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Dáil Éireann díospóireacht -
Wednesday, 5 Apr 2000

Vol. 517 No. 4

Other Questions. - National Health Strategy.

Ulick Burke

Ceist:

55 Mr. U. Burke asked the Minister for Health and Children if he will give details of his quality control strategy applicable to our hospital and health care services. [9881/00]

Alan Shatter

Ceist:

220 Mr. Shatter asked the Minister for Health and Children if he will give details of his quality control strategy applicable to the hospital and health care services. [10214/00]

I propose to take Questions Nos. 55 and 220 together.

Quality is one of the key principles underpinning the 1994 national health strategy and continues to be a cornerstone of health policy. I have a strong belief in the value of developing and supporting system-wide quality initiatives which have as their principal focus the pursuit of continuous improvement of standards across the health service. I recognise that in health care, quality is not an option but a feature of the service which consumers have come to demand and expect. Quality improvement should be supported centrally but its implementation needs to be locally based and involve each member of the organisation. The overriding objective is to achieve real and measurable improvement for the consumer by putting the interests of the patient to the fore.

I am supporting important initiatives across the health sector which focus on quality improvement in health care services. Examples of these initiatives include governance and management development, risk management, clinicians in management, clinical audit, patient advocacy, the development of hospital performance indicators and the introduction of a hospital accreditation.

In the area of governance and management development, my Department has initiated a programme in collaboration with the major academic teaching hospitals in Dublin to strengthen the governance and management function at hospital level. Also, hospitals and agencies are being supported in the development of risk management programmes aimed at minimising all types of risk to which hospitals may be exposed and thereby ensuring the provision of a safe service to patients.

Clinicians are increasingly becoming involved in the management function at hospital board level to facilitate the setting of and monitoring of quantitative and qualitative service targets, the design of care plans and the provision of a more patient focused service. Moreover, clinical audits involve a systematic review of clinical practice against local and external standards.

My Department has invited proposals from health agencies for the development of patient advocacy structures to deal with patient dissatisfaction and complaints and hospital performance indicators have been developed by my Department for use in annual service plans.

Another initiative which I was particularly happy to support since becoming Minister for Health and Children is the development of an Irish hospital accreditation programme. The development of a hospital accreditation programme should act as a support – and in some cases a prompt – for a wide range of mechanisms which combine to improve quality in health care. The introduction of this programme represents a major advance in promoting quality improvement and presents an opportunity for providers to maximise and improve standards. As evidence of my commitment to the scheme, I am providing in excess of £1 million to advance the initiative. This represents a significant investment dedicated to the promotion of quality improvement in the hospital sector and represents tangible evidence of my commitment to support the improvement of standards.

I agree that quality control is the most important factor in the delivery of any service or product. However, we have a new problem in the health service which, frighteningly, is being generated within hospitals – MRSA. Is there a strategy in place in the hospitals for infection control? If so, who is responsible for taking the initiative to provide the service? Do we audit standards within the hospitals? The Minister said the Government is providing £1 million for hospital accreditation. Does he think that is sufficient in view of the difficulties there are for hospital management? Is there a project team reporting to the Department from hospitals?

MRSA is an issue of considerable concern to me, as it was to my predecessor. The National Disease Surveillance Centre has responsibility for developing a national strategy on MRSA which will involve the recruitment of a dedicated consultant microbiologist to head the strategy and to develop guidelines for all hospitals.

The £1 million for the hospital accreditation programme is adequate to meet the development of the pilot programme involving the ten major teaching hospitals. The programme involves both private and public hospitals. It is essential that a proper system of standards and quality control is developed which uses peer review, external assessment and the establishment of objective criteria against which hospitals can be measured in terms of overall performance across a range of indicators. We will provide additional resources as required.

What is the Minister's response to recent reports in the media of cross-infection? Does the Minister have any figures for the number of patients who have suffered cross-infection in hospitals and the number of patients readmitted because of infections picked up in hospitals?

Does the Minister acknowledge that there are not sufficient microbiologists within the health service? Will he indicate if there are plans to ensure that each hospital has a microbiologist with specific duties to address issues of cross-contamination and MRSA? Does the Department intend to issue guidelines to hospitals and health boards concerning a recent report which indicates that part of the problem arises as a result of nurses and physicians, in particular, not washing their hands frequently enough as they go from patient to patient? That is a source of disease and contamination in the hospital system.

Is the Minister confirming that at present no Department personnel monitor and report inadequacies in this area?

The question did not ask about MRSA, it dealt with quality control measures.

The two are related.

I do not have the figures the Deputy requested but I will supply them to him if I can get them. We need more microbiologists. That is an issue we are taking up with the various health board agencies. The Deputy is correct; to a great extent the spread of infection can be prevented by very simple procedures. Surveys indicate that a high incidence of infection in hospitals is occasioned by a failure on the part of physicians or nurses to wash their hands after dealing with a patient before moving to another. We should ensure there are adequate facilities within institutions so that can be easily done. It is a cause for concern but we have already issued guidelines to hospitals on the basic, simple processes which should be the norm in all hospitals.

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