Other Questions

Ambulance Service

Denis Naughten

Question:

6. Deputy Denis Naughten asked the Minister for Health the progress that has been made in the Health Service Executive west region since the introduction of standardised ambulance response times; the steps being taken to improve ambulance response times in the region; the way that is to be evaluated following the non-implementation of Health Information Quality Authority standards; and if he will make a statement on the matter. [13683/13]

Emergency response times vary significantly between regions, depending on, among other things, geography and the rural-urban mix. Despite the geographical diversity of the national ambulance service west region, improvements in emergency response times were achieved in 2012. I am informed by the national ambulance service that there has been an improvement in response times in the west from 2011 to 2012.

The national ambulance service has been addressing response times through a number of measures, including the intermediate care service, ICS, for non-emergency ambulance transport such as inter-hospital transfers, thus freeing emergency vehicles for emergency calls. Almost 40 ICS staff were appointed last year, with further resources to be deployed in 2013. Other measures include the trial emergency aeromedical service, EAS, which reduces transit times, particularly in the West, and allows emergency vehicles to remain within their regions, and the national control centre reconfiguration, with one national control system on two sites, in Tallaght and Ballyshannon, for improved dispatch and response times, with regional rather than local deployment and better use of first-responder schemes. These measures, together with more effective use of existing resources, for example with improved training and better deployment through more efficient rostering, will drive the improvement of response times in every region, including the west of Ireland. This will lead to better services and better outcomes when our citizens need these services.

I am disappointed that the Minister did not give more specific information on the provision of services in the west. As he is aware, response times in the west are some of the worst in the country. Difficulties include the wide geographical spread and the lack of adequate resources. The Minister's counterpart in Northern Ireland, the Minister for Health, Social Services and Public Safety, Mr. Edwin Poots, MLA, said that 90% of people in Northern Ireland who suffer a heart attack outside hospital die. Does the Minister believe that the figures are similar here? I ask him to respond to the comments of the coroner for south Mayo, Mr. John O'Dwyer, who said that it was physically impossible and totally unachievable for patients in Mayo to be in the catheterisation lab in Galway within 90 minutes. The same would apply to heart attack sufferers in County Roscommon, especially since the closure of the accident and emergency department there.

What steps are being taken to improve the ambulance service in the region and to deal with the lack of a catheterisation lab north of the line from Galway to Dublin?

With respect, I am not aware of the coroner's comments and I fail to see why a patient in Mayo would not be in a catheterisation lab in Galway within 90 minutes, particularly if he or she was being transported by air ambulance. I do not have the transit times from Mayo to Galway before me but we all know that outcomes are considerably improved for those who have an ST segment elevation myocardial infarction or STEMI if they are brought to a catheterisation centre, where a stent can be inserted.

Many improvements are being put in place, some of which I have enumerated. We will continue to review and upgrade the service to meet the needs of the people on an ongoing basis.

It is a pity the Minister did not answer the question I put to him. What mechanisms are now in place to monitor ambulance response times, in light of the fact that the Minister has now stated that he is not going to comply with the HIQA criteria? I am surprised that the Minister is not aware of the coroner's comments, not only because of the extensive media coverage given to them but because I tabled a parliamentary question on that specific issue. I am disappointed that something as prominent as this has not been brought to the Minister's attention.

On the west specifically, what is the situation regarding the use of existing resources? What are the plans, for example, for the ambulance base in Tuam that is lying idle because of a lack or resources and staff to man it? Where is the long-promised and long-planned ambulance base for the communities in west Roscommon?

I must reject out of hand what the Deputy has just said with regard to HIQA and non-compliance. Perhaps the Deputy will set out in writing an explanation of how he forms that opinion.

Will the Minister respond to the letter?

I have made it very clear that we now have the technology to monitor response times and that is being used. If the Deputy requires a more comprehensive answer, I will respond to him in writing.

What about the ambulance base?

In a previous reply to a parliamentary question on current national targets for ambulance response times, the Minister indicated that the targets were being abandoned and replaced with new criteria. Could we have an update on what is happening in that regard and the process being used? Does the Minister accept that with the loss of critical services at some of our smaller hospital sites, it was advised to dependent communities that services lost would be compensated by greatly improved state-of-the-art paramedic services? The reality is far from that, however, and there are many gaps in the service. Will the Minister comment on that?

The Deputy is alluding to the position in Mayo and there was an incident, which has been reviewed, with the issues addressed. I know there have been six ST elevation myocardial infarction transfers from Mayo General Hospital to Galway, with the procedure successfully carried out under protocol. I reassure people that there is a service that can be trusted and depended upon.

With regard to the more general comments from Deputy Ó Caoláin, there is ongoing review and monitoring. I am in contact with Mr. Edwin Poots on a regular basis with regard to cross-Border ambulance co-operation and air ambulance co-operation in particular.

Question No. 7 is in the name of Deputy Áine Collins.

A number of questions are being taken together.

There is a grouping of questions.

On a point of order, I object to the grouping. I have seen cynical exercises in this House. We have a case of-----

-----25 questions-----

The Deputy could listen to the answer. It is because this is good news. This always happens when there is good news.

It is the Deputy's first time in here at this time. It is a cynical exercise the like of which I have not seen in years.

Deputies, please-----

The Deputy is a disgrace.

With the 25 questions tabled, we cannot ask questions-----

The Chair is on its feet.

There are 42 questions on waiting lists. I have seen it all.

The Deputy should resume his seat or leave the House.

It is an absolute disgrace.

The Deputy is a disgrace. Let the Minister answer.

The Deputy should resume his seat.

Let the Minister answer.

I am sorry, Deputy-----

I object to this House being abused to the extent that there are 25-----

Deputy Kelleher-----

-----questions on MRSA being tabled-----

What about the rest of us who tabled questions?

I do not begrudge any Deputy tabling a question-----

The Deputy should resume his seat.

-----but these were tabled by the press office of the Department. It is a disgrace.

For the last time, Deputy-----

The Leas-Cheann Comhairle and everybody in the Chamber knows it is a disgrace.

The Deputy should resume his seat. We are proceeding with the questions.

Deputies are lined up. It is an absolute farce.

Please resume your seat.

A Leas-Cheann Comhairle-----

If the Deputy does not resume his seat-----

On a point of order-----

-----I will suspend the House for five minutes.

-----there are 42 questions on waiting lists alone. It is a sham.

Sitting suspended at 3.20 p.m. and resumed at 3.25 p.m.

Hospital Acquired Infections

Áine Collins

Question:

7. Deputy Áine Collins asked the Minister for Health the measures that have been taken to tackle MRSA in Cork University Hospital; the impact of these measures; and if he will make a statement on the matter. [14273/13]

Andrew Doyle

Question:

9. Deputy Andrew Doyle asked the Minister for Health the measures that have been taken to tackle MRSA in Tallaght hospital, Dublin 24; the impact of these measures; and if he will make a statement on the matter. [14315/13]

Paul Connaughton

Question:

27. Deputy Paul J. Connaughton asked the Minister for Health the measures that have been taken to tackle MRSA in Portiuncula Hospital, Ballinasloe, County Galway; the impact of these measures; and if he will make a statement on the matter. [14331/13]

Joe Carey

Question:

35. Deputy Joe Carey asked the Minister for Health the measures that have been taken to tackle MRSA in Mid-Western Regional Hospital, Ennis, County Clare; the impact of these measures; and if he will make a statement on the matter. [14332/13]

Peter Mathews

Question:

36. Deputy Peter Mathews asked the Minister for Health the measures that have been taken to tackle MRSA in Our Lady’s Children’s Hospital, Crumlin, Dublin; the impact of these measures; and if he will make a statement on the matter. [14328/13]

Nicky McFadden

Question:

50. Deputy Nicky McFadden asked the Minister for Health the measures that have been taken to tackle MRSA in Midland Regional Hospital, Mullingar, County Westmeath; the impact of these measures; and if he will make a statement on the matter. [14284/13]

Brendan Griffin

Question:

56. Deputy Brendan Griffin asked the Minister for Health the measures that have been taken to tackle MRSA in Kerry General Hospital; the impact of these measures; and if he will make a statement on the matter. [14336/13]

Noel Harrington

Question:

58. Deputy Noel Harrington asked the Minister for Health the measures that have been taken to tackle MRSA in Mercy University Hospital, Cork; the impact of these measures; and if he will make a statement on the matter. [14277/13]

Pat Breen

Question:

65. Deputy Pat Breen asked the Minister for Health the measures that have been taken to tackle MRSA nationally; the impact of these measures; and if he will make a statement on the matter. [14261/13]

Eoghan Murphy

Question:

69. Deputy Eoghan Murphy asked the Minister for Health the measures that have been taken to tackle MRSA in St. Vincent’s University Hospital, Elm Park, Dublin 4; the impact of these measures; and if he will make a statement on the matter. [14311/13]

Tom Barry

Question:

72. Deputy Tom Barry asked the Minister for Health the measures that have been taken to tackle MRSA in Mallow General Hospital, County Cork; the impact of these measures; and if he will make a statement on the matter. [14334/13]

Joe McHugh

Question:

86. Deputy Joe McHugh asked the Minister for Health the measures that have been taken to tackle MRSA in Letterkenny General Hospital, County Donegal; the impact of these measures; and if he will make a statement on the matter. [14338/13]

Charles Flanagan

Question:

94. Deputy Charles Flanagan asked the Minister for Health the measures that have been taken to tackle MRSA in Midland Regional Hospital, Portlaoise, County Laois; the impact of these measures; and if he will make a statement on the matter. [14287/13]

Noel Coonan

Question:

100. Deputy Noel Coonan asked the Minister for Health the measures that have been taken to tackle MRSA in Mid-Western Regional Hospital, Nenagh, County Tipperary; the impact of these measures; and if he will make a statement on the matter. [14327/13]

Frank Feighan

Question:

107. Deputy Frank Feighan asked the Minister for Health the measures that have been taken to tackle MRSA in Sligo General Hospital; the impact of these measures; and if he will make a statement on the matter. [14303/13]

Frank Feighan

Question:

111. Deputy Frank Feighan asked the Minister for Health the measures that have been taken to tackle MRSA in Roscommon County Hospital; the impact of these measures; and if he will make a statement on the matter. [14335/13]

John O'Mahony

Question:

123. Deputy John O'Mahony asked the Minister for Health the measures that have been taken to tackle MRSA in Mayo General Hospital; the impact of these measures; and if he will make a statement on the matter. [14339/13]

Liam Twomey

Question:

127. Deputy Liam Twomey asked the Minister for Health the measures that have been taken to tackle MRSA in Wexford General Hospital; the impact of these measures; and if he will make a statement on the matter. [14325/13]

Tom Barry

Question:

137. Deputy Tom Barry asked the Minister for Health the measures that have been taken to tackle MRSA in South Infirmary-Victoria University Hospital, County Cork; the impact of these measures; and if he will make a statement on the matter. [14330/13]

Anthony Lawlor

Question:

146. Deputy Anthony Lawlor asked the Minister for Health the measures that have been taken to tackle MRSA in Naas General Hospital, County Kildare; the impact of these measures; and if he will make a statement on the matter. [14340/13]

Jim Daly

Question:

152. Deputy Jim Daly asked the Minister for Health the measures that have been taken to tackle MRSA in Bantry General Hospital, County Cork; the impact of these measures; and if he will make a statement on the matter. [14265/13]

Olivia Mitchell

Question:

153. Deputy Olivia Mitchell asked the Minister for Health the measures that have been taken to tackle MRSA in Midland Regional Hospital, Tullamore, County Offaly; the impact of these measures; and if he will make a statement on the matter. [14291/13]

Jim Daly

Question:

158. Deputy Jim Daly asked the Minister for Health the measures that have been taken to tackle MRSA in Waterford Regional Hospital; the impact of these measures; and if he will make a statement on the matter. [14323/13]

Kieran O'Donnell

Question:

165. Deputy Kieran O'Donnell asked the Minister for Health the measures that have been taken to tackle MRSA in Mid-Western Regional Hospital, Dooradoyle, County Limerick; the impact of these measures; and if he will make a statement on the matter. [14281/13]

Peter Mathews

Question:

169. Deputy Peter Mathews asked the Minister for Health the measures that have been taken to tackle MRSA in St James’s Hospital, Dublin; the impact of these measures; and if he will make a statement on the matter. [14329/13]

I do not wish to cause any aggravation but I wish to have my view put on record. There are 91 questions in the names of Fine Gael Deputies. I would judge eight of those questions to have been written by their respective authors, the named Deputies, but 83 of them are definitely manufactured by a single hand, each of them seeking information on measures that have been taken. I do not deny anyone the right to pose a question but the consequence of this is that I, as an Opposition Deputy, will not have the opportunity to pose an oral question to the Minister during the single opportunity I have each month to hold him to account in the House. That is my solemn objection. This is indefensible and I ask the Leas-Cheann Comhairle to report this to the Ceann Comhairle. I also appeal to the Minister and, particularly, to the two Ministers of State in the Department, who are both in the Labour Party, the Members of which are not party to this which has solely and wholly emanated from Fine Gael, to address this matter so this abuse does not continue in this House.

As a back bench Member of this House, elected by the people, have I the right to place a question to the Minister of any Department for oral or written reply?

They must be telepathic. Every one of the Fine Gael offices must be linked telepathically because they all wrote the same question.

Every Deputy is entitled to table two questions to a Minister. That is clear.

I thank the Leas-Cheann Comhairle for that answer.

If Deputies have issues about this, they should raise them at the Committee on Procedure and Privileges.

It is done to avoid any accountability. He is up to his usual tricks.

I propose to take Questions Nos. 7, 9, 27, 35, 36, 50, 56, 58, 65, 69, 72, 86, 94, 100, 107, 111, 123, 127, 137, 146, 152, 153, 158, 165 and 169 together.

I am pleased to inform the Deputies that MRSA rates are at a six year low and I would like to assure all Deputies that the management of health care associated infections, HCAIs, including MRSA, is a key patient safety issue for my Department and the Health Service Executive. A number of significant initiatives have been developed to address that important public health issue, including the HSE's national infection control plan, which was launched in 2007 and the aim of which was to reduce HCAIs and to target MRSA infection and antibiotic consumption. A national surveillance system was also established by the HSE to collect data and provide information to monitor HCAIs in our health system, along with the establishment of the clinical care programme for HCAIs.

With regard to the prevention and spread of MRSA, it should be noted that the number of cases of MRSA has decreased steadily.

Individual hospital MRSA rates are also collected and published - annually for 2006 and 2007 and quarterly from 2008 onwards. These results provide a good benchmark for the future to enable us to measure effectively the progress of each hospital on its performance in infection prevention and control. The data can be used by individual hospitals to monitor their progress in the control of healthcare associated infections and the Health Protection Surveillance Centre's regular reports allow for public assessment of that progress. It should be noted that this data does not allow direct comparison between individual hospitals as it does not take account of differences in patient populations, clinical services provided, inter-hospital patient transfers and other differences in activity between hospitals.

I presume I will get the written reply showing the figures on Tallaght hospital in due course.

I welcome the progress and the effort the Minister and front-line staff in the hospitals have been making. I note that over the past couple of years every effort has been made to tackle this MRSA issue.

I know at first hand of the dedication of the professionals, such as nurses and doctors, who work in the health service and in infection control. However, the number of deaths, amputations, chronic infections and debilitating conditions that the MRSA has caused is devastating, especially in circumstances where it can be prevented.

A question, please.

I welcome the announcement today. I am looking forward to getting the figures on Tallaght hospital which serves those in my constituency.

I say this to Deputies Kelleher and Ó Caoláin.

Deputy Keating may say what he likes.

Over the past two years, I have sat for many long hours in this House, at the Committee Stage of Bills and at Oireachtas committee meetings and listened while members of Fianna Fáil, the Technical Group and Sinn Féin have got priority time. Often I have gone away from those meetings and Dáil sessions without having the opportunity of speaking, and I have never once complained.

My only concern is that each Deputy has one minute.

And I have never brought the House into disrepute.

I am pleased to be able to tell Deputy Keating that Tallaght hospital's rate of MRSA has fallen, from 27 cases in 2008 to seven cases in 2012. This is a provisional figure because we must be absolutely sure.

The hospital follows national MRSA guidelines and has a comprehensive programme to reduce MRSA, including screening of patients for infection. Infection control measures include hand-hygiene, appropriate use of antibiotics, surveillance and audit of infection, and staff education and research.

Given that there is such interest from Deputy Kelleher, perhaps he would like to know the Cork University Hospital rate of MRSA has fallen, from 25 cases in 2008 to 17 cases in 2012. The infection prevention control service for Cork University Hospital is based on an internationally accepted model. Measures to minimise the spread of MRSA within Cork University Hospital include adherence to hand-hygiene protocols; detection of MRSA cases and carriers and prompt isolation of patients with MRSA to prevent and control spread; prompt decolonisation protocols; strict anti-biotic control of both systemic and topical antibiotic uses; and early discharge of patients and environmental hygiene controls. Since 2010, there has been a 20% reduction in MRSA across the country.

I welcome the figures announced by the Minister on Tallaght hospital.

As somebody who has not submitted a question I welcome the fact that in the city of Cork there has been a 46% reduction in MRSA cases. The significant progress we have made in Cork is something about which we should not become complacent. I believe the Minister will agree that no patient should have to endure the horror of picking up an infection in hospital. Having recently met staff in all of the Cork city hospitals on the matter, I thank the workers, the healthcare professionals and healthcare assistants, who work in the hospitals.

In light of the fact that there has been a reduction of 20% nationally, and of 46% in the case of Cork, what plans has the Department in regard to every patient having a right to feel safe in our hospitals?

It is not acceptable for people to be allowed to become seriously infected as a consequence of MRSA within hospitals, as happened in the past, in some cases leading to death.

I thank the Deputy for his comments. In fairness to the previous Government, figures for MRSA incidence were beginning to fall after 2008. It is important that all of us in the House should reassure patients going into hospitals that they will be in a safe place and come out better than when they went in. With hospital acquired infections, sometimes that is not the case and we need to strive to do everything we can to address that. One of the main areas we need to address is the overuse of antibiotics. It often takes doctors - particularly in primary care but also in hospitals - longer to explain to people why they do not need an antibiotic than it does to prescribe it. We need to continue to strive to address that issue. We have made progress, but we need to make much more and we will continue to do that. Patient safety and outcomes must be to the fore of all our policies. As long as we do that, I do not believe we will go too far wrong.

How many new isolation beds have been introduced in hospitals in the past two years to address the issue of hospital-based infections? For several years an issue of great concern to many of us here has been the failure of hospital authorities to advise either patients or their families that they had contracted MRSA or other hospital-based infections. Can the Minister assure the House that the current practice is that the presentation of MRSA or any other hospital-based infections is advised to patients and their families so that, unlike in the past, we do not need to wait to read it on a death certificate?

Health care associated infection prevalence in the Republic of Ireland, at 5.2%, was lower than that reported for England at 6.4%, but higher than that reported in Scotland at 4.9%. We have made progress and have much more progress to make.

The Deputy asked about the increase in the number of single rooms or isolation rooms. I would need to delve into the system to get a comprehensive answer to that question. We have had the advent of the new 100 bed wing at St. Vincent's hospital and any newer hospitals or new wings being developed are all single bed en suite rooms, which represents the way forward. Of course, the national paediatric hospital will consist of single rooms as well. In Beaumont, Cork and other areas, additional en suite facilities have been built on, often with the help of the Cystic Fibrosis Society of Ireland, which is always very welcome.

I call Deputy O'Donovan.

It is not just CF, of course.

I understand that.

I ask the Minister to answer the question about notifying patients and their families, which is very important.

Two other Deputies are offering and I have called Deputy O'Donovan.

I have previously asked the Minister about clothing policies in hospitals vis-à-vis the risk of the spread of infection. In the UK there is a policy of bare below the elbow and no neckties. I know some Members of this House also follow that policy. Regarding the spread of infection from patient to patient in a hospital environment, are the Department and the HSE giving consideration to this matter? Research and reports on it are mixed and varied.

We welcome any reduction in MRSA incidence. Obviously the HIQA report did not glorify all aspects of reductions in MRSA incidence. Clearly much work needs to be done on the basics of hand hygiene and basic cleanliness in our hospitals. Rather than grandstanding and backslapping and complimenting the Minister on the reduction in MRSA incidence, we should ensure basic hand hygiene and cleanliness of our hospitals are to the fore in any policies or the review of any policies.

I agree with the Deputy that more work needs to be done and that we need to reinforce continually to professionals - doctors in particular - the message on hand cleaning and hygiene. The same applies to people coming into and going out of hospitals.

The issue raised by Deputy Ó Caoláin of the reporting of MRSA, including to the patient that he or she has contracted it, is an important one. I would not stand over anything else. It should be only on a very rare occasion that that would not happen. We need to move away from defensive medicine and an unwillingness to share information. As far as I am concerned, it is for this reason we need a patient safety authority, which will be introduced on an administrative basis this year. As a doctor, my experience has been that when something goes wrong, what people want is an acknowledgement that it went wrong, an apology for it having gone wrong and an assurance that it will not happen again because change will be brought about. If they get this, they do not feel the need to go to the law. Very often, people are utterly frustrated because they do not get the information they want. Everyone then becomes defensive and the matter ends up in the hands of the legal profession. Sadly, approximately one third of what we pay out in terms of these events goes to the legal profession, which issue I want to address.

We now move to Question No. 8.

I would like to ask a question of the Minister in relation to the previous question.

The Deputy may run out of time.

To be helpful, I will read my response to Question No. 8 quickly. That should afford Deputy McLoughlin with ample opportunity to put his questions.

Hospital Waiting Lists

Tony McLoughlin

Question:

8. Deputy Tony McLoughlin asked the Minister for Health the measures that have been taken to tackle inpatient waiting lists for children in Sligo General Hospital; the impact of these measures; and if he will make a statement on the matter. [14302/13]

At the end of February 2011, four children were waiting more than a year for an inpatient procedure in Sligo General Hospital. Waiting lists in excess of a year for inpatient procedures for children have now been eliminated in Sligo General Hospital. At the end of February 2011, 11 children were waiting more than nine months for an inpatient procedure in Sligo General Hospital. Waiting lists in excess of nine months for inpatient procedures for children have now been eliminated in Sligo General Hospital. At the end of February 2011, 18 children were waiting over six months for an inpatient procedure in Sligo General Hospital. Currently, only one child is waiting longer than six months for an inpatient procedure in Sligo General Hospital.

This reduction in waiting lists for inpatient procedures for children is mirrored throughout the country. At the end of February 2011, 169 children were waiting over a year for an inpatient procedure. Currently, ten children are waiting this length of time. This waiting list has been reduced by 94% since this Government took office. At the end of February 2011, 372 children were waiting more than nine months for an inpatient procedure. Currently, 26 children are waiting this length of time. This waiting list has been reduced by 93% since this Government took office. At the end of February 2011, 634 children were waiting more than six months for an inpatient procedure. Currently, 82 children are waiting this length of time. This waiting list has been reduced by 87% since this Government took office. As a result of these improvements, there are now 333 fewer children waiting for inpatient procedures.

I am determined that the progress made in 2012 will be maintained and improved upon and that the 20 week target will remain in place for 2013. It is important to recognise that the progress made in 2012 does not mean the problem is solved. The year 2013 will be extremely challenging. For example, winter pressures have impacted on scheduled care waiting times for children. However, in the coming months, as winter pressures ease, the special delivery unit, SDU, will work towards re-balancing scheduled care to maintain the improvements seen in 2012.

I take this opportunity to again thank the men and women on the front line in our health services for their extraordinary efforts in improving outcomes for patients and providing a better service.

I welcome the Minister's positive reply. It is hoped the positive trend will continue. Government policies over the past two years have resulted in a reduction in hospital waiting lists. I concur with the Minister's remarks in relation to front-line staff, who must be given recognition for their work in our hospitals, in particular staff at Sligo General Hospital. The situation as outlined by the Minister is encouraging. I know this positive trend will continue over the next number of years.

When will the second consultant neurologist, promised nine months ago, be appointed to Sligo General Hospital? Also, as promised by the Minister prior to the general election in 2011, when will mammography services at Sligo General Hospital be restored?

On the latter question, mammography services will be restored as soon as we can locate mammographers, of whom there is a huge shortage. I remain committed to restoration of that service. Discussions are being held on the re-opening of a discontinued internal training programme to ensure training of more mammographers, of which there is genuinely a shortage and who, when a need is identified for them, are inclined to be taken up by the acute services, which is only right because it is important the most acutely ill be taken care of first. However, this impacts on the service in Sligo General Hospital, which I want to see restored and have given a commitment to this effect.

When will a consultant neurologist be appointed to Sligo General Hospital?

I will communicate in writing with the Deputy on that matter.

That was a very helpful Question Time session.

Accountability my eye.

It is a disgrace.

Written Answers follow Adjournment.