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Dáil Éireann debate -
Tuesday, 20 Feb 2007

Vol. 631 No. 6

Other Questions.

Medical Cards.

Breeda Moynihan-Cronin


89 Ms B. Moynihan-Cronin asked the Minister for Health and Children if she has issued 2007 updates on guidelines to the Health Service Executive for the procedures used for evaluating savings or investments in the means test for medical cards; and if she will make a statement on the matter. [6261/07]

The Health Service Executive has detailed operational guidelines in place for the assessment of medical card applications. The purpose of these guidelines is to ensure every person entitled to a medical card or GP visit card is given the opportunity to avail of his or her entitlement and that a consistent approach is taken to means testing nationally. The guidelines include provisions dealing with how applicants' savings and investments are treated. I have not issued any instruction to the HSE on this aspect of the assessment process.

Since the beginning of 2005, the medical card assessment income guidelines have been increased by a cumulative 29%. Other significant changes which I have introduced are that applications are now considered on the basis of income net of tax and PRSI and that allowance is made for reasonable expenses incurred in respect of mortgage or rent, child care and travel to work. In June 2006, I agreed a further adjustment to the income guidelines for GP visit cards. These are now 50% higher than those used in respect of medical cards.

I thank the Minister for her reply. However, the answer to the question remains unclear. According to Comhairle, no rules are set out for assessing income from savings and practices vary among health service areas. The Minister stated that rules are in place, so she might outline them.

Does she accept that guidelines are extremely important? For example, all social welfare recipients formerly qualified for medical cards but that is no longer the case. A person aged 65 who just retired may have difficulties in getting a medical card. These guidelines need to be crystal clear if such people are to be able to obtain medical cards.

Will she comment on the dramatic decrease in the proportion of people on medical cards? The proportion has fallen from 35% ten years ago to 29% now, despite the introduction of the over-70s scheme. That decrease is having a serious effect in terms of preventing people from attending their family doctors. In the Republic of Ireland, it is estimated that 18.9% of people do not visit their doctors when they should because of the costs involved, whereas the figure in Britain is 1.8%.

Guidelines are in place with regard to savings. The first €20,000 in savings for a single person, or €40,000 for a couple, is disregarded, €1 is applied per €1,000 per week for the next €10,000 and €2 is applied in respect of the following €10,000. These guidelines have either just issued or are issuing in the context of special savings incentive accounts.

I take it they were not in place from 1 January.

I am unclear on the matter because I have been supplied with two different notes, one which states the guidelines have issued and another which states they are about to be issued.

With regard to medical cards, some 1.3 million people hold doctor-only or full medical cards. Incomes have increased by 60% in real terms over the period to which Deputy McManus refers. The scenario was very different ten years ago, with 17% unemployment and 8% long-term unemployment. We have substantially increased the income threshold and have moved it to disposable income. In addition to the traditional medical card, a further 50% increase has been made in respect of the doctor-only card.

However, notwithstanding the advertising and public awareness campaigns which have been conducted, I continue to meet people in my constituency clinic who are unaware they qualify for medical cards. It is similar to the family income supplement in that I wish we could find another way of ensuring everyone who qualifies for the medical card is aware of his or her entitlement. A continuing programme of assessment will be required in that respect, possibly including having general practitioners target some of their patients.

I will investigate Deputy McManus's claims with regard to people on social welfare. The intention is that people will not be excluded from the medical card scheme by virtue of annual budget increases to social welfare payments.

I ask that the guidelines to which the Minister refers be circulated to all Deputies. The issue regularly arises, so they could be useful.

Will I circulate them before I resign?

I do not mind when they are circulated.

He expects me to be nice to him.

It is in giving that one receives.

Hospital Acquired Infections.

Simon Coveney


90 Mr. Coveney asked the Minister for Health and Children if she is satisfied that MRSA is coming under control; and if she will make a statement on the matter. [6222/07]

Billy Timmins


125 Mr. Timmins asked the Minister for Health and Children the number of staff diagnosed with MRSA in the past 12 months; and if she will make a statement on the matter. [6225/07]

Bernard J. Durkan


175 Mr. Durkan asked the Minister for Health and Children the extent to which she, her Department or the Health Service Executive have studied or implemented the best international practice for combating MRSA; if she will produce evidence to re-assure patients or potential patients that the issue is under control; and if she will make a statement on the matter. [6175/07]

Olwyn Enright


191 Ms Enright asked the Minister for Health and Children if she is satisfied that hospital acquired infections are coming under control; and if she will make a statement on the matter. [6224/07]

Paul Nicholas Gogarty


196 Mr. Gogarty asked the Minister for Health and Children the reason her strategy to combat MRSA is not working; the cost of implementing this strategy; and if she will make a statement on the matter. [6300/07]

Olwyn Enright


199 Ms Enright asked the Minister for Health and Children the rate of blood-borne MRSA in hospitals here; and if she will make a statement on the matter. [6223/07]

Kathleen Lynch


206 Ms Lynch asked the Minister for Health and Children the number of cases of MRSA in each of the past three years and to date in 2007; the number of fatalities attributable to MRSA; the steps being taken to reduce the incidence of MRSA; the measures to improve facilities and tackle overcrowding in hospitals that have been made to deal with MRSA; and if she will make a statement on the matter. [6258/07]

Bernard J. Durkan


367 Mr. Durkan asked the Minister for Health and Children the action taken to prevent the spread of MRSA throughout the hospital network; and if she will make a statement on the matter. [6522/07]

Bernard J. Durkan


368 Mr. Durkan asked the Minister for Health and Children the number of incidents of MRSA confirmed to date; the number of hospitals affected to date; the action taken arising therefrom; and if she will make a statement on the matter. [6523/07]

I propose to take Questions Nos. 90, 125, 175, 191, 196, 199, 206, 367 and 368 together.

While it is an unfortunate fact that health care associated infections are not preventable in all cases, I assure the House that every effort is made to minimise the incidence of such infections. The Health Service Executive has appointed an assistant national director of health protection as the lead person nationally to address the issue of MRSA. Since its establishment, the health protection group has concentrated on a number of key issues, including the development of a three-year action plan and overseeing its implementation, as well as putting a high quality governance structure in place.

The Health Service Executive is also appointing a number of new infection control nurses, surveillance scientists and antibiotic pharmacists. These staff will strengthen specialist support for infection control and facilitate the development of the national surveillance system. Some posts have already been filled and the remainder are currently being recruited. The Health Service Executive has also initiated a number of other actions, including a two-year national publicity campaign on health care associated infections and antibiotic resistance which will use the full range of media at national and local levels, the development of a national surveillance system, a national infection control education programme, information for patients and the public, a new hygiene assessment scheme, a GP education initiative on antibiotic prescribing and measures to tackle overcrowding.

I have asked the Health Service Executive to set up a national helpline through which patients and their families can report incidents of poor infection control in our hospitals. If, for example, patients are unhappy that a hospital staff member is not disinfecting his or her hands between patients, they or their family members can call the helpline if they feel they are not in a position to raise the matter directly with staff in the hospital. This is not about blaming people, but about helping all of us, including patients, visitors and health care staff, to play our part in improving patient care.

Although MRSA is not a notifiable disease, the health protection surveillance centre of the Health Service Executive collects data on it as part of the European antimicrobial resistance surveillance system. The European surveillance system collects data on the first episode of blood stream infection per patient per quarter. The Irish data from the European surveillance system which are published on a quarterly basis by the Health Service Executive show there were 445 cases in 2002, 480 in 2003, 553 in 2004, 592 in 2005 and 435 up to the end of the third quarter of 2006. It is difficult to identify the number of fatalities attributable to MRSA as many people also have significant co-morbidity factors.

In 2006 Ireland participated in the Hospital Infection Society's prevalence survey of health care associated infection in the United Kingdom and Ireland. The survey which included 45 Irish acute adult hospitals, including eight private hospitals, provides accurate and comparable data for the prevalence of health care associated infections, including MRSA. Preliminary results of the study are now available. The overall prevalence of health care associated infection in the United Kingdom, excluding Scotland and Ireland, is 7.9%. The figures for England, Wales, Northern Ireland and the Republic of Ireland are 8.2%, 6.3%, 5.5% and 4.9%, respectively.

No figures are available for the number of staff diagnosed with MRSA. Routine screening of staff is generally not recommended because staff colonisation with MRSA is rarely implicated in MRSA transmission. Compliance with good practice, including the wearing of protective clothing and hand hygiene measures, should minimise the risk of cross-infection.

A primary element of the fight against health care associated infections involves changing practices and procedures and the manner in which many health care staff go about their daily work. Accordingly, it is unrealistic to try to isolate the overall cost of implementing such a strategy. The reduction in the incidence of such infections will both improve patient care and generate savings in the cost of service delivery. While accepting that many health care associated infections are not preventable, I am satisfied that significant steps are being taken to reduce the rates of infection and treat them promptly when they occur.

This reply is not good enough. I told the Minister at last Thursday's meeting of the Oireachtas Joint Committee on Health and Children that in the event of a pandemic of avian flu, there was a plan. The plan starts with putting the Minister for Defence, Deputy O'Dea, in charge and consists of a book, approximately two inches thick, on what to do in the event of avian flu affecting the population.

Ireland has an epidemic of MRSA. Professor Drumm's comments in this respect are important because they lead on to the question. When I asked him how many front-line staff in our hospitals had been swabbed for MRSA, he replied:

We have not swabbed staff at large in the hospitals . . . If we swabbed everybody in the system for MRSA, how many staff would immediately be taken out of the system?

The Minister has just stated it does not matter whether staff have MRSA. At the same joint committee meeting Professor Drumm stated that simply shaking hands could spread MRSA. While a plan for MRSA is desperately needed, is it true the HSE has only got as far as drawing up draft guidelines on how it will deal with MRSA in hospitals? Professor Drumm has no idea of the number of staff affected. Subsequently, he stated that when one did swab staff——

A debate on Question Time is not in order.

This question is important, as the Minister has no idea. She should confirm these figures. Professor Drumm stated: "It looks like up to 40% of isolates from staff in this country may be multiply resistant." Is it true that of the staff being swabbed, 40% have MRSA or some variant thereof? Is Professor Drumm wrong when he claims it can be spread by shaking hands? The Minister has stated it is not spread by staff.

There is serious concern in respect of MRSA in Ireland. Members want to know who will be in charge and what is the plan. There are no clear guidelines as to how the Minister will deal with this issue, apart from talking about public campaigns and raising issues in respect of prescribing. While Members are aware that these are the key issues, they want to know whether the Government has a clear plan. This is particularly true when one considers the enormous number in the community and who work in the health care services whom Professor Drumm is afraid to swab because of the possible consequences.

The Government has a plan. I understand Fine Gael recently held a meeting that was addressed by my good friend, Dr. Maurice Nelligan, who told the audience that half of them had MRSA. Deputy Twomey is a doctor and knows that one can swab people's hands and they may have it and one can swab their noses and they do not, or vice versa.

The action plan is being led by Dr. Doorley, Dr. Kelleher and Dr. Hynes of the HSE's medical team, with others. I met them two weeks ago to discuss the plan and I have mentioned some of its requirements such as the recruitment of specialist nurses and surveillance scientists and antibiotic pharmacists. It involves an education programme with general practitioners and the public because, as the Deputy is aware, the main reason for the increased incidence of MRSA is the over-prescription of antibiotics. This has been shown worldwide and the countries that do best are those that have in place an active programme with general practitioners and patients. It involves a helpline to assist patients to draw the attention of the authorities to matters about which they are unhappy, rather than expecting patients or their families to complain at local level, which the Government understands can often be difficult.

The plan also involves the swabbing of staff. Will we swab visitors? A host of measures are involved and the statistics I cited regarding the comparison between Ireland and England, Wales and Northern Ireland demonstrate we are better. I do not boast about this because an incidence of 4.9% is still not good enough. I would prefer to see Ireland reach the levels that obtain in the Scandinavian countries or Holland in which the rates are substantially lower. While that is the target we must set for ourselves, it will take us some time to reach it.

There is a major programme of training under way within the HSE in respect of this issue. I refer to the general practitioner programme and the recruitment of staff. In addition, there is the entire issue of hygiene. As the Deputy is aware, the standards of hygiene that apply when one visits a food production or pharmaceutical company are substantially higher than those in hospitals. I visited a company recently in which one was obliged to cover one's hair, shoes and so on. We probably need to reconsider the standards that apply to those of us who visit hospitals, particularly those of us who visit seriously ill patients.

Written Answers follow Adjournment Debate.