Providers.

Speaking on a phone line, she explains that IHCP is a group representing providers of care home and homecare services.

The independent sector provides 15,000 out of 16,000 care home beds, Ms Shepherd says.

She will concentrate on care homes as this is "where the virus is particularly challenging".

"PPE was a particular concern," she says, adding that initial guidance was issued on 17 March stating that the independent sector needed to source its own equipment and to contact the trusts if it couldn't access supplies.

Ms Shepherd says PPE eventually began to flow around mid-April and has "greatly improved now" but with some concerns about quality.

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She says financial support has been provided to cover staff absence due to self-isolating.

Turning to testing, she says that "pre-admission to care homes was a concern that I raised on 19 March".

Ms Shepherd welcomes the testing of symptomatic members of staff and residents but "we know people can have this virus and show no symptoms at all".

She says "there needs to be further clarity in terms of timing" regarding the minister's latest announcement on testing in homes, including how often tests will be repeated.

Ms Shepherd turns to the subject of restricted visiting and the effect on residents and families, particularly on those with dementia and learning difficulties.

She says these restrictions need to be assessed regarding the balance between health risks and family contact.

Alan Chambers of the UUP asks if there “inevitably will be increased demand” for services as a result of the pandemic and whether the panel has a sense if the “sale of illegal drugs has been disturbed by the lockdown”.

Alex Bunting of Addiction NI says looking at what has happened in other countries, there have been impacts on mental health and outlines the correlation between poor mental health and an increase in addiction.

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Ian Cameron from Extern says he was expecting to see a reduction in availability of heroin, but “it seems to be just as available now as when the pandemic started”.

He says some people have shifted to different substances as a result of lacking funding to access heroin.

Colm Gildernew, the committee chair, thanks the panel for the contribution to the meeting and proposes a short break.

Gerry Carroll of People Before Profit says “I’d be concerned we don’t have enough funding as it is for these services” and asks the panel if they feel more funding is needed.

Mal Byrne of Extern says most providers have seen an increase in suicidal idolisation and says mental health has been badly impacted by the pandemic.

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“I think we should look at some pragmatic approaches to mental health and to try and lessen the impact of this at the end,” he adds.

Alex Bunting of Addiction NI says those who suffer economic inequalities also suffer health inequalities.

“It’s not that we don’t have communities that have come through significant issues,” he says but adds he believes they will be “disproportionately hit on top of that”.

Alliance's Paula Bradshaw asks about a pilot for a nasal spray of Naloxone run by the PHA. She wants to know if it's still going and if it is useful.

The south Belfast MLA also wants an update on the size of the waiting list for those seeking opioid subtitution therapy.

Ian Cameron from Extern says "to be honest we have no idea on the waiting list".

"We don't know how long it’s going to take," he says, adding "we have identified roughly 30-35 people who were either street homeless or in or out of the hospital system" that could benefit.

"If the Belfast Trust are talking about inducting two people a week," he says "if you have 30 people, that’s extending into months".

"Certainly the waiting list continues to grow," says Mr Cameron.

"I think that’s just going to continue after Covid".

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Simon Community representative Eoin Ryan turns to the nasal spray pilot and says there was an initial discussion and then Covid happened so “we’re waiting to hear”.

He says he has been told it “definitely is going to happen” but that time frame has been pushed back.

“It is on the agenda to happen pretty soon."

Pam Cameron of the DUP asks about the need for PPE for addiction workers.

She's also asks the witnesses if they are working with the police on tracing the production "of what I call fake drugs".

Ian Cameron of Extern says a arrangement has been made with the PSNI when drugs are found in Belfast city centre.

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"We try to make the service users aware of the dangers of the fake drugs and the stuff that are out there," he says.

Anne-Marie McClure of Start 360 says that "in terms of our staff an the front line, the trusts have been providing PPE and scrubs".

Sinn Féin’s Pat Sheehan joins the meeting by audio link and praises the collaboration which the representatives have mentioned during the session.

He says one “negative observation” is around access for service users to the internet in relation to the potential Covid-19 contact tracing phone app.

He asks a “quick question” about gambling and asks if the panel have any evidence of “any increase in gambling in this period”.

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Alex Bunting from Addiction NI replies to the gambling question.

He says “the biggest concern” was increased levels of investment from companies and how they were “able to target people during lockdown”.

“There’s no doubt when we come out of this, and look back at this, there will definitely be increases in gambling,” he adds.

The DUP's Alex Easton is on the end of a phone line.

He asks if the organisations have the resources required to deal with the extra demands on their services, and he also asks Eoin Ryan about the Simon Community's problems regarding sending drug samples to Wales for testing.

Alex Bunting from Addiction NI says there was a gap in funding before the issue of the pandemic "coming on top of it".

Mr Ryan says that "when we have been able to get accurate information about the content of what people are taking we've been able to relay that back to the users" and it has enabled them to modify their intake.

He says there was a death in Belfast last week and Diazepam was found in the young man's room, but "we wont get information in terms of the confirmed cause of death and that's an issue as well".

Sinn Féin’s Orlaíthi Flynn joins the meeting by audio link. She wants to know more about suicide prevention, the number of suicides relating to drug and alcohol abuse during the pandemic and the panel's thoughts on the increase in alcohol use by the public during lockdown.

Anne-Marie McClure says she doesn't have the number of suicides relating to drugs and alcohol to hand but she knows there have been some.

She knows of one death that happened 24 hours after release from prison, and says Naloxone was used but “unfortunately the person did not survive”.

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The big issue around alcohol, says the Start 360 representative, “is it has increased in the general population, it has definitely increased among those who are more vulnerable”.

Mrs McClure raises concerns about the "lack of digital access" and says while "a lot of our clients will have smart phones but they don't have internet".

"They would've used the internet of shopping centres, libraries," she says - "they don't have that access anymore".

Colm Gildernew then turns to the capacity of services to cope with demand during Covid and asks the panel for their opinion.

Alex Bunting from Addiction NI says “there was a gap” in the framework for Belfast services following the closure of FASA (the Forum for Action on Substance Abuse).

Addiction NI is “oversubscribed but doesn't have the capacity to deal with the number of service users coming forward or being referred from professionals” says Mr Bunting and adds there has been support from PHA but that they are “restricted in the support they can give us in terms of an uplift”.

He says that during the pandemic there has been an increase in alcohol use and an increase in professional referrals.

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Mal Byrne from Extern wants “to flag” a trend which could "potentially be a growth in the use of heroin in our major cities" when countries enter a recession.

"It's to out a sort of put a marker down," he says, "that potentially we could have more issues with heroin as we move forward here and access to treatment will be even more important".

"We need to learn from other models," says Mr Byrne, on how other countries deal with the issue.

Colm Gildernew, the committee chairperson, asks the panel for their thoughts on whether services have remained fully operation and how effective the trusts and the PHA have been to date?

Anne-Marie McClure says, speaking on behalf of Start 360 and “more generally from a NIADA perspective”, the support from the PHA has been “really good” in terms of “working closely with them as we start to transition our services from face-to-face to remote engagement”.

She adds the PHA has extended the funding to December.

“Our contacts with the trusts have continued as well, and for some of our staff we continue to deliver face-to-face,” she says, adding that some staff have been redeployed within the prisons to work as part of the trust surge plan.

In that regard, she says her organisation is "not delivering services we were contracted to do, but are doing our usual committal and meetings with prisoners that are soon to be released".

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The "mental health team in prisons is very busy indeed," she adds.

In the community, Mrs McClure says trusts have given support, adding that some other staff "have been redeployed into children's homes to deliver again on trust surge plans".

She pays tribute to "one of the big positives out of this" as being the joint working approach between the trusts, PHA "and ourselves".

Alex Bunting of Addiction NI says his organisation provides services for the Belfast Trust and the courts and probation service, and services for older people affected by alcohol addiction in the Western Trust area.

He says Addiction NI has moved to adapt its delivery models during the lockdown., and they continue to have considerable waiting lists for their Belfast services.

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"Alcohol is the primary drug causing issues for our client group," Mr Bunting says, but prescribed medication also causes significant issues.

"We have seen that 31% increase in alcohol sales through off-sales as has been reported in the media," he adds.

Mr Bunting says that people are trying to deal with the mental health issues brought on by the pandemic.

Mal Byrne from Extern says his organisation provides “nine drug and alcohol services across three trusts” that aim to help “severe drug and alcohol users”.

“There has been a lot of difficulties in terms of adapting our practice but overall we have done the best we can,” he tells the committee.

Mr Byrne explains that “working face-to-face on the street is quite difficult” due to the Covid-19 pandemic, but says “one of the new ways of working, the new normal, is a lot of phone contact and meeting people in the garden”.

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But he emphasis that this brings “it’s own challenges” in trying to help those abusing substances.

He adds there has been a “rise in desperation” and an “increase of aggression” of some of those using services.

A deterioration of mental health for those who are homeless, or who were homeless in the past, is prevalent, says Mr Byrne.

The Extern representative also says access to money to purchase drugs “has led to a certain level of desperation”.

He says some service providers have continued to give out Naloxone to “prevent overdose if possible”.

Next up is Eoin Ryan of the Simon Community, which is a homelessness charity.

He says that during the early party of the Covid lockdown they experienced "quite a reduction" in overdoses but this has changed in the past three weeks.

"We have seen a significant increase in overdoses particularity in relation to street-bought Diazepam", Mr Ryan says.

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He adds that the streets have been flooded with these "street blue" pills and when sent for analysis, none have had Diazepam in them.

"We're quite concerned about the potency of these pills," Mr Ryan adds.

He says there has been an increase in aggression due to the use of these drugs and a number of people have been arrested.

Mr Ryan says it would be analysed locally it would be a great help as sending them away to Wales slows up their work.

He says another problem is with mental health support, which has also been affected by the lockdown.

Anne-Marie McClure from Start 360 joins the meeting by audio link.

She says “mental health is a challenge in Northern Ireland anyway but it’s even more of a challenge as we move through these different times”.

Mrs McClure says her organisation provides drug and alcohol and employment services to young people in the community and in the prison setting.

She explains that she is also the chair person of the Northern Ireland Drug and Alcohol Alliance (NIADA) and says members “in the main” hold contracts and deliver for the PHA (Public Health Agency).

NIADA is funded by the PHA and has been since 2019, but Mrs McClure says groups that are members do pay fees as part of "transition into full independence".

Mrs McClure explains that this is because NIADA wants to be an "independent voice" and provider for service users "who are key to all that we do".

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The chair of NIADA says at a recent meeting members raised a number of issues, one of which was "specifically OST, opioids substitution therapy" and the services across the five trusts.

She says concerns were around a "lack of information about the service, particularly for new introductions" and she says members felt there was a "a bit of a postcode lottery".

Mrs McClure says the body wrote to the minister and the chief medical officer in relation to their concern and did receive a response which clarified OST availability, but she says the concerns were not fully addressed.

She adds that there is a need to ensure the "postcode lottery does not continue" and a more "joined-up approach is required" across trusts.

Mrs McClure says this is important for "high-risk clients" and says the "lack of access to these services has a range of knock on effects".

Sinn Féin's Colm Gildernew is chairing this morning's meeting.

Three members are attending the meeting via audio link.

They are Sinn Féin's Órlaithí Flynn and Pat Sheehan and the DUP's Alex Easton .

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Mr Gildernew introduces the first item of business - a briefing from representatives of a number of addiction services organisations:

• Mrs Anne-Marie McClure, Start 360• Mr Eoin Ryan, Simon Community NI• Mr Alex Bunting, Addiction NI• Mr Mal Byrne, Extern