I wish to share time with Deputy Andrew Doyle.
Health Care Associated Infections.
Is that agreed? Agreed.
In the two terms plus one year I have been a Member of the Dáil, this is one of the most outrageous and regrettable incidents I have come across. Also, while I acknowledge the presence of the Minister of State, Deputy Pat the Cope Gallagher, it is regrettable the Minister for Health and Children, Deputy Mary Harney, has chosen not to attend the House this evening.
It was Florence Nightingale who said "The very first requirement in a hospital is that it should do the sick do no harm." I want to extend my sympathy to the families, relatives and friends of the 16 people who lost their lives in 2007 in St. Columcille's Hospital, Loughlinstown.
It is regrettable that it was the county coroner who sought to push this issue up the agenda. There were 16 deaths in total, ten of which related to C. difficile. In five of these cases C. difficile was the direct cause of death. Some six deaths were related to MRSA. In October 2007, Dr. Crowe called for the appointment of a consultant microbiologist. This has not happened to date. The coroner, Mr. Kieran Geraghty, made recommendations in January 2007 but it cannot be established if these were implemented. I hope the Minister of State can tonight give us some explanation for these deaths. The situation is totally unacceptable. I do not know if people died from C. difficile or MRSA 50 or 100 years ago but I know they have died in St. Columcille's Hospital, Loughlinstown, in the past year. It is a terrible indictment on the HSE and the health service and ultimately the buck stops with the Minister. We can talk all day about a consultant microbiologist. I go into several hospitals not only Tallaght Hospital. I visited Whitfield Clinic outside Waterford at Christmas. It was very hygienic. The disinfectant was inside the door and it was spick and span. Most of our hospitals, which are under the control of the State, are in a terrible condition. Basic cleaning is not actually being done in the hospitals.
It is regrettable that I find myself in a position where if somebody told me in the morning he or she was trying to get into Loughlinstown, I would have to advise against going there at present. Our local councillor, John Ryan, was on the national airwaves this morning in regard to this issue. I want the Minister to be able to tell me there is no infection in that hospital and that it is safe to go in there.
Why did this happen? What measures are being put in place to ensure it will not recur? Can the Minister of State give a guarantee to the House that it is safe for patients to go into St. Columcille's Hospital, Loughlinstown? I would like to be able to tell them it is safe but I am not so sure.
I am somewhat confused because yesterday's article in The Irish Times stated “Minister Harney says HSE unable to fill the post of microbiologist”. I tabled a parliamentary question in November about the infection control policy in St. Columcille’s Hospital, Loughlinstown, and the way in which the absence of a vital staff member, that is, a microbiologist was going to be addressed as a matter of urgency. The response I received from the HSE on 7 November was to the effect that specific policies are in place for the control and treatment of MRSA and C. difficile at St. Columcille’s Hospital which are compliant with national infection control policies. There is an infection control committee in place and there is one whole-time permanent specialist infection control nurse. Consultant microbiology is available on request, when required.
Yet Dr. Donal O'Shea, whom the Tánaiste quoted earlier today, had acknowledged that there were improvements. We acknowledge there have been improvements. The challenge in St. Columcille's is that the building is 200 years old and it was built as a workhouse. It is the one hospital of that age that remains in what was the old Eastern Health Board area.
When a councillor from 1999 to 2004, I sat on a hospital review committee which recommended that this hospital be knocked and rebuilt either on the existing site or a new site, depending on other issues. That appraisal has not taken place. The HSE and the Department have concentrated on putting all their resources into a couple of major hospitals. That is the hospital for Wicklow people and the people of Shankill, Killiney, Ballybrack and Loughlinstown. It is unacceptable in this day and age that the staff who work hard are left with the challenge of trying to address MRSA without the help of a microbiologist. The manger, the consultant endocrinologist and the county coroner have all called for such a post. We need answers.
I apologise to the House on behalf of the Minister for Health and Children, Deputy Harney, who is unable to be present and I thank Deputies Timmins and Doyle for raising this important matter.
Like the Deputies, I express my sympathy to any patients and families who have been affected by this issue. I share the Deputies' concerns about MRSA, C. difficile and health care associated infections generally. I take this opportunity to reiterate the Minister's commitment to ensuring that high-quality care is made available to all patients and to the further development of our health services and, in particular, the issue of patient safety.
The House will recall that the Tánaiste dealt with this matter in considerable detail earlier today during Leaders' Questions. Health care associated infections, HCAIs, are not new. For centuries they have been a side effect of medical treatment, especially in hospitals. There are a number of types of HCAI, including MRSA and Clostridium difficile, C. difficile. The more medical care a person requires, the more likely he or she is to develop a health care associated infection. These infections are, therefore, more common among people with serious illnesses or at high risk such as patients with a weakened immune system.
The extent to which hospitals are affected by HCAIs such as MRSA and C. difficile varies with the type of hospital. In the 2006 prevalence survey of health care associated infections, the prevalence of MRSA was 0.5% in tertiary-regional and general hospitals, and was zero in specialist hospitals. The survey found that 36 patients had C. difficile representing 0.5% of patients studied. However, C. difficile was not, up to now, a notifiable disease and, as a result, it was difficult to quantify the extent of infection in the health care system generally. In March 2008, the Minister instructed the HSE to make C. difficile a notifiable disease and I am happy to inform the House that from 4 May all cases will have to be notified to the relevant department of public health.
The Department understands that the 16 cases referred to by the Deputies were the subject of recent communications between the Dublin County Coroner and the HSE. Some of the patients are reported to have had MRSA and others C. difficile infections at the time of death. Most such instances involve significant co-morbidity factors and while the HSE will deal with the issues raised by the coroner, the Minister wants to assure the House that she is fully aware of the problems posed by health care associated infections and the stress they cause. This is an issue facing health services worldwide.
Tackling these infections remains a priority for the Government and for the Health Service Executive. The HSE has established a national infection control action plan. It has put in place an infection control steering group, chaired by Dr. Pat Doorley, national director of population health, to oversee the implementation of the plan. Over the next three to five years the HSE aims to reduce HCAIs by 20%, MRSA infections by 30% and antibiotic consumption by20%. These targets will be achieved through the development of national and local level action plans to reduce the potential for spread of infections in health care settings. The steering group is supported by eight local implementation teams which will ensure that all local facilities are focused on achieving the national targets.
The availability of microbiology services in the hospital setting is an absolute necessity. However, it is not feasible or practical to have a full consultant microbiologist position in every location. Currently, consultant microbiologist advice is accessed by St. Columcille's from St Vincent's Hospital. The Minister has been informed that funding has been earmarked for the provision of dedicated consultant microbiologist sessions at St. Columcille's Hospital, Loughlinstown. However, the post has been advertised on a number of occasions and it has proved difficult to get the necessary expertise.
The availability of isolation facilities is another important factor in the overall solution to this issue. In that context, the Minister has agreed with the HSE that designated private beds should be used where isolation facilities are required for patients who contract MRSA and this policy has been adopted by the HSE. New environmental building guidelines have also been developed by the HSE to inform infection control policy in all new builds and refurbishments.
Improvements on hygiene are critical to effective infection control. The Health Information and Quality Authority, HIQA, undertook a comprehensive review of hygiene in our hospitals in 2007. The report represents a thorough assessment of how hygiene services are provided and managed in 51 HSE-funded acute care hospitals. Hospitals generally performed well on hygiene in the service delivery area. Most hospitals achieved either extensive or exceptional compliance with the standard in the service delivery section of the report. HIQA is currently working with managers and clinicians to develop national standards for infection prevention and control. When completed these, along with the national hygiene standards, will provide a comprehensive framework to help reduce the spread of infection throughout the entire system and improve the quality of our health care.
A national surveillance system has recently been established by the HSE to collect data and provide information on four key areas, to monitor health care associated infections, HCAIs, in our health system. One of these areas is antibiotic consumption which is an important factor in the emergence of more virulent strains of C. difficile resulting from the over-use of antibiotics.
While accepting that not all HCAIs are preventable, the Minister is satisfied that significant steps are being taken to reduce the rates of HCAIs generally and to treat them promptly when they occur.
School Accommodation.
I thank the Ceann Comhairle for affording me the opportunity to raise this important issue for my constituency, namely, the need for the Minister for Education and Science to give the go-ahead for Ballymahon vocational school's refurbishment project to go to tender without further procrastination or reconsideration on her part. A sum of €1.3 million was ring-fenced for the project under the devolved grant and guaranteed by Deputy Peter Kelly and Councillor Barney Steele before the previous general election. Approval was confirmed several times during the election campaign, as highlighted in the Longford newspapers and on local radio stations.
"Procrastination" is the operative word in this context. How much longer can this 202-pupil post-primary school be expected to wait for the necessary refurbishment to provide a 21st century education for those under its care? I will cite the words of the Minister in a reply to a parliamentary question I tabled on the issue:
The proposed project referred to is at an advanced stage. Further progression will be considered on an ongoing basis in the context of my Department's multiannual school building and modernisation programme.
I have twice received an identical reply aimed at deflecting my request for confirmation of the time at which the project will be allowed to go to tender. The board of management, under the chairmanship of Councillor Sean Farrell, principal, teachers, pupils and parents of Ballymahon vocational school have heard these words once too often. The time has come to face up to the question and answer it directly.
In December 2007, the VEC was told not to proceed to tender until the Minister made a further announcement. However, Ballymahon vocational school was not included in the list of projects announced in the meantime. A further announcement is to be made shortly and the school is clinging to the hope that it will be given the green light and the project will proceed to tender. The Minister should imagine, if she can, a school which offers a wide range of subjects to junior and senior cycle pupils at junior and leaving certificate, leaving certificate applied and post-leaving certificate levels but does not have an upgraded computer room or home economics room. The Minister will be aware that the school has its fair share of special needs pupils who are very welcome and well integrated and a fine special needs unit. In addition, the school urgently needs new vehicular access, an external link corridor between buildings and a new administration area. A complete mechanical and, most important, electrical upgrade is urgently required in the interests of health and safety.
Ballymahon vocational school is a vibrant school with a wide range of sporting and extra-curricular activities running in conjunction with its excellent academic programme. However, it is being impeded in its educational endeavours by the delays and continued reconsideration of the progression of its vital development project. I ask the Minister of State to give me a definite time for the project to go to tender. The school has been disgracefully let down by the Minister and only a guarantee given this evening that the project can proceed to tender will satisfy the principal, teachers, parents and board of management.
It is unacceptable that the Minister, Government and local public representatives from the Government parties, Deputy Peter Kelly and Councillor Steele, make mileage at the expense of the school. Empty promises may win elections but such spin is shameful when the education of our children is concerned. I demand a positive answer which will allow the school to go to tender immediately because it is badly needed in the heart of my constituency.
I thank the Deputy for raising this matter as it provides me with the opportunity to outline to the House, on behalf of the Minister for Education and Science, the position regarding the proposed building project for Ballymahon vocational school, County Longford.
I will outline the procedures involved in selecting school building projects for inclusion in a school building programme. All applications for large-scale capital funding are assessed in the planning and building unit of the Department in accordance with published prioritisation criteria, which were formulated following consultation with the education partners. Under the criteria, individual applications are assigned a band rating which reflects the nature of the works required. There are four band ratings overall, with band 1 being the highest and band 4 the lowest. Progress on individual projects is consistent with the assigned band rating.
The band rating system was introduced to ensure openness and transparency in the allocation of capital funding to school infrastructural projects, target funding at the most urgently required projects first and ensure an orderly flow of projects through the school building and modernisation programme based on the priority of need presenting. Projects are selected for inclusion in any given capital programme on this basis. In other words, a building project moves through the system based on the band rating assigned to it, with the highest band rated projects moving first because the type of work required is the most urgent.
On the proposed building project referred to by the Deputy, Ballymahon vocational school is a co-educational post-primary school with a current enrolment of 156 pupils and enrolments have remained static over the last five years. The school does not have a deficit of mainstream accommodation but requires improvement works to be carried out to the existing school building. A design team has been appointed to this project and stage 2 of architectural planning has been approved, subject to certain technical requirements being adhered to.
Subsequent to the appointment of a design team, Longford VEC submitted an application for approval to acquire additional lands as part of the project. Although the additional lands are desirable, they are not essential to the project and this application was refused. As to when the project can proceed further, the Department's priorities for budgetary expenditure this year have to be for schools which have no mainstream accommodation and this project along with other projects will be considered in that context.
I thank the Deputy for raising this matter. The Government has invested heavily in extending and upgrading our existing school stock in recent years because it has a full appreciation of the need to ensure that all our schools have adequate facilities. The Minister and her Department are committed to providing suitable high quality accommodation for Ballymahon vocational school at the earliest possible date.
It is another broken promise in County Longford.
As Deputy Tom Sheahan is not present, I call Deputy John Cregan.
Local Authority Contracts.
I am pleased to have an opportunity to raise on the Adjournment my request that the Government afford some form of protection in law for suppliers and sub-contractors to main contractors which are awarded local authority contracts. Unfortunately, some main contractors go into liquidation during the course of contracts. I have observed too many of these cases in my county and local authority area in recent years. In a number of contracts, the main contractor has been unable to complete the works he has been contracted to carry out, leaving a trail of disaster and many suppliers and sub-contractors facing financial ruin.
I had hoped this matter would be discussed by a Minister from the Department of the Environment, Heritage and Local Government because it is an issue for local authorities and the Department. I do not cast aspersions on the Department of Enterprise, Trade and Employment and thank my good friend, the Minister of State, Deputy Michael Ahern, for coming to the House to respond. Nevertheless, I do not believe the issue I raise is a company law raise. That is, however, a matter for another day.
In each of the cases to which I refer, I understand the main contractor was awarded a contract based on submitting the lowest tender. I am not sure it is always appropriate for local authorities to accept the lowest tender. In the case of the most recent incident involving the provision of a sewerage scheme for Feenagh, I understand a six-figure sum separated the selected contract from the second lowest tender. This should have set alarm bells ringing, although I accept public officials do not have a crystal ball and cannot foresee such eventualities. Ultimately, in such cases, the losers are suppliers and subcontractors.
In the case of the sewerage scheme in Feenagh, the community has shown tremendous spirit and a local voluntary group is now responsible for the provision of local housing units. I understand this group has entered into a partnership with Limerick County Council to provide a sewerage scheme for the new houses and the village generally. This will benefit the village in the future. However, we now have a half completed job. Landowners and householders who were prepared to give right of way and access through their back gardens or land to a contractor on the assumption that normality would resume in the spring, with fences mended and farmers able to leave their cattle outside, have been disappointed. The county council will now be required to re-advertise to have the works completed.
I have a simple solution to this problem. When a local authority awards a contract to a main contractor it demands a list of his or her suppliers and subcontractors. Before each stage payment is made to the main contractor, a simple telephone call is made to each supplier or subcontractor asking whether he or she is paid up to date. If not, questions must be asked of the main contractor.
Human nature being what it is, if a subcontractor feels that the main contractor is under financial pressure he or she will wonder whether to pull back or stop supplying the product. A subcontractor who pulls back may get nothing so he or she may continue, making a bad situation worse and involving more money. When the main contractor goes into liquidation and returns to wherever he or she came from, the county council has the benefit of the bond that was put in place on the first day, but the supplier, subcontractor, landowner and, in this case, household, have no come-back. It is high time we afford some protection to these people, many of whom work on a very small scale and could face financial ruin because a main contractor took on a commitment when, from the beginning, he or she was unable and did not have the proper resources to do.
I question the lowest tender bid rule. Is there undercutting? Are people offering a very low price to get the contract and then high-tailing it half way through? I appeal to the Government to take this on board. Company law is fine where we have protection for late payments, but this is not about late payment, it is no payment. When a company goes into liquidation no payment is made so there is no compensation. People on all sides of this House have stood for the rights of workers, immigrant workers and everybody else, and that is correct. I commend them on it, but tonight I call for rights for suppliers to main contractors. There is an obligation on the State though our local authorities to put some protection in place to prevent what has happened a number of times in my county. I appeal to the Department of the Environment, Heritage and Local Government to do so. My county is not unique; I am sure this has happened on a number of occasions all over the country. I will proceed by way of a parliamentary question to the Minister asking him to ask each local authority how many main contractors have gone to the wall during construction of various projects and how many of those had made the lowest tender.
I thank Deputy Cregan for raising this matter. The issue raised by the motion has complex legal and policy dimensions. From a legal perspective, it involves the rule of privity of contract. This means only the parties to a contract, those privy to it, have enforceable rights and obligations under the contract. In its recently published report, Privity of Contract and Third Party Rights, the Law Reform Commission of Ireland referred to the problems posed by the privity rule for large-scale construction and civil engineering projects. Such projects typically involve many different parties and interests which are reliant on each other and may suffer a loss if another party involved in the project fails to meet its contractual obligations. It noted the use made of so-called collateral contracts or warranties in the construction sector in order to deal with this issue. These warranties are a contractual promise from one party to a contract to a third party which relates in some way to the terms of the original contract. In the present context, for example, a collateral warranty could take the form of a contract term in a contract between the employer and the main contractor stipulating that the employer would make a direct payment to the subcontractor in the event that the main contractor could not or would not do so.
In its recent report, the Law Reform Commission recommended that complex contractual arrangements of this kind entered into to circumvent the privity rule could be simplified by the creation of a general statutory exception to the rule which would allow third parties to enforce contracts entered into for their benefit. It noted that, following legislative reform of this nature in the United Kingdom in 1999, standard form contracts for large-scale construction projects increasingly contained a schedule dealing with the rights of third parties.
While at one level the matter at issue concerns rights and obligations under contract and, as such, can be addressed by means of express provisions in contracts, the public policy dimension must also be fully considered. The implications of any general provision making local authorities or other public bodies the guarantors of the third party liabilities of contractors are far-reaching and would require full and stringent examination. There is a clear risk, for example, that a main contractor safe in the knowledge that a public body would meet his liabilities to subcontractors might not feel impelled to do everything in his power to discharge those liabilities.
The proposal in the motion also raises the issue of the relation between a provision of the kind proposed for the direct payment of subcontractors in the event of the main contractor's inability to pay and the existing, well established requirements of insolvency law. For this reason, clauses in standard form United Kingdom construction contracts giving an employer discretion to operate direct payment provisions in respect of nominated subcontractors do not apply, to my knowledge, where the main contractor is in bankruptcy or liquidation.
While I am sympathetic to the intention behind the proposal, in view of the complex legal and policy issues which it raises it must be considered in the context of the overall management of public works contracts.
On public procurement, following a Government decision in May 2004 to reform construction procurement a new contract for standardised conditions of engagement for construction consultants and a suite of five new forms of construction contracts for public works were developed. These were implemented on a phased basis from 1 January 2007 and 19 February 2007 respectively. A short public works contract, for contracts that have a value of €500,000 or less, was also put in place with effect from 3 March 2008. Supporting guidance notes have also been developed for use with these contracts.
The contracts and guidance notes form part of the capital works management framework, which is being developed to deal with the whole life cycle of project delivery. Improved cost certainty, better value for money and cost effective delivery of public works contracts are at the core of these construction procurement reforms. The reform measures are particularly important if the State is to maximise value for money from the very large expenditure on infrastructure projects under the NDP. The new contracts have introduced fixed price lump sum contracts tendered on a competitive basis, with appropriate rebalancing of risk. In the new contracts, risk can be transferred to those best able to manage and control it. Contracts for all projects must be awarded using either the new public works contracts or the conditions of engagement for consultants from 13 February 2008 or, in the case of the short form contract, from 3 March 2008.
The construction procurement reform programme seeks to change the approach of consultants, contractors and public sector clients to procuring large infrastructure projects by: having more client-focused construction contracts that require a more optimum allocation of risk between contractors and public sector clients; provides the right incentives for construction consultants to ensure that projects stay within budget — fees will be bid competitively on a fixed price basis but without compromising on quality; and ensures that public sector clients provide comprehensive project information at tender stage — it is essential that the scope of projects must be well defined by the client to allow tendering on a fixed price lump sum basis. As I stated, the matter raised by the Deputy involves complex legal and policy issues that require detailed consideration.
Natural Heritage Areas.
I raise this issue because it was brought to my attention by landowners in the Kenmare area that the Minister for the Environment, Heritage and Local Government, Deputy Gormley, who I am disappointed is not here, sought approval from the EU to designate 5,000 acres along the Kenmare river as a special area of conservation, SAC. This is an extension of the area, to the tune of 5,000 acres, designated in 2003. What the Minister has done is illegal and I find it shocking that a Minister is doing something illegal. No notice of this was given to landowners, no maps were made available to anybody and no discussions took place with farmers, landowners or interested parties. In particular what is illegal about it is that, because the proposal was sent to Europe for approval, the right of appeal of the landowners has been taken from them. When the 2003 designations were made, maps were printed and landowners were informed of the proposed designations. They had a right of appeal and they did appeal. In 2008, however, nobody has been informed and the landowners and farmers have been kept in the dark.
I must ask why it is proposed to designate as a SAC 5,000 acres along the banks of Kenmare river. It was seen fit in 2003 to designate so much ground along the river and now, five years later, without any consultation with landowners, this further designation is taking place. Unfortunately, the Minister is not here, but I ask him to withdraw or defer this proposed designation that has gone to Europe and to make the maps available. When this issue was raised in Kerry, the farming bodies asked to be provided with the relevant maps, but these have not been forthcoming. If the maps could be made available, farmers would at least know who is to be affected and to what extent. I also ask the Minister to afford to farmers the right to appeal this proposal. Who does the Minister think he is to designate the land of landowners and farmers as an SAC without any consultation whatsoever and send the proposal directly to Europe? Why was this done in such an underhand manner? I would like a clear answer to these questions.
I thank Deputy Sheahan for raising this matter, which I will be taking on behalf of my colleague, the Minister for the Environment, Heritage and Local Government, Deputy John Gormley.
Special areas of conservation, SACs, are proposed for designation under the European Communities (Natural Habitats) Regulations 1997. These regulations transpose the 1992 habitats directive and provide a mechanism for designation and protection of important ecological areas in Ireland as part of the contribution Ireland is required to make to the EU-wide Natura 2000 network of sites for the protection of Europe's most important and rare habitats, birds and species.
Proposals to designate areas of land as the Kenmare river SAC were published by the Department of the Arts, Heritage, Gaeltacht and the Islands, which was then the responsible Department for the designation process, in May 2000 in local media in Cork and Kerry. Maps were also displayed in local public offices such as Garda stations. Where landowners were identified, they were notified directly in writing of the proposed designation. Any person with an interest in the land covered by the proposed designation had an opportunity to appeal.
Under the procedure set out in the habitats directive, each member state was required to transmit an initial list of sites proposed for designation as SACs. The Commission reviews the sites proposed by each member state and, if it finds them to be appropriate for inclusion, adopts the sites as part of the overall EU list. The initial 413 sites in Ireland were adopted in November 2004. It is understood, however, that the list of Natura 2000 sites will continue to be updated, particularly to allow for the inclusion of new areas or to address any concerns or omissions identified by the Commission when reviewing each member state's proposed list of sites. The Commission and member states have therefore agreed a programme for updating the lists over the coming years.
To meet certain Commission concerns about Ireland's initial list of sites, and to ensure each area was included in a designation on robust scientific grounds, a number of assessments and reviews, collectively known as the map validation project, were undertaken between 2001 and 2005 by the National Parks and Wildlife Service of the Department of the Environment, Heritage and Local Government. As a result of this project, additional areas, both land and sea, have been recommended for inclusion in the Kenmare river SAC for the purpose of protection of an important habitat. The area now proposed for designation has increased in size by approximately 10,000 hectares from its previous value of 32,000 hectares. However, a large part of the additional area is at sea and does not affect landowners directly.
The Department of the Environment, Heritage and Local Government will shortly republish the revised proposed boundaries for the Kenmare river SAC for public consultation. To facilitate this, the identification of landowners affected by the extensions is under way using new and more comprehensive databases such as the LIPIS database of the Department of Agriculture, Fisheries and Food. Landowners will have the opportunity to seek the exclusion or inclusion of their land in the extended SAC within the statutory timeframe of three months. A request by a landowner to include or exclude land from the designation will be assessed on scientific grounds only, following which Ireland will communicate any proposed revisions to the boundary to the Commission for review.
It is now intended that Ireland will have 423 SACs, encompassing a larger area and wider range of habitats, as well as some 160 special protection areas for birds. Ireland already lost a case on the designation of SACs before the European Court of Justice in 2001. It is critical that we provide a comprehensive and scientifically justified suite of designated areas to ensure that Ireland fully complies with its obligations under the habitats directive.
The Dáil adjourned at 9.25 p.m. until 10.30 a.m. on Wednesday, 30 April 2008.