Vol. 741 No. 4
1 Deputy Billy Kelleher asked the Minister for Health his views on the lack of inspections of hygiene standards in hospitals undertaken by the Health Information and Quality Authority; and if he will make a statement on the matter. [26437/11]
The control of health care associated infections, HCAIs, continues to be a policy priority for the Department of Health and the Health Service Executive, HSE. Maintaining hospital hygiene practice is an essential component of the drive to reduce HCAIs.
Under section 8 of the Health Act 2007, the Health Information and Quality Authority, HIQA, has statutory power to set standards on safety and quality in relation to services provided by the HSE and service providers in accordance with specified Acts. However, it is a matter for the authority to determine how it can most effectively deliver on its responsibilities having regard to competing priorities and available resources.
HIQA's national infection prevention and control standards were published in May 2009. The authority carried out a national hygiene audit in late 2009 and undertook hygiene audits of hospitals during 2010. My Department is continuing to work with HIQA and the HSE to prepare for the inspection of acute hospitals and other health care facilities against these standards. HIQA, in association with the Department, is currently putting together a comprehensive assessment of its current and likely future staffing requirements within the context of the comprehensive expenditure review. The resources required to monitor compliance with the national standards for prevention and control of healthcare associated infection will be considered as part of this assessment.
Appropriate steps are being taken to address the issue of health care associated infections in our hospitals and to treat them promptly when they occur. The HSE's performance indicators at national level continue to demonstrate encouraging improvements in the area of infection prevention and control with the reported incidence of MRSA dropping by 48% between 2006 and 2010. I welcome the appointment earlier this year by the HSE, jointly with the Royal College of Physicians in Ireland, of a national clinical lead on health care associated infections.
I thank the Minister for the reply. Niall Hunter, the editor of irishhealth.com, stated:
A HIQA spokesman confirmed to irishhealth.com that the safety body was no longer proactively going into hospitals and checking on their hygiene standards at this time. "We have to prioritise our work as best we can," he said.
It is clear that HIQA, which is statutorily set up to give information and ensure that quality controls are in place in hospitals, is not able to carry out its statutory functions. No audit of hospital hygiene has been carried out in any hospital in Ireland in over a year. Will the Minister accept that, in effect, it is putting patients' lives at risk if the body statutorily obliged to carry out audits is not carrying them out? Will he further agree that in the context of the workload put on HIQA there is now a need to ensure that its basic functions are upheld and that it would begin to carry out audits on hygiene in our hospitals throughout the country?
HIQA is responsible for standards and inspections but that does not remove the obligation on the Health Service Executive, HSE, to maintain its standards and continue its own in-house inspections. That is currently the case. The position is clear from the reduction in antibiotic consumption since 2008 and also the continuing drop in cases of MRSA from 592 in 2006 to 536 in 2007, and to 439 in 2008. In 2009, there were only 355 and last year there were 305. A 48% increase is extremely encouraging but we will not stop at that. HIQA will reinspect, as it sees fit, when it sees the need arising but as an independent regulator we must accept what it is and is not happy with, and we should not attempt to interfere in that.
Nobody is asking for interference. At the outset the Minister clearly stated that the HSE is a discredited organisation. That was one of his policy platforms in the recent election. When he took office he sacked the board and stated he would be assuming control of the HSE because he felt it was inadequate in trying to provide the basic functions and services. He is now saying he trusts the HSE in the context of making sure that audits are carried out and that hygiene inspections take place in hospitals. I am not asking any Minister to interfere with HIQA even though it has been often said by Members opposite that HIQA is an organisation that only makes recommendations and its policies do not have to be implemented but all we are asking for is that HIQA is given the resources and the direction in the context of making sure it carries out independent audits, in view of the fact that the Minister has already stated that the HSE is a discredited organisation. Those are the Minister's words.
I will make a number of points. In recent months the HSE has made great strides in getting its budget in order and many other innovations which will become more clear as the special delivery unit makes more recommendations, which I would expect the HSE to put in place. The Deputy is right, however. It is part of our policy that the HSE would be replaced by a different organisation.
I will address the core issue which is that of HIQA funding. HIQA's funding will match its requirement to allow it carry out its duties. I have no doubt it will be in contact with my Department when we reach the end of this annus horribilis which, unfortunately, the Deputy and his Government left us to deal with. We start next year with a clean slate and a new budget. We will have central control over the fair deal scheme. We will have full control over the budget for a year. We will have visibility over hospital spending on a fortnightly basis. We will have real-time information on emergency department flows and on inpatient waiting lists, none of which was available before this Government came into power.
2 Deputy Caoimhghín Ó Caoláin asked the Minister for Health the action he is taking in response to the findings that the swine flu vaccine Pandemrix may be linked to narcolepsy; and if he will make a statement on the matter. [26439/11]
It is estimated that approximately 250,000 Irish children and adolescents aged five to 19 received Pandemrix vaccine to protect them against pandemic, H1N1, swine flu. Thirty potential cases of narcolepsy have been identified, 16 of which have been confirmed by the Irish Medicines Board as having been vaccinated with Pandemrix. Of the 16 cases, 15 were under 18 years of age. The remainder of the cases include those who have not had a final clinical diagnosis of narcolepsy and also includes a small number of patients who have been diagnosed but who may not have had Pandemrix vaccine.
The Department of Health and the health protection surveillance centre, HPSC, of the HSE are working with the Irish Medicines Board and clinical experts in narcolepsy to examine the Irish data. However, the number of cases in Ireland is relatively small and may not allow causality to be determined. The results of this study are expected before the end of the year. Further studies are also ongoing in several European countries.
Relevant health care professionals, that is, GPs, paediatricians, psychiatrists, clinical psychologists and public health nurses have been advised on the possible association between Pandemrix vaccination and narcolepsy and on the referral of suspect cases for diagnosis. The HSE has agreed to provide discretionary medical cards to children affected on an interim basis pending the outcome of decisions to be made around supports necessary on an ongoing basis.
A group called Sufferers Of Unique Narcolepsy Disorder, SOUND, has been set up by parents. This group is actively engaged with the HSE and has two representatives on the HSE incident management team that is managing this issue.
The Department of Education and Skills together with the National Council for Special Education is also considering what further supports are required for the education of the young people affected.
Later today I will meet with representatives from SOUND and I understand that a meeting is being arranged with the Minister for Education and Skills also.
The Minister has indicated that some 30 cases of narcolepsy with a direct link to Pandemrix have been identified by the HSE. What assistance does the State intend to provide for these children and their families, given that it is a direct result of the administration of the swine flu vaccine? The Minister said that discretionary medical cards will be provided on a temporary basis, but will he elaborate on that? Will all children in whom narcolepsy presents and where there is a clear link with Pandemrix receive a medical card irrespective of the circumstances of the families concerned? Does he share the concern of parents and the wider community that new cases are still presenting and we do not know the full extent of the problem? With the recent publicity around the launch of the SOUND group, which the Minister mentioned, several new cases have come to light, and that is likely to continue for some time to come.
When the Joint Committee on Health and Children met on 8 September 2009 to address the swine flu issue, I and other members, including the Minister, expressed concern about the indemnity granted to vaccine manufacturers, including GlaxoSmithKline, the maker of Pandemrix. Is the nature of that indemnity such that GlaxoSmithKline will be legally absolved from any accountability for the drug causing narcolepsy in Irish children? That needs to be clarified. Is the State now finding itself in the dock in this connection?
First, I reiterate that no link has been established as yet. It is interesting that some of the Nordic countries such as Finland and Sweden are concerned about large numbers of cases there, but other countries such as the UK and the US do not seem to have an issue. Like Deputy Ó Caoláin, I remain concerned about the matter. As a parent, I am concerned about the possible damage the vaccine could have caused, but I will not prejudge the situation until all the facts are before us.
In defence of my predecessor, I have to say that she acted in good faith. It was an emergency because the country's health was at risk. We can never know how many people would have died had there not been a vaccination programme. That is always the problem with these situations. We will do the most important thing, which is to support all our citizens who suffer from narcolepsy, including children in particular, and give them the medical and social supports they require. The broader issue of the causality can be pursued in a more orderly fashion. What is important is that people who have a problem have it addressed from both the medical and social perspectives.
At the committee meeting I mentioned, an HSE representative said that the HSE and the World Health Organisation expected "adverse events to be at a minimum". The Minister compared the number of people presenting with narcolepsy and the number of those who received the Pandemrix vaccine, but this is a serious matter for the children and families concerned, and such assurances have proved hollow to them. Does the Minister accept that, with hindsight, granting an absolute indemnity to a multi-billion-euro international drugs company in relation to an untested vaccine was not the correct way to go? Does he agree that we need to ensure we do not make the mistake of administering such a vaccine in future without all the proper checks being in place?
Finally, on the assistance to be offered to the children, we should be clear that they are in their early years of school attendance and this matter will significantly impact on their potential development through the education process. The Minister said he is speaking to the Minister for Education and Skills, but will the Government ensure that the necessary supports are provided for these children so that they do not fall behind? Let there be no mistake — the issue is not about attentiveness in the classroom. These children fall asleep and they will miss out on critical hours of education in the years ahead. Will the Minister ensure supports for them?
It is easy to forget the situation that pertained. The reality is that we were facing a swine flu epidemic.
We have to deal with the situation here and now.
Excuse me. I did not interrupt the Deputy. We were dealing with an epidemic. I was not in charge at the time, but nonetheless I believe in fairness, and the Minister of the day was faced with this enormous threat to the wellbeing of the people, and to younger people in particular. Given the genetic make-up of the flu and the fact that it related somewhat to an epidemic that occurred years ago, people over 55 perhaps had some degree of immunity. Younger people were at more serious risk. Vaccine manufacturers go through a range of safety checks, but when they are put to the pin of their collar in relation to producing enough vaccine around the world to protect people from a looming crisis, perhaps not all the research that would usually be done can take place, because some of it is time related. No doubt that is why they sought the undertaking from the Government in relation to indemnity. I will revert to the Deputy in writing on the exact nature of the indemnity, but we have to be fair. It is easy enough to give out, and there is plenty to give out about without giving out about those things, which were not under the Government's control and had to be done in the way they were done.
To return to what I believe is the substantive issue, the Government will endeavour to ensure that all the social, educational and medical supports are there for people who might have suffered as a consequence of the vaccine. However, the Deputy should bear it in mind that the individuals in nearly half of the cases that have been identified, or certainly a large minority, never had the flu jab. They are owed a duty of care, too.
3 Deputy John Halligan asked the Minister for Health if he will provide funding for a national screening programme for prostate cancer involving a simple examination and a PSA blood test which a prostate cancer charity recently described as the first line of defence against the disease; and if he will make a statement on the matter. [26436/11]
International evidence does not support the introduction of a population-based screening programme for prostate cancer at this time. The Department and the HSE are keeping the emerging international evidence under review, including the results of randomised trials that are being conducted internationally.
However, I am pleased that Deputy Halligan has raised the issue and the recent publicity on prostate cancer is welcome. I am pleased to advise that rapid access prostate cancer diagnostic clinics are now operational in six of the eight designated cancer centres. Two further clinics are due to open later this year. Patients who are judged to be at higher risk of prostate cancer, based on agreed high-risk criteria, are being fast tracked directly to these clinics. These patients will have a definitive diagnosis established within two weeks of referral and, if cancer is confirmed, they will have immediate access to a multidisciplinary specialist cancer consultation regarding appropriate management. I encourage any man who has concerns in this regard to contact his GP for referral, where that is deemed appropriate.
I am disappointed, to a degree, by the Minister's answer. The statistics show that well over 2,500 men in Ireland are diagnosed with prostate cancer every year, with deaths reaching well over 550 per year. Prostate cancer has become the most common male cancer in Irish men, one in 12 of whom will develop it. There is extensive publicity about breast cancer, but incredibly, the risk of a man getting prostate cancer is only 2% lower. Those are significant statistics. With the ageing population, it is predicted that there will be a 275% increase in prostate cancer by 2020. The statistics also show that early detection is crucial. More than 69% of men who have not shown any signs of prostate cancer, but in whom it is detected by the test, will survive. The prostate cancer charity recently estimated that two thirds of men who are at risk of prostate cancer do not know that the simple blood test is available. Is there funding for national screening and a national information programme? Many men are not even aware of the availability of the simple PSA blood test.
I have to accept what the medical experts tell me and they say at this moment in time, particularly when we have to make hard choices about where the limited resources we have are spent, decisions and responses must be informed. On many occasions since I entered office, I said our policy would be evidence-based and so it will be.
The second part of the Deputy's question related to funding for charity to raise awareness of the possible symptoms. I have no issue with that and I will discuss it with the Deputy. There is little sense, however, if I am left with a choice between colorectal cancer screening and prostate cancer screening and there is no international evidence to support the latter and there is ample evidence to support the former, in doing other than what I am advised by the range of experts the Department has access to internationally.
I accept the six fast-track clinics that have been chosen but those are for people who have already been diagnosed with prostate cancer who can be fast-tracked for treatment. Surely when we are talking about saving money, all the international evidence shows that early intervention saves lives and reduces costs. To go for a simple PSA test without a medical examination costs €20. I have spoken to doctors about this and they say it should be done free because it would not cost the health service a huge amount. Why do people not pay for it? In the current climate, and given that many men are not even aware of it, it would be a small cost to the health budget to roll out national screening, which would inevitably save money for people who would be diagnosed with cancer having to be treated. The 2,500 men who have to be treated each year would be substantially reduced, as has been shown in many countries. This does not make economic sense.
I do not want to get into a debate on the sensitivities of the prostate specific antigen blood test, which is not 100% infallible and I accept the Deputy is passionate about this and he is trying to save lives and that is the business of my Department as well. In reality, however, it happens that patients who do not have symptoms are picked up in examinations for all conditions. That does not mean that by providing a hugely expensive screening programme, the sort of results the Deputy wants to see will happen in terms of picking up cases early, not having high false positives and worrying people unnecessarily. There is a raft of criteria that medical experts can present. The best thing I can do is speak to the Deputy directly about the existing medical evidence behind the rationale for this decision. If he still has issues I am happy for him to come back to the House and have a further debate.
4 Deputy Billy Kelleher asked the Minister for Health his views on the strike at the Mid Western Regional Hospital, Limerick undertaken by the Irish Nurses and Midwives Organisation and the concerns about cutbacks and staff shortages expressed by their members; and if he will make a statement on the matter. [26438/11]
I do not believe that any useful purpose is served by this industrial action. I am concerned that a further stoppage has happened today and would urge the INMO to reflect on the impact which these actions have on the general public.
The shared focus of all those working in the health service should be on safeguarding frontline care in the face of the continuing very serious economic situation. The Mid-Western Regional Hospital Limerick was €16.2 million over budget at the end of July 2011 and has had to take measures to reduce its spending including a prohibition on staff overtime and on the hiring of agency staff.
In recent months I have established the special delivery unit under the leadership of Dr. Martin Connor. The SDU is working to unblock access to acute services by improving the flow of patients through the system. It is focusing initially on emergency departments and will be working to support hospitals in addressing excessive waiting times for admission to hospital. I look forward to the co-operation of all health service staff with this very important initiative, which is aimed at ensuring that patients receive a safe and appropriate service when they present at our acute hospitals.
I find it hard to reconcile the fact that the nursing unions are taking this industrial action given that they are parties to the public service agreement, particularly in view of the fact that the agreement focuses on the need to deliver services in the changed circumstances in which we now find ourselves and with co-operation between management and unions.
Last night the LRC put a series of measures to the unions to resolve this issue and those measures were refused. It appears, rightly or wrongly, that they will not yield on this issue until the moratorium is lifted and a cap put on the number of beds that may be put up in a hospital. I might be wrong on that but it is the message I am getting back. That is not possible.
As in all areas of the economy and the public service we must focus on solutions, including efficiency, flexibility and innovative working, to allow us to maintain our public services in the face of the economic crisis.
Does the Minister agree the overriding concern of those involved in the industrial dispute in the mid-west is patient safety? This morning there were six people on trolleys in the accident and emergency unit but there were 41 in an overflow ward. There is a massaging of figures for people on trolleys awaiting proper treatment. The nurses involved in the industrial dispute are clear that they are very concerned about patient safety and that there is gross overcrowding in accident and emergency wards that compromises their ability to deliver proper clinical supports and services to patients who present in the accident and emergency department. Does the Minister agree their overriding concern is patient safety?
The special delivery unit did not carry out a "dawn raid" but informed management in advance that it would inspect the hospital to see how it could assist with overcrowding in the accident and emergency ward. When it arrived at the hospital it found very few people on trolleys but there is now an overflow ward where 41 people are awaiting admission. Clearly the special delivery unit should not inform hospitals of visits in advance so it can see at first hand the concerns being expressed by the INMO members.
As a doctor and as Minister I fail to see how patient safety is improved by taking industrial action. In my view that endangers the very patients we are seeking to protect. I accept the right of the INMO to highlight the situation but it must acknowledge we are acutely aware of the situation. The special delivery unit was down there last week, I have its report and I am studying its recommendations before I pass it on to the HSE for implementation.
This action is unsafe, unsound and unwarranted. I have asked the Department to contact the HSE with a view to contacting the Croke Park agreement implementation body because I believe this is ultra vires and outside the agreement.
Is the Minister clearly stating the action by the INMO in the mid-west puts patient safety at risk and increases the dangers the INMO has highlighted in the accident and emergency ward and is further exacerbating the problem, threatening the lives of patients attending?
I fail to see how this improves the situation and in my view this could lead to more danger for patients, not less.
5 Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will commence a programme of reopening public hospital beds in view of the research by the Irish Nurses and Midwives Organisation showing that more than 1,900 public hospital beds are currently closed [26440/11]
There are some 13,000 acute hospital beds, including some 1,800 day beds, in the Irish public acute hospital system. The exact number available for use at any one time varies according to a number of factors, including planned levels of activity, refurbishment and infection control.
Beds are also closed to control expenditure because, like all other public agencies, hospitals have to operate within budget.
As I have already outlined for the House and as I will outline again, we started this year with a hospital overrun of €70 million. In the first three months of this year, under the previous Government, we had a wild overrun of activity, whether by design or through negligence. Because of the economic situation we must, effectively, take €1 billion out of the budget. We must also maintain a service that is safe for patients and implement the reform programme.
The criteria for counting bed closures and methods vary between hospitals. Instead of having a debate about the exact number of beds that are judged to be open or closed at any one time, we must concentrate on getting the best possible services for patients from the budgets available to us.
This means we need to focus on how beds are used, on the throughput of patients, on reducing length of stay to international norms and on having as many procedures as possible carried out as day cases rather than inpatient work.
The work of the special delivery unit, together with implementation of the clinical care programmes in the HSE, will help to improve the efficiency of our hospitals, allowing us to treat as many patients as possible within budget.
I believe that pursuing efficiencies through these means will be a far more productive approach than debating the number of beds open or closed at any one time.
Shortly after he came to office, the Minister indicated, in his address to the INMO conference, that he accepted the INMO trolley-watch figures. Does he also accept the INMO figures for closed hospital beds? It is strange that he does not want to talk about bed closures because he talked about them ad nauseam when he was on the Opposition benches. At the last count the INMO figure was 1,847.
The Minister is repeating the mantra of his predecessor about the fluctuation of beds at any one time. We heard all this before. The Minister himself, when in opposition, described it as a dodge. It was a dodge then and it is dodge now.
Of course we must have greater efficiency. The Minister must also accept, as he repeatedly stated when in opposition, that too many beds have been taken out of the public hospital system and that those closures must stop. Indeed, a significant number must now be reversed.
What about the closures of the very beds that he himself says are the most needed for efficiency? What about beds for day cases and short stays? Does the Minister agree that more beds closed means more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations? Does the Minister agree with that statement and will he commence a public bed re-opening programme as an essential part of addressing the current crisis in accident and emergency departments and acute hospitals across the State?
I will start with the Deputy's last point, lest I forget it. I do not agree that more beds closed means more patients on trolleys and more people waiting. I do agree with something I said myself when in opposition: "Not another bob more into health until the black hole is found and fixed."
We are in the process of doing that and of changing how hospitals operate and how and where operations are carried out. We are placing more emphasis on day surgery. People are being admitted into hospital the night before procedures when they do not need to be. They could be admitted on the day. Five beds have been freed up in the Mid-Western Regional Hospital, Dooradoyle, as a consequence of this happening.
Deputy Ó Caoláin asked if I agreed with the INMO trolley-watch figures and I said I did. I did not say I agreed with the bed closure figures. No joint study on bed closures between the INMO and my Department has taken place. While I do not utterly reject the INMO numbers I cannot accept them because I have not had advice from my own Department.
There are great inefficiencies in our system and much work is being done inappropriately. The basic principle of what we are trying to achieve is that the patient will be treated at the lowest level of complexity that is safe, timely and efficient and as near to home as possible. That remains the principle. We do not want patients going to see GPs when nurses could see them or going to see consultants when GPs could see them. We do not want operations being carried out in large hospitals, which should be reserved for more serious complex cases, when those procedures could be carried out safely nearer to the patient's home in smaller hospitals around the country.
The Minister is good at citing what he said previously.
The Deputy is pretty good at it himself.
What the Minister has just indicated he does not agree with is what he said himself on a previous occasion. I quote from a statement of May 2010:
More beds closed means more patients suffering needlessly on trolleys and more patients waiting at home in pain due to cancelled operations.
Who said that? The Minister said it when 33 beds were closed on a five-day ward in Beaumont Hospital in Dublin.
The Minister has played a game of double standards. He championed various positions as Opposition health spokesperson but since taking office he has regurgitated what the previous Minister said. He now employs exactly the same language in parliamentary questions. He promised to take up the issues of responsibility and accountability. The parliamentary replies he gives me and other Deputies when we raise matters with him are verbatim what the previous Minister, former Deputy Harney, used to give.
Will the Minister not recognise, as he has said previously, that we need to see the restoration of some of the beds that have been closed and which are contributing to a calamitous situation in hospitals and accident and emergency departments across the State?
The nature of the Deputy's question has changed somewhat.
Not at all. The only thing that has changed is the Minister's response.
I would always be prepared to review the situation in an individual hospital. In the past a blunt instrument was used, with 10% of capacity being taken out across all hospitals with no regard to where they were within their own capacity, so that some hospitals suffered more than others. An analysis of that is taking place at present to see where there is a capacity issue, as opposed to a perceived capacity issue. I am not yet in a position to report on that.
Six months after the formation of the Government, there is a real prospect of getting real-time information from our emergency departments and on inpatient waiting and financial situations. We will know within two weeks what the financial situation of a hospital is, what its spend is and if it is going off budget and out of control.
We are also seeking, through the clinical programmes, to improve the delivery of service within hospitals, making it more appropriate and making sure patients are treated at the appropriate level and in the appropriate setting.
I do not accept the Deputy's contention that the Government is the same as the previous one or that I am the same as the previous Minister. I have a very different approach. Within months the Deputy will see greater improvement than is currently the case.
It is not in evidence as we speak.
