Dáil Éireann debate -
Tuesday, 29 Apr 2008

Vol. 653 No. 2

Leaders’ Questions.

Deputy Enda Kenny

While the Tánaiste may find it a little facile or simplistic to raise cases in regard to health, I would like to make a point. Last Friday, The Irish Times reported that a woman named Kathleen Whiston was admitted to St. Colmcille’s Hospital in Loughlinstown on 15 May 2007 with an infection for management of a diabetes problem. Ms Whiston died in the hospital two weeks later on 29 May. According to the inquest, the cause of her death was a hospital-acquired infection or C. difficile. Her daughter is quoted in The Irish Times as saying: “We certainly didn’t expect my mother to have gone so soon and she wouldn’t have only she got that bug”. The problem is that Kathleen Whiston, God rest her, was not the only casualty of this bug. Over a seven-month period, 16 other people died in the hospital from hospital-acquired infections. C. difficile was the direct cause of death in five cases and a contributory factor in five other cases. In half of the remaining cases, MRSA was directly to blame.

Could these deaths have been prevented? The answer must be that they could have been prevented if the essential staff had been in place and proper procedure and practice followed. What really concerns people and causes them to lose confidence is that the hospital stated in October 2007 that it would discontinue the procedural policy of swabbing for MRSA all patients admitted to the hospital due to the failure to appoint a microbiologist. Five times in the past six months, the Dublin County Coroner has called for a microbiologist to be appointed. Today, almost one year after Kathleen Whiston passed away, a microbiologist has still not been appointed to St. Colmcille's Hospital, Loughlinstown, and it does not have a formal relationship with St. Vincent's Hospital. Yesterday, we heard a great deal of rhetoric about putting citizens at the centre of the public service and patients at the centre of the health service. How does a failure or inability to appoint a microbiologist over a two-year period put the patient at the centre of the health system?

The Tánaiste

I sympathise with the family on the death of the person concerned. I will make a general point about trying to put the citizen at the centre, which is the purpose of trying to have better public services. The Minister for Health and Children has taken a systematic approach to hygiene in the health system. HIQA has been established and we are now measuring hospital infection in a manner which was not done previously under any Administration. We are systematically approaching this issue in a manner which seeks to improve the provision of health care in our hospitals and throughout the health system.

The Minister for Health and Children today dealt with a question from a Fine Gael Deputy inquiring as to the reason we are spending more on cleaning and infection control, yet Deputy Kenny — quite rightly — places priority on the need to deal with these basic amenity requirements to ensure we provide as good and healthy an environment as possible in our hospitals. Consistency is needed in this regard, as is a preparedness to look at what is being done to address these issues.

On the appointment of microbiologists, the Deputy will be aware that a microbiologist is shared between St. Colmcille's Hospital, Loughlinstown, and St. Vincent's Hospital. That we have secured some agreement on the consultants' contract enables us to look at the appointment of another 120 consultants, including in the specialty of microbiology, in an effort to improve the situation. All the evidence shows the work of the Minister for Health and Children in this Administration has been to seek to address the basic issues of hygiene and infection control, measurement and reduction. There is a downward trend, according to the latest data available.

Deputy Alan Shatter

The Minister has failed abysmally.

The Tánaiste

As the Deputy knows, infection control is a rising priority in all advanced health systems in view of the number of people who come through the system.

Deputy Alan Shatter

This is waffle.

The Tánaiste

This a serious issue about which I am not in any way complacent. In fairness to the Minister, she has brought forward a systematic response to those issues and phenomena in the health service.

On the question of the microbiologist post specific to Loughlinstown hospital, I cannot say if that specific area will be addressed but the changes in the consultants' contract provide the opportunity, over time, to move towards a consultant-provided service rather than the current consultant-led service.

Deputy Alan Shatter

That has nothing to do with it.

Deputy Enda Kenny

This is a Minister who is stripping services from hospitals and not replacing them with anything better. Question No. 17 in the name of Deputy Coonan queries the value for money achieved in respect of the extra moneys spent on hygiene because more money does not mean cleaner hospitals. We need to ask what happened when information about the deaths in Loughlinstown hospital became known. These are not just statistics; they are deceased persons. They went into hospital to get better but got these hospital acquired infections and are now dead. Regardless of having hand gel or solution at the entrances to the wards or at the doors in this case, the monitoring and assessment of the value for money achieved must be examined. Extra money does not mean cleaner hospitals.

The 15 people in Ennis who passed away all had hospital acquired infections. The Tánaiste has been the paymaster general. He is paying €15 billion to a health system. This year, €170 million is being spent on cleaning our hospitals and we cannot get that system right. I do not know if the Tánaiste can appreciate the real fear, anxiety and lack of confidence people have about going into hospital.

God rest her, Ms Kathleen Whiston went into Loughlinstown hospital to be treated for a diabetes problem and management of an infection. She died, as did 16 others there and 15 in Ennis General Hospital, and we do not know what has happened in other hospitals around the country. The Tánaiste is paying €170 million for hospital hygiene but has no monitoring of the impact or benefit of it. Extra money does not mean extra hygiene. Through the HSE the Tánaiste is paying private contractors huge sums of money with no assessment of the outcome of that work.

What happened in Loughlinstown after it became known that C. diff, MRSA and hospital acquired infection were the causes of death in those persons? What happened in Ennis when it became known that 15 deceased people had hospital acquired infections? The end result is that while we are spending a significant amount of money, we cannot keep our hospitals clean. When the Tánaiste and I were much younger, one could smell the disinfectant from 200 yd. away. People want to know they can have confidence that when they go into hospital to be treated for an ailment or illness, they will not die because of lack of hygiene or a hospital acquired infection. That is the problem to which the Minister for Health and Children should apply herself with the money the Tánaiste has given her for extra hygiene controls. Where is the assessment, the value for money and the extra benefit? Patients are dying.

The Tánaiste

Those assertions are not evidence based to the extent to which Deputy Kenny speaks.

Deputy Alan Shatter

They are. The Tánaiste need only go to Loughlinstown hospital.

The Tánaiste

Will the Deputy allow me to answer the question? I have listened

Deputy Billy Timmins

The coroner reprimanded the HSE after it refused to do anything on several occasions and nothing was done. The Tánaiste and I know. It is a disgrace.

An Ceann Comhairle

The Tánaiste without interruption.

The Tánaiste

If Deputy Timmins has a good case to make, he does not need to shout me down. That is if he has a good case.

Deputy Billy Timmins

It is not getting through to the Tánaiste any other way.

The Tánaiste

Will Deputy Timmins let me respond to Deputy Kenny? He said we do not measure the outcomes but we do. There are annual hygiene audits in every hospital in Ireland. They were initiated and introduced by the Minister for Health and Children.

Deputy Alan Shatter

The outcomes are that people are dying in Loughlinstown and Ennis.

The Tánaiste

I wish to respond to the assertions Deputy Shatter's leader has made.

Deputy Alan Shatter

Why is the Tánaiste sitting back while people die?

The Tánaiste

It is important we try to get some facts on the record. On the second point on hospital infection, as a result of advances in microbiology, we can identify many of these infections in a way that they were never identified before. In Ennis, people died not because of that infection but with it, because when people are sick and vulnerable they are open to many infections.

Let us take what happened in Ennis as an example in value for money. As a result of management working with staff in Ennis General Hospital in the past number of months, they have significantly reduced the incidence of infection and great credit is due to them for doing it without the need for huge capital investment or cost. They reviewed procedures and practices and brought in some very practical methods of operation which have greatly improved the situation — much to their credit. I acknowledge that. There is a need for constant monitoring through the systems put in place by HIQA, the annual hygiene audits and the management changes of methods that have been instigated, of which we have the evidence in Ennis, for example, after a very serious situation there. Those people have got down to the business of trying to ensure that is not replicated and great credit is due to them in that regard. Deputy Joe Carey and others from Clare would be aware of that. In an interview on RTE last Friday, Dr. Donal O'Shea, a consultant in St. Vincent's Hospital, said there has been a significant improvement in hospital infection rates.

Deputy Alan Shatter

What about Loughlinstown hospital?

The Tánaiste

Infections are happening in hospitals. That phenomenon has been taken on by every advanced health system in the world. We have put in a systematic approach. Last week, when I referred to a Deputy raising an individual case, I did not suggest it was not significant or had not been a very traumatic experience for a family. Of course I appreciate that situation. I have held the office of Minister for Health and Children and have some acquaintance with those issues. However, if we are to improve our health service, we will not do it on the basis of anecdotal evidence but only on the basis of a systematic response. That sort of systemic response, outlined in reports like the one we received yesterday, to continuing public sector reform will provide us with the prospects of improving the service rather than suggesting there have been no improvements in the service. The example of Ennis General Hospital and what happened there on infection control is a very salutary example of what can be achieved on a daily, weekly and monthly basis if the right approach is adopted, which does not necessarily mean increased capital resources.

Deputy Alan Shatter

What about Loughlinstown hospital?

The Tánaiste

On Question No. 17, improvements are taking place as a result of that increased investment. The evidence available from the annual hygiene audit confirm that we have a downward trend in the level of infection in our hospitals compared to when we began to measure it. Is it sufficient? No, it is not. Have we a means to measure, monitor and improve it? Yes, we have, and that is to the credit of the Minister for Health and Children.

Deputy Paul Kehoe

Will the Tánaiste listen?

Deputy Joe Carey

A key recommendation of the report is that the hospital be upgraded.

Deputy Paul Kehoe

Will the Tánaiste listen?

Deputy Enda Kenny

How much for a microbiologist?

Deputy Alan Shatter

What about Loughlinstown hospital?

Deputy Seán Power

Let the real Opposition leader speak.

Deputy Eamon Gilmore

I want to pursue this issue a little further with the Tánaiste, not least because Loughlinstown hospital is in my constituency. The county coroner examined the case of 16 deaths and concluded that the C. diff infection was the direct cause in five and a contributory factor in another five. Loughlinstown is not the only example of this. As Deputy Kenny said, earlier this month we had the report on Ennis, which showed that of the 46 cases examined there, 15 were as a result of hospital infections. We are talking about people dying. People go to hospital to get cured, not to get killed. A report from the HSE last year concluded that one out of every 20 hospital admissions ends up with a hospital-related infection. This represents 30,000 people in a year, 600 per week or 80 per day who acquire hospital infections. That is an epidemic. We know from what the medical personnel in the hospitals have been saying that they have sought help. One common thread running through all this is that the medical professionals in the hospitals flagged the problem some time ago and went looking for help. They did so in Ennis. The consultant, Mr. Hennessy, said it was as a result of overcrowding in the wards and sought help on that front. At Loughlinstown, medical consultants and staff at the hospital, for whom I have enormous respect, stated on five different occasions that they needed a consultant microbiologist. The coroner who examined this issue over a six-month period repeatedly supported the call for the appointment of a consultant microbiologist. The problem in Loughlinstown is that swabs cannot be carried out due to the absence of a consultant microbiologist. Because of this, doctors cannot even tell whether a person acquired his or her infection in the hospital or brought it into the hospital.

The solution has been there for some time. The first request for the appointment of a consultant microbiologist was made as far back as 2005. I do not accept the answer that this was held up by negotiations on the consultants' contract. Will the Tánaiste explain why such a person has not been appointed? The HSE said there were difficulties with the appointment of a microbiologist. What are the difficulties? When will a consultant microbiologist be appointed at Loughlinstown hospital so that the problem can be brought under control at least at this hospital?

The Tánaiste

In my previous reply I mentioned Dr. Donal O'Shea, an endocrinologist who practises at both St. Vincent's and Loughlinstown hospitals. He stated on public radio last Friday that there has been a significant improvement——

Deputy James Reilly

He still wants a microbiologist.

Deputy Liz McManus

This is the man who is looking for a microbiologist.

An Ceann Comhairle

We must hear the Tánaiste without interruption.

The Tánaiste

I have been asked to respond to suggestions that there has been no improvement or that the situation is out of control. An endocrinologist who works in those two hospitals has said on public radio, although I did not hear him, that there have been improvements in infection control in these hospitals as a result of proactive steps taken by staff and consultants after previous incidences of infection. That is a statement from a person who works at the front line.

The suggestion is being made — perhaps this is a corollary to the argument made by Deputy Gilmore — that if a hospital has a microbiologist it will not have infections. That is not the case.

Deputy James Reilly

It is an essential part of infection control.

The Tánaiste

The Deputy should let me answer the question. I am either going to be allowed to answer the question or I am not. At present a microbiologist is shared between St. Vincent's and Loughlinstown hospitals.

Deputy Liz McManus

That is nonsense.

Deputy James Reilly

That was utterly rejected. It was rejected today on the radio.

The Tánaiste

Either we will have a response or we will keep playing like children.

Deputy James Reilly

If the Tánaiste speaks the truth he will not be interrupted.

An Ceann Comhairle

The Tánaiste must be allowed to answer without interruption.

The Tánaiste

A serious question has been raised and I would like the opportunity to answer it. The Deputies have had an hour for Question Time and they have probably got nowhere, but I would like to deal with Deputy Gilmore's inquiry.

Deputy James Reilly

We were getting nowhere because we could not get straight answers. We are not getting them from the Tánaiste either.

The Tánaiste

The Deputy is not at an IMO meeting now.

Deputy James Reilly

The Tánaiste is not in Tullamore at a Fianna Fáil cumann either.

Deputy Liz McManus

This is the great debate.

The Tánaiste

Perhaps the Deputy should come to one and he might learn something.

Deputy James Reilly

If it is more of what I have seen already, I doubt it.

Deputy James Bannon

More corruption.

The Tánaiste

I am simply making the point in response to Deputy Gilmore that there have been incidences of infection in hospitals which already have microbiologists. The presence of a full-time microbiologist does not change this as things stand. I have simply made the point——

Deputy Emmet Stagg

It does change it.

The Tánaiste

If that were the case, we would not need infection control in hospitals with microbiologists. However, that is not my main point. In Ennis, for example, where there has been a significant improvement in infection control, it was not due to the presence of a microbiologist but to proactive steps that were taken to improve basic hygiene in the hospital to the extent that it now has a reduced incidence of infection. That is a statement of fact. Although the argument can be made that there should be more microbiologists in the system, one cannot jump to the conclusion that the presence or absence of a microbiologist in the hospital determines success in reducing the incidence of infection. The proof of this is what happened in Ennis.

Deputy Emmet Stagg

The Tánaiste is wrong.

(Interruptions).

The Tánaiste

The Deputy's attempt to shout me down does not stop me from making the point.

Deputy Emmet Stagg

I am not shouting down the Tánaiste.

The Tánaiste

I thank the Deputy. As a result of the changes to the consultants' contract that have been achieved we can look forward to the quick appointment of another 120 consultants to the system. These will probably include some microbiologists. The whole purpose of this long and too drawn-out negotiation on the consultants' contract was to enable the Government, or any Government. to move from a consultant-led service to a consultant-provided service in due course.

Deputy Alan Shatter

The Tánaiste should not blame this disaster on the consultant negotiations. That is grossly dishonest.

The Tánaiste

We will appoint more consultants and have fewer junior doctors, which will deal with one of the structural problems with the provision of hospital services that has existed for years and perhaps decades.

Deputy Eamon Gilmore

Dr. O'Shea stated that a microbiologist was needed. He was not trying to explain the problem away. We all acknowledge that Dr. O'Shea and his colleagues in the hospital are doing their best to get the problem under control. The Tánaiste's argument that there will still be hospital infections even if there are microbiologists is a bit like saying that people still get sick after they visit the doctor. It does not get us anywhere. The medical personnel in Loughlinstown hospital concluded that what was required was a microbiologist. They looked for a microbiologist three years ago and have done so repeatedly since. The request came from the consultants and from hospital management and was supported repeatedly by Dr. Geraghty, the Dublin county coroner, who had the task of examining the deaths that occurred because of these problems.

I do not want a lecture on the generality of the relationship between the presence of a microbiologist and possible levels of infection in the system as a whole, nor do I want a response based on the number of consultants to be employed. I have two specific questions, neither of which the Tánaiste has answered. Why was a consultant microbiologist not appointed to Loughlinstown hospital in the past three years? When will one be appointed? That is what people who are being admitted to this hospital or have relatives in the hospital want to know.

Deputy Ciarán Lynch

Hear, hear.

Deputy Eamon Gilmore

Why was this appointment not made? Why have there been 16 deaths, ten of which were related to hospital infections that were either brought into the hospital or contracted there? When will a microbiologist be appointed to help the hospital deal with the problem?

The Tánaiste

I accept that the appointment of more microbiologists adds value to the system. I am not suggesting otherwise.

Deputy Emmet Stagg

That is better.

The Tánaiste

I emphasise to Deputy Stagg that I am not suggesting otherwise.

Deputy Emmet Stagg

The Tánaiste was saying otherwise.

The Tánaiste

I was not. What I am saying is that there is plenty of evidence for reductions in infection incidence in the absence of a resident microbiologist. Why do we not have that speciality in Loughlinstown? The structural problem with the system is that we have half the number of consultants we should have and twice as many junior doctors as we should have. One of the only ways in which we can make the switch is to change the terms of the contract to allow us to employ more consultants. That process, unfortunately, took far too long. Perhaps Deputy Reilly knows more about this than I do, but——

Deputy James Reilly

I was not Minister for Health and Children for two years.

The Tánaiste

——it took far too long.

Deputy James Reilly

The Tánaiste should give me a couple of years in the Department of Health and Children and I will sort it out.

An Ceann Comhairle

The Tánaiste, without interruption.

Deputy Alan Shatter

A microbiologist has deliberately not been employed. That is what it comes down to.

The Tánaiste

A structural change is required and we are engaged in this.

Deputy Alan Shatter

Sixteen people have died because of the lack of a microbiologist.

The Tánaiste

I also accept that Dr. O'Shea was one of the people who was seeking another microbiologist. I do not want to use his name in a partial way. That was his view and I accept what the man said. However, the idea that we can improve the service without the structural changes required, including reform of the consultants' contract, is known by everybody to be impossible. Such a change is the only way in which we can move from where we are to where we want to go. The fact is there are 120 consultants who can now be appointed as a result of the new arrangements and the issue that Deputy Gilmore correctly raises, both as a constituency TD and as a party leader, can better be addressed on the basis of the reforms we have introduced in the interests of trying to move this situation along.

Deputy Eamon Gilmore

It will be a great comfort to the relatives.

The Tánaiste

It is some comfort to them.

Deputy Alan Shatter

So they deliberately ignore the coroner and the local doctors, and let people die in Loughlinstown. That is the conclusion.