Dáil Éireann díospóireacht -
Tuesday, 14 Jun 2005

Vol. 603 No. 6

Adjournment Debate.

MRSA Incidence.

Mr. McGuinness

I raise the issue of MRSA in our hospitals and the reaction of the Health Service Executive to that problem. Some weeks ago in Kilkenny, a public meeting was attended by over 150 people, representing individuals and their families who have been affected by MRSA, the hospital superbug. The group was representative of the whole country. People travelled from Galway, Dublin, Cork and Ennis. Deputy James Breen attended and I chaired the meeting.

I was horrified by the cases recounted at the meeting. One of the issues complained of by most people was that MRSA is not even spoken about in the hospitals. In one case where a lady who had MRSA asked for her file under the Freedom of Information Act, an official stood with her as she looked through it. She noted that the nurse had put a note on the file to the effect that this lady had MRSA and was not to be told.

A wall of silence exists with the Health Service Executive on this issue. I ask the Minister for Health and Children to do what she can to expose this problem, to advise all the frontline operatives and the patients about it, and to ensure that support is given to those who have MRSA and are being cared for at home. One of the unusual requests from those who attended the meeting was that if a person died from MRSA, this should be put on the death certificate. I find all of that quite disturbing.

There were also people there who represented companies which have advised the Health Service Executive of this problem and are selling product into the system that needs to be improved. They say a better alcohol-based hand wash is where one should start. A public awareness campaign needs to be undertaken to advise all patients, or those visiting hospitals, of the problem. We need to put money into the system, so that various handwash points can be provided in wards and isolation units made available. In particular, elderly people who are patients within the hospital system should be advised and cared for in isolation units.

I was horrified when, at a recent Committee of Public Accounts meeting, the Secretary General and officials of the Department of Health and Children could not answer questions when challenged about this issue. The representatives from the Health Service Executive refused, or could not give the information, for which they were asked. The Minister answered a parliamentary question on 1 March this year by saying that full and comprehensive information would be issued by the Health Service Executive. To this date that question has not been answered. Is that any way to treat a Member of this Parliament who was asking about MRSA on behalf of a concerned public? A recent report has shown that MRSA is a serious problem in Ireland. It stated that this is one of the countries which has a problem within its hospitals. All I ask is that the Minister should engage with those who have contracted MRSA in hospital and outline how exactly she intends to deal with the problem.

I spoke to a young woman last week whose uncle had been discharged from Waterford hospital and told that he did not have MRSA. When he turned up to the nursing home he was told he had MRSA and would not be admitted as it was now active in his heel. He went back to Waterford hospital and was not admitted there. He was held for four hours in the waiting room while someone came to deal with him. When I spoke to the young woman who was trying to care for her uncle, she was in tears over problems involved in trying to have him admitted and the difficulties in dealing with the situation. That is entirely unsatisfactory. The national organisation which represents those people wants the Minister to meet with them, outline a campaign of action and state where the appropriate funding is going. I am told there is funding within the system to deal with this problem. They also want to see a plan within the hospitals for caring for patients who have MRSA.

I ask, too, that the Department respond to the complaints being made by the professionals within the system. They flagged this problem for the Department 12 months ago and to date have not received any response to what they regard as a crisis. These are the people on the frontline of our health services. I urge the Minister to take this seriously, to deal with the families concerned and make an immediate public response to the issue of MRSA.

Minister of State at the Department of Health and Children (Mr. T. O’Malley)

I thank Deputy McGuinness for raising this matter and I am happy to have the opportunity to respond.

The strategy for the control of antimicrobial resistance in Ireland, SARI — including MRSA — was launched by the Department of Health and Children in June 2001. Since then, approximately €20 million in funding has been made available under the strategy. This SARI funding is in addition to normal hospital funding arrangements for infection control.

In 1995 a committee convened by the Department, comprising consultant microbiologists, specialists in public health medicine, general practitioners and infection control nurses produced guidelines for the management of MRSA in acute hospitals. These guidelines have been widely circulated and include an information leaflet for patients.

The infection control sub-committee of the national SARI committee recently prepared revised guidelines in relation to the control of MRSA in Irish hospitals and community health care settings. They key recommendations cover such areas as environmental cleanliness, bed occupancy levels, isolation facilities, hand hygiene, appropriate antibiotic use and protocols for the screening and detection of MRSA. These draft guidelines are based on the best evidence available internationally. The guidelines are being considered by the Health Service Executive at present and when cleared by the HSE will replace the guidelines issued in 1995.

The Deputy will be aware that responsibility for operational issues in relation to the services provided by acute hospitals now rests with the Health Service Executive. The prevention and control of hospital acquired infections, HAIs, is a priority issue for the HSE. Effective infection control measures, including environmental cleanliness and hand hygiene, are central to the control of HAIs, including drug-resistant organisms such as MRSA. The SARI infection control sub-committee released national guidelines for hand hygiene in health care settings during 2004. These guidelines have been widely circulated by the Health Protection Surveillance Centre and are available on its website.

Improving the standards of cleanliness in hospitals is a priority. One of the specific actions identified by the Minister for Health and Children in the ten point plan to improve the delivery of accident and emergency services refers to the need to address this particular issue.

My Department understands that the director of the National Hospitals Office will have a hygiene audit of hospitals carried out this summer by external consultants. The results of the audit are expected to inform the national standards for infection control and cleaning. The HSE is responsible for the follow-through on the ground of pragmatic and concrete efforts to deal with this challenge and to ensure that patients receive appropriate levels of protection. Standards of hygiene must be upheld and the Minister is committed to ensuring this.

Child Care Services.

Ms B. Moynihan-Cronin

I thank the Leas-Cheann Comhairle for the opportunity to raise this important issue, namely, the need for capital funding under the equal opportunities childcare programme for child care centres in Ventry, Lispole and Ballyferriter in the Dingle area of County Kerry.

In 2002, the Kerry county child care committee strategic plan 2002 to 2006, which secured approval from the Department of Justice, Equality and Law Reform, identified west Kerry as an area in need of substantial development of its child care services. The three areas seeking funding are Lispole, Ventry and Ballyferriter and the child care committees of the three villages have come together under the umbrella of Coiste Curama Leanaí Chorcha Dhuibhne to co-ordinate their campaign for funding. On 16 December last the Department refused funding to Coiste Forbharta Fionn Trá in Ventry, a significant blow to the local community following a major fundraising drive locally.

The locality has a crying need for a child care centre. The existing pre-school facility, which has been in place since 1979, is in a community hall which is neither suitable nor appropriate for such a facility. Coiste Forbharta Fionn Trá has appealed the decision to the Department and I implore the Minister to award it funding.

Lispole and Ballyferriter child care committees await decisions on their applications, which were submitted to the Department in December 2003. Both communities went to great lengths to acquire sites for the construction of child care centres. For 18 months, however, ADM Ltd., which administers the funding, has led them from pillar to post with their applications and there is growing concern that the available sites may be in jeopardy if a positive outcome does not emerge from the Department soon.

At present, the facilities in Ballyferriter, a pre-school centre which caters for only 16 children, are wholly inadequate in an area of expanding population. In Lispole, the pre-school centre is located in a community hall which is subject to regular flooding.

Between Ventry, Ballyferriter and Lispole the Coiste Curama Lianaí Chorcha Dhuine intended to provide 155 child care places in their communities. The three child care committees in west Kerry, with which I met recently, believe they are being treated unfairly and strung along with questions and queries from the Department. The groups have received letters from ADM Limited. questioning aspects of their application and asking them to submit and resubmit and fill and refill forms. Then, faceless people in the Department who have never seen the position on the ground adjudicate on their applications. They are concerned that, given that the information the Department and ADM Limited. sought has already been provided, the Department is engaged in a time wasting exercise.

The three groups in question estimate it requires up to 1,000 volunteer man-hours to prepare an application for funding for child care facilities and do not believe this effort has been recognised or rewarded. Is the reason for the strict more unfair criteria the Department applied to the administration of funding under the equal opportunities childcare programme due to a decline in the amount of money available under the programme? Groups such as those in west Kerry, which found it difficult to acquire sites when the EOCP funding first became available and was plentiful are suffering now that the pot of money is drying up.

Will the Minister give an assurance that funding will be made available to the child care groups in west Kerry that have done all that was asked of them? If the Government is committed to the provision of child care services, their applications for funding should be approved.

As I have stated in the House on previous occasions when discussing staffing grants the Government attempted to remove from child care centres as of this September, the State must play a role in funding the provision of adequate and appropriate child care services. We cannot in future rely solely on capital funding from the European Union. I appeal to the Minister to fund three vital child care centres in Lispole, Ballyferriter and Ventry. The amount of money involved is relatively small and no less than the communities, parents and children of the area deserve.

Minister for Justice, Equality and Law Reform (Mr. McDowell)

I thank the Deputy for affording me the opportunity to update the House on the important issue of child care. I reject the suggestion that I attempted to withdraw funding from any groups.

Ms B. Moynihan-Cronin

I did not suggest the Minister withdrew it.

Mr. McDowell

The Deputy said I attempted to withdraw it.

Ms B. Moynihan-Cronin

I did not.

Mr. McDowell

She should check the record.

Ms B. Moynihan-Cronin

The Minister attempted to withdraw staffing grants.

Mr. McDowell

The Deputy just said it again.

Ms B. Moynihan-Cronin

He withdrew funding for staffing and then changed his mind. He did another U-turn under pressure.

Mr. McDowell

That is not so. The equal opportunities childcare programme is the Government's key response to the need to develop child care to support the child care needs of parents, with a particular emphasis on those who may be in employment or education or training to prepare for employment. The programme aims to increase the supply of centre based child care places by 55% at its conclusion.

Since the equal opportunities childcare programme was launched in 2000, the funding package has been increased on a number of occasions to match increased demands to develop this important sector. The Government is aware of the importance of providing child care to support the economy and social inclusion through labour market participation. It has made additional capital funding available immediately to build on the momentum generated by the programme in community groups throughout the country, rather than await a follow on programme under a new national development plan.

The original funding package of €318 million allocated for the seven year programme in 2000 has increased to slightly more than €499 million and includes increased provision for capital developments for which €205 million has been allocated. This figure includes part of the additional capital provision of €90 million made available by the Minister for Finance, Deputy Cowen, in budget 2005 over the period 2005-09 to develop child care infrastructure. Far from decreasing the amount of funding available, it has been increased as late as the most recent budget.

Since budget 2005, I have announced a record allocation of some €67 million in capital funding for community based not for profit groups in two tranches, one in December 2004 and another on 4 March 2005, bringing the total amount committed under the programme to date to more than €395 million. This funding will lead to the creation of more than 36,000 new child care places, of which 24,600 have already been completed.

I am aware that capital grant applications for funding under the Equal Opportunities Childcare Programme 2000-06 are with my Department from groups in County Kerry, including Aonad Óige an Fhirtéaraigh, Ballyferriter, Comhlacht Óige Lispóil Teoranta and Coiste Forbharta Fionn Trá from Ventry. The availability of the additional capital funding allocated in budget 2005 will enable me to make further capital grant assistance available to groups that address significant child care service gaps, where the project proposal represents good value for money. In light of this, Aonad Óige an Fhirtéaraigh and Comhlacht Óige Lispóil Teoranta were advised in December 2004 that, while their projects had not been prioritised for immediate funding, they will be reconsidered in future.

I hope to make further capital commitments in 2005 and, thereafter, to child care projects which link clearly with the aims of the programme, are sustainable, offer value for money and can clearly demonstrate that they would fill a clear service gap in their local area.

In December 2004 the programme appraisal committee appraised an application for capital grant assistance from Coiste Forbharta Fionn Trá Teoranta in Ventry. The appraisal process raised concerns about the range of services being offered by the proposed service and its long-term sustainability. As a result, it was not recommended for capital grant assistance. The group has recently appealed this decision. Following receipt of an appeal in the child care directorate of my Department, Area Development Management Ltd., which is engaged to assess all applications for funding on my behalf, is requested to re-assess the application in light of any additional information which may be supplied by the group in support of its application. When this reassessment is complete, the application will then be considered further by the programme appraisal committee chaired by my Department. The group will be informed of the outcome in due course.

Efforts are being made to achieve a good geographical spread through the appraisal and approvals process. Almost € 17.4 million has been approved for County Kerry under the child care programme, with 52 capital grants approved to establish either new or quality enhanced community-based not-for-profit or private child care facilities. The county has also benefited from 47 staffing grants to groups which have a focus on disadvantage. This funding to child care providers in Kerry is leading to the creation of over 1,700 new child care places and to the support of over 1,000 existing places. Kerry County Childcare Committee also receives annual funding to support its developmental work. The levels of support going to County Kerry under the equal opportunities child care programme compare very positively with other counties in the southern and eastern regions.

Ms B. Moynihan-Cronin

There is nothing in west Kerry.

Mr. McDowell

When the assessments on the outstanding projects in Kerry are completed, the applications will be considered by the programme appraisal committee, chaired by my Department, before I make a decision on each case.

In addition, the Deputy may be aware that I have recently approved the continuation to the end of December 2007 of staffing grant assistance for all groups whose first three year funding has elapsed unless the level of service being offered has declined significantly below that which they had originally undertaken to deliver. The extension of the duration of funding follows a review of the services in question and is conditional on the services continuing to meet the objectives of the equal opportunities child care programme and the conditions set down within their contracts with ADM.

It is fair to emphasise that the equal opportunities child care programme has been central to the development of child care in Ireland. I hope that Deputy Moynihan-Cronin will acknowledge the progress made to date in Kerry and will be reassured that all possible steps are being taken to further develop the child care service throughout the county to meet local need.

Special Educational Needs.

Mr. S. Ryan

I thank the Ceann Comhairle for the opportunity to raise this important issue for three children who live in my constituency. I draw to the attention of the Minister of State my serious concerns about the treatment of these three young children, aged between four and six years, by both the Department of Education and Science and the Department of Health and Children. These children have been attending the speech and language therapy department in Swords for the past two years and during that time they have made progress. Unfortunately, however, they have been diagnosed with a significant speech and language disorder and require further assistance.

Their parents were elated when informed by the speech and language therapy section of the Health Service Executive that the special education and speech therapy needs of their children could be catered for in St. Marnock's national school in Portmarnock. The special needs language class provided in St. Marnock's is limited to seven children who have significant speech or language difficulties. This class is held in a mainstream primary school where the children follow the national curriculum. The pupils are also seen by a speech and language therapist on an intensive daily basis. They remain in this class for one to two years and, following this, return to the local primary school.

This language class caters for what is known in health board terms as "area 8", which has a population of 250,000 people. From this population, the Health Service Executive identified five children who require a place in the school. The parents of these five children were dismayed when notified last weekend that only two of the five children were offered places in St. Marnock's and one of the seven places on offer went to a referral from a private therapist.

This decision has left three children without a service which was deemed necessary by the Government's own Department to meet their needs and prepare them for the future. Clinical psychologists have confirmed that without this specialist input, they may become quickly frustrated at school and, as a result, display behaviour management difficulties. This behaviour may have long-term implications resulting in serious psychological problems at a later stage. This can be avoided if the necessary resources are put in place now. The window of opportunity to learn language and address this problem is between four and six years of age. Time is rapidly running out for these children. They are desperately disappointed at not being offered places in St. Marnock's and are in despair, having been informed that there is no alternative service available to them.

It would be an indictment of our health and education systems if the Minister of State is unable to provide the necessary resources in September 2005 for three children with special needs out of a population of 250,000. Schools will close shortly for the summer break and positive decisions are urgently required.

I have been informed that earlier today the principal of St. Marnock's national school met the parents and told them that a classroom is available in the school for September. It is now up to the Minister for Education and Science to ensure the additional resources, including an additional teacher and speech therapist, are made available. Nothing less will be acceptable to me or the parents of the children, who are understandably very angry at how their children have been treated.

In the past we have had positive responses from the Minister of State on various issues. This goes to the heart and soul of three children who are looking for the education and health systems that will prepare them for their journey in life. It is up to the Government in these good economic times to provide them for the children. Anything else is unacceptable.

Minister of State at the Department of Community, Rural and Gaeltacht Affairs (Mr. N. Ahern)

I am pleased to have been given the opportunity to clarify the position of the Department of Education and Science on the matter referred to by the Deputy.

St. Marnock's national school in Portmarnock currently has the services of one principal, nine mainstream teachers, one learning support teacher, one resource teacher and one special class teacher. The enrolment of the school stands at 262. Special classes for children with specific speech and language disorders are established where a need has been identified and supported by up-to-date psychological and speech therapy reports in respect of the children in question. Each class caters for a maximum of seven children and each class requires the services of a speech therapist. The speech therapy service is provided by the Health Service Executive. The school currently has a special class for speech and language disorder. There will be seven pupils enrolled in the class in September 2005 and, therefore, there is no available spare capacity in this class for additional pupils.

I can confirm that correspondence has been received in the Department of Education and Science from the parents of three children with speech and language disorders requesting that an additional class for specific speech and language disorder be established.

The Deputy may be aware that the National Council for Special Education, which became operational on 1 January 2005, processes applications for special educational needs supports, including requests for the establishment of special classes. The council has a key role in the development and delivery of services for persons with special educational needs, including children with speech and language disorders. The council has a local area presence through a network of 71 special educational needs organisers.

I understand from the Department of Education and Science that the council has not received any application for the establishment of an additional class for speech and language disorder from St. Marnock's national school to date. However, following from the correspondence received from parents, the Department will make contact with the school with a view to ensuring that these children's needs can be met in St. Marnock's, if possible, or in other suitable premises.

I hope this clarifies the position for the Deputy and I thank him again for the opportunity to give an update on the current position in regard to the need for a special needs class at St. Marnock's national school. The school had not sent the application to the proper section. I accept it is a new process that only came into place this year.

Mr. S. Ryan

The school was not aware of it.

Mr. N. Ahern

Those people who are part of the system should have been aware of it. I hope matters will be put right.

Hazardous Substances.

Mr. Morgan

I welcome the opportunity to raise this issue with the Minister. Several issues regarding the presence of previously unidentified quantities of asbestos at domestic dwellings have been brought to my attention in recent weeks. Asbestos poses serious health risks. There is an onus on the Minister of State to ensure that all possible measures are taken to protect the people of the State from the health risks connected with exposure to asbestos. I am concerned the instances are indicative of a wider problem in respect of the presence of asbestos and a decline in public awareness of its dangers

South Dublin County Council's Sinn Féin councillor, Cathal King, recently raised with the county manager the issue of asbestos sheeting used as the main material in the roofs of all outhouses built between the late 1970s and mid 1980s by Dublin Corporation and County Council. These houses are now in South Dublin County Council's administrative area. He asked the manager a series of questions regarding the presence of this asbestos, the health risk which it posed, the procedures in place for tenants to have the asbestos sheeting removed and whether the council was prepared to replace the asbestos sheeting for tenants.

The manager confirmed that asbestos carrying material was used in a large proportion of roofs of fuel sheds in former Dublin Corporation Housing stock but claimed it poses little risk. He also claimed the material poses minimal risk to the tenants or workers. The manager continued in his reply that it is advisable not to remove the material. He stated:

However, under the refurbishment programme, the roof covering is being removed by South Dublin County Council staff, where the integrity of the roof is found to be breached, i.e. in poor condition due to leaks. All removal is being carried out in accordance with best practice and current health and safety regulations. Training is in place for all county council operatives involved in this work.

This is not an adequate reply because there is a real risk that some homeowners will interfere with the asbestos sheeting while involved in DIY work on their property, a summer activity for most householders. Some may independently undertake work to dismantle these sheds and become exposed to the asbestos material. An information leaflet from ENFO warns that disturbance of such materials by non-specialists could cause risks to health. Given that this material has to be dealt with at some stage and has a limited lifespan, will the Minister of State agree that it is best to put in place a programme for the removal of all such asbestos material? Has the Minister of State given consideration to introducing a scheme of assistance for householders removing asbestos from their homes? Will the Minister of State instruct all councils to make householders aware where asbestos sheeting is contained in the roofs of sheds of former local authority dwellings?

Another similar case was brought to my attention by Fingal County Council's Sinn Féin councillor, Felix Gallagher. He was approached by a constituent who, while carrying out some work in his house, discovered asbestos panelling in the ESB circuit board box. When Councillor Gallagher looked into this issue, he was told that every house in the State built between 1974 and 1982 was fitted with this asbestos cement panelling in the ESB circuit board box. Will the Minister direct the ESB to remove this asbestos panelling? The real problem is that people are not aware there is asbestos in their home or on their property. While the information leaflet entitled Asbestos in Your Home, available from ENFO, refers to the possibility of asbestos in shed roofs in the section, Where Might Asbestos Be Encountered in Homes, it does not refer to asbestos panelling in ESB circuit board boxes. Will the Minister at least ensure this leaflet is amended to make people aware that asbestos is contained in ESB circuit board boxes?

Mr. N. Ahern

I thank Deputy Morgan for raising this issue. In the past, asbestos-containing materials were used in some roofing materials, as a constituent of some floor tiling and in some fire resistant panels. The extent of usage of asbestos-containing materials in housing construction since the 1970s is not known to my Department. However, the marketing and reuse of asbestos products has been banned since 1 April 2000. While it is a matter for individual authorities responsible for housing maintenance to consider, in particular circumstances, the desirability of removing asbestos-containing materials present in their rented housing stock, it is not considered necessary to instigate a specific programme in this respect. The Department has not been requested by local authorities to do so generally.

In the case of South Dublin County Council, as the county manager outlined to the council some weeks ago, a large percentage of former Dublin Corporation housing stock, now managed by the council, used asbestos-containing material in the roof of fuel sheds. The council employed a company to advise on the health and safety issues arising. This company carried out a risk assessment and advised that the asbestos-containing material used in the construction of these roofs poses little risk. The council has, therefore, concluded there is no requirement from a health or risk perspective to remove the material and it is advisable not to do so.

The council has, however, advised that when they are undertaking improvement works to their rented stock under the refurbishment programme, the roof covering is being removed where the integrity of the roof is found to be breached. All removal is being carried out in line with best practice and current health and safety regulations while training is in place for the operatives involved.

The possible use of asbestos in electricity installations is a matter for the ESB and I have no responsibility in this area. From a general perspective, where risk assessments indicate that asbestos should be removed, the removal and disposal must comply with regulations. An information leaflet entitled, Asbestos in Your Home, is available from ENFO, my Department's public information service on environmental matters. This includes advice on the maintenance of asbestos materials and their removal and disposal. The leaflet advises the public to contact the Health and Safety Authority to obtain information on the handling and use of asbestos.

The Environmental Protection Agency is responsible for the preparation of the national hazardous waste management plan with regard to the prevention and minimisation of hazardous waste, the recovery of hazardous waste, the collection and movement of hazardous waste and the disposal of such hazardous waste as cannot be prevented or recovered. Any proposed form of treatment or disposal of asbestos must be consistent with this plan and subject to stringent Environmental Protection Agency licensing requirements. I emphasise that the regulatory framework and the appropriate advice is available to deal with concerns relating to asbestos-containing materials used in construction in the past, including its safe removal and disposal where necessary.

While asbestos is a dangerous product, materials with a small percentage of asbestos are not dangerous when it is tightly bound into the cement mix. If it is not disturbed and the fibres are not released into the air, it is of no danger.

Mr. Morgan

Will the ENFO leaflet be amended to indicate this is present in ESB circuit board boxes?

Mr. N. Ahern

I am not sure if people will excessively toy with their fuseboards. It is not an asbestos fuseboard but one with a content of asbestos in it. There could only be 0.5% of asbestos in a product. A health and safety consultant employed to examine this matter, recommended there is no need to do anything. When general refurbishment programmes are introduced, these materials will be replaced at that time.

The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 15 June 2005.