Adjournment Debate.

Health Services.

Deputy Caoimhghín Ó Caoláin

I thank the Ceann Comhairle for the opportunity to raise the matter of the crisis in our hospitals with the continuing proliferation of MRSA and other fatal hospital-borne infections. I was prompted to raise this matter when it was revealed yesterday that Beaumont Hospital is so overcrowded and lacking in beds that it is unable to provide isolation facilities for a third of its patients with MRSA.

This is a shocking and scandalous matter. Beaumont Hospital is a large teaching hospital serving the population not only of the north side of Dublin, but for many services the entire north-east region, including Cavan, Monaghan, Meath and Louth. It is a national centre for renal dialysis and kidney transplant, a national centre for neurosurgery and it is planned to locate one of the promised centres of excellence for cancer care at Beaumont.

The 2006 annual report of the infection control team in Beaumont states that because of a lack of beds it was not possible to isolate or ring-fence one in three patients colonised by or infected with MRSA. The report contains the following paragraph, which I can only describe as frightening:

The physical resources of the hospital are under enormous pressure to deliver a quality service and serious questions remain about the safety of patients in certain situations, for example non-MRSA patients being cared for in ward areas with MRSA-positive patients due to inadequate isolation facilities and a cramped, out-dated intensive care unit.

That is absolutely shocking. The report states clearly that facilities are inadequate in the hospital for the control and prevention of MRSA and other infections. Beaumont has clearly identified the need for additional beds and without these it cannot provide isolation units and single rooms, which are absolutely essential for the treatment of MRSA and to prevent its further spread throughout our hospitals.

In other countries, such as the Netherlands, where hospitals have a far greater proportion of single rooms, there have been great advances in stamping out these infections. On the other hand, we are still living with the legacy of the overcrowded Victorian ward system. Action is needed to provide the facilities to address this grave threat to patients in our hospitals.

The critical issue regarding MRSA and other major infections has been thrown into stark relief by the release yesterday of the first national hygiene services quality review by the Health Information and Quality Authority. This also makes frightening reading. It states the majority of public hospitals in Ireland need to dramatically improve their hygiene standards. Just seven of 51 hospitals have good hygiene standards and none was found to have very good standards. Nine hospitals are rated as poor and the remaining 35 as fair.

HIQA has indicated these findings show that most hospitals must take measures to improve standards. In welcoming the audit, the Health Service Executive stated it reflects significant improvements in hygiene and is a validation of the focus it has placed on the matter in the last two years. That may well be so and I commend all those who have made increased efforts to improve these standards in our hospitals. However, the HSE statement begs the question as to what hospitals were like prior to this two-year drive, if yesterday's HIQA report is seen as a sign of improvement.

It was revealed last June that as far back as May 2001, the infection control committees for University College Hospital and Merlin Park Hospital in Galway were expressing anger and dismay at the non-implementation of policies to combat MRSA. These revelations confirmed that if concerted action had been taken at an early stage, MRSA would probably not have become as widespread as it is now throughout the hospital system. The need for many more single rooms and isolation units was clearly identified as long ago as 2001 but no action was taken.

The continuing high prevalence of MRSA in Irish hospitals is a national scandal. A total of 587 MRSA bloodstream infections were reported last year, compared to 592 in 2005. These figures represent only a proportion of people infected with MRSA as it does not include those with wound infections.

This is a damning indictment of successive Governments, particularly the Fianna Fáil-PD coalition of the last ten years, which has favoured privatisation over the upgrading of the public hospital system. The high incidence of MRSA is a direct result of overcrowding, a lack of beds and a shortage of personnel in our public hospitals. The prevalence of MRSA is one of a number of reasons the promised 3,000 additional beds must be delivered, including single rooms and isolation units. I appeal to the Minister and Ministers of State to use their influence to have this important need addressed.

Minister of State at the Department of Health and Children (Deputy Jimmy Devins)

I am taking this Adjournment matter on behalf of my colleague, the Minister for Health and Children.

I share the Deputy's concerns about MRSA and health care infections generally. I reiterate my commitment to ensuring that high-quality care is made available to all patients and to the further development of our health services, in particular the issue of patient safety.

Tackling health care associated infections, HCAI, including MRSA, is a priority for the Government and for the Health Service Executive. The HSE has established a national infection control action plan. It has put in place an infection control steering group, chaired by Dr. Pat Doorley, the national director of population health, to oversee the implementation of the plan. Over the next three to five years the HSE aims to reduce HCAIs by 20%, MRSA infections by 30% and antibiotic consumption by 20%. These targets will be achieved through the development of national and local level action plans to reduce the potential for spread of infections in health care settings. The steering group is supported by eight local implementation teams which will ensure that all local facilities are focused on achieving the national targets.

The availability of isolation facilities is an important factor in the overall solution to this issue. In that context, the Minister has already agreed with the HSE that designated private beds should be used where isolation facilities are required for patients who contract MRSA and this policy has been adopted by the HSE. New environmental building guidelines are being prepared by the HSE to inform infection control policy in all new builds and refurbishments.

The infrastructure of our current stock of hospitals is an issue but it is impossible to simply take an existing building like Beaumont Hospital and convert it into single rooms. There will be, however, an additional 28 single rooms in a new building planned for Beaumont Hospital that will address this issue which is due for completion next year. There will also be another four rooms in the new high dependency unit and two in the new intensive care unit.

The report the Deputy refers to relates to 2006 and many positive things have happened since then in the whole area of hygiene and infection control. Beaumont Hospital participated in the national acute hospitals hygiene audit in 2005 and again in 2006. The hospital's score of 83% in the 2006 audit was a considerable improvement on the 62% recorded in the first audit and just two points off the "good" category. This improvement was the result of enormous commitment and effort by staff throughout the hospital. In yesterday's hygiene assessment report by the Health Information and Quality Authority, Beaumont Hospital emerged as one of seven hospitals with a "good" rating.

That is a significant improvement, probably the biggest we have seen for any hospital. It shows that the approach of using audits to focus attention where it needs to be clearly works. I commend Beaumont Hospital on that achievement.

Beaumont has also introduced a new electronic alert mechanism on its computer system to notify staff of patients with MRSA on readmission. This has also been incorporated into the emergency department and hospital information systems. It allows bed managers to isolate potentially infective patients more effectively and earlier, where this is possible.

Not all HCAIs are preventable but significant steps are being taken to reduce the rates of infection and to treat them promptly when they occur. While there is much more work to be done, I note the improvements to date that Beaumont has achieved and expect this trend to continue in the best interests of patient care.

State Airports.

Deputy Pat Breen

I welcome the opportunity to raise this important matter.

Media reports yesterday indicate that the business plan for Shannon Airport has been completed and forwarded to the Dublin Airport Authority for approval and that Cabinet members have been canvassed to support this plan. I remind the House that the previous Minister for Transport, Deputy Cullen, said, "Both I and the Minister for Finance must be satisfied as to the state of operational and financial readiness of the Shannon and Cork Airport Authorities before the assets of the airports are invested in those authorities". Following questions from my colleagues, Deputies Clune and Coveney, it is now clear that Cork will be burdened with payment of some of its debt, in spite of commitments given by the then Minister, Deputy Séamus Brennan, and the Taoiseach. This is appalling. Is this also the case for Shannon Airport? It is a shame the Minister for Transport is not here to answer these questions because they are very important.

The clouds have gathered over Shannon Airport since the general election. Prior to this, the Government was giving out commitments like confetti at a wedding but now, one by one, they are evaporating. The Government has failed to safeguard our Heathrow slots, failed to intervene and has not secured an alternative airline. As a result, 320,000 passengers have been wiped off the airport's bottom line.

The Department of Transport and the Minister failed to act. Shannon Airport is not a priority in the Department. I am seriously concerned that the independence of Shannon is being rushed through without any proper evaluation of the airport's ability at this time to stand on its own two feet to deflect attention from the Government's inaction on Shannon.

We must look at the real picture in Shannon. We must ensure that another failure by this Government does not come back to haunt us. Today, the CSO figures confirm that for the second month in a row there has been a drop in the number of trips to Ireland from North America, a drop of 8,900 trips for September 2007 and 4,100 for August 2007. These figures do not address the length of stay, the average spend or the regional imbalance.

The previous Minister told us in Shannon that we should embrace the opportunity, that aircraft were sitting in 22 new US airports ready to take off and that we would share in that business. They have not landed in Shannon, the story there is very different. American Airlines has ceased its Shannon operation. US Airways did not operate for the winter and the Aer Lingus chief executive Dermot Mannion has only given a guarantee of direct transatlantic flights from Shannon up to October 2008. The reality is that direct seats sold from the US into Shannon are falling year by year, down from 577,000 in 2006 to 442,000 for 2007, with projections of 355,000 direct seat sales for 2008.

This Government told us that in tandem with the introduction of open skies, there would be a €53 million tourism and economic plan to help soften the landing at Shannon. Not one cent has been received and the plan is still in its infancy. The former Minister, Deputy Cullen, also told us that he "sought and received guarantees from Aer Lingus" that it would deliver 400,000 transatlantic passengers post-open skies. Another commitment and another broken promise.

The industrial climate in the Shannon region is also quivering. Over the past few weeks there were announcements of job losses at Tyco Electronics, John Crane Limited, Thompson Financial and at Aer Lingus at Shannon. Many more companies in the Shannon free zone are facing difficulties because this Government has failed to address Ireland's deteriorating competitiveness. If we do not maintain our link to Heathrow, this may only be the tip of the iceberg. Confidence in doing business in our region is being eroded.

Does this Government intend to write the obituary for Shannon and the region? If we do not ensure that our airport's future operational and financial requirements are addressed, our fate will be sealed. The airport has a debt of between €70 million to €80 million. Will this be written off by the Government? Has the business plan been finalised without a commitment on writing off this debt?

The cost of developing the necessary infrastructure to sustain the future needs of the facility could be up to €250 million. The extension of car parks, resurfacing the main runway and taxi-ways and replacing air bridges cost money. When one lands at Shannon one notices many temporary buildings in a dilapidated state, all of which require refurbishment. Shannon Airport faces an uncertain future with 320,000 passengers wiped off the Heathrow route, no guarantees on transatlantic passengers, significant capital cost projections, a dependency on military traffic and an over-reliance on low-cost operations.

Therefore it is important that before any decision on the break up is finalised, the airport's ability to fund its future capital investments should be addressed. This is the reason the location and control of Aer Rianta International is pivotal to any decision. It is imperative that this is retained under the umbrella of Shannon Airport. When the State Airports Act 2004 was being debated, the then Minister, Deputy Séamus Brennan, reaffirmed that the trade unions would be consulted fully on all issues of concern, including the preparation of business plans for each airport. Has this process taken place?

An Ceann Comhairle

The Deputy's time has expired.

Deputy Pat Breen

I am uncertain whether my constituency colleague, Deputy Tony Killeen, will reply to this matter this evening. Whoever does so should be aware that fast-tracking independence without ensuring the ability of the airport to stand alone may come back to haunt us, as have the Heathrow slots. I ask the Minister to get it right this time.

Minister of State at the Department of Community, Rural and Gaeltacht Affairs (Deputy Pat Carey)

I thank Deputy Breen for raising this important matter. I will take this motion on behalf of the Minister for Transport, Deputy Noel Dempsey. The State Airports Act 2004 provides the framework for the establishment of Shannon as an independent airport. As part of the airport restructuring process, the board of Shannon Airport is required to prepare a business plan for eventual separation.

In their examination of the plan, the Ministers for Transport and Finance must be satisfied that all three airports have the capacity to operate on a sound commercial basis before giving final approval to the business plans. The agreement of the Dublin Airport Authority, DAA, will be central to the conclusion of the business planning processes for Shannon. The Shannon Airport Authority, SAA, has submitted its business plan to the DAA to pave the way for eventual autonomy for Shannon Airport. The Department of Transport has recently received a copy for its information. My colleague, the Minister for Transport, Deputy Noel Dempsey, understands there will be engagement shortly between the DAA and SAA on the plan's content and he looks forward to hearing the outcome of the DAA-SAA discussion process with a view to making progress on separation in a timely fashion.

Subject to satisfactory progress being made on this plan, the Minister for Transport awaits the DAA's overall considered views on airport separation to enable the plans to be examined by him, together with his colleague, the Minister for Finance.

Services for People with Disabilities.

Deputy Thomas McEllistrim

I thank the Ceann Comhairle for allowing me to raise this important issue in my constituency. I call on the Minister for Community, Rural and Gaeltacht Affairs to provide the necessary funding for the Kerry Network of People with Disabilities in order that it can employ a project co-ordinator. At present, the network operates without a project co-ordinator, which is completely unsatisfactory as every ship needs a captain.

The Kerry Network of People with Disabilities was established in 1996 by local volunteers following the publication of the report by the Commission on the Status of People with Disabilities in Ireland. It is one of 30 networks of people with disabilities in Ireland that together form the national organisation known as People with Disabilities in Ireland Limited, PwDI. The Kerry Network of People with Disabilities catchment area comprises all of County Kerry. The remoteness between rural and urban parts of the county is easily seen when one considers that County Kerry has an area of slightly more than 1,800 square miles and a road network of more than 4,000 miles. Tralee is the administrative capital. Membership of the Kerry Network of People with Disabilities is open to all people with disabilities, their families, carers and advocates in County Kerry. At present, it has a registered membership in excess of 500. The Kerry Network of People with Disabilities is unique in that it is an organisation of, as opposed to for, people with disabilities.

From the outset, the Kerry Network of People with Disabilities has operated to the principles of community development. Hence it employs a community development worker to deliver a community development programme to its members. The network has developed and grown in direct response to the expressed needs of its members. Over the years, together with the capacity of the network to influence positive change that affects the lives of people with disabilities, individual capacity building has seen members become stronger advocates, negotiators and representatives of the network's aims and objectives. The aim of the Kerry Network of People with Disabilities is to promote the human, civic, social, economic, political, cultural and recreational rights and freedoms of people with disabilities in County Kerry.

The Kerry Network of People with Disabilities works to create opportunities for the full and equal participation of people with disabilities. It attaches particular importance to the defence and promotion of rights. Indeed the network's work has always been diverse and includes team building, work plan development, representation and facilitation. The network has also carried out access audits, made submissions to both local government and national Government and organises training for its members. The Kerry Network of People with Disabilities is a model of best practice that keeps people with disabilities at the centre of all decision making. It promotes full inclusion and opportunities for all. The network's focus is always on ability, diversity, challenging inequality and encouraging others to embrace diversity and become more inclusive in line with current legislation and best practice.

The network believes that unless there is a sense of involvement in decision making, the alienation and exclusion of disabled people will grow. It works to ensure that disabled people are central not only at the consultation stages of development that has an impact on their lives but that they are present at the stages of implementation, monitoring and evaluation of any such initiatives. The network always promotes best practice regarding disability issues. The Kerry Network of People with Disabilities will continue to work hard to ensure it has the capacity and resources to participate in the new opportunities contained in the national disability strategy.

The network's current staffing consists of a voluntary management committee, which is representative of those involved, such as, for example, people with all forms of disability, groups and organisations, parents, advocates etc. Its staff comprises one community development officer, two part-time finance officers who are funded by the HSE, one outreach worker and three community employment staff who are seconded from Partnership Tralee, as well as volunteers drawn from approximately 25 active members. At present as the Kerry Network of People with Disabilities does not have a project co-ordinator. The community development worker must assume responsibility for the management of the project and must support and supervise the staff, functions which go far beyond her job description.

The appointment of a project co-ordinator is absolutely necessary to respond to the need for overall co-ordination of the project and the issues involved in the increased workload. A co-ordinator would enable the network to continue to develop and respond to the expressed needs of its members, that is, people with disabilities in Kerry, as well as their families, carers, advocates and its partners. Such a co-ordinator is an essential element of the future development of the network. The management committee and staff have been very proactive over the years in undertaking new work regarding people with disabilities throughout County Kerry. However the lack of a project co-ordinator within the network has hampered the efforts of the project to develop to its full capability and has, as stated, greatly increased the workload and responsibilities of the community development worker. The proposed co-ordinator would be expected to facilitate and implement the work plan as drawn up by the management team of the Kerry network and will be accountable to it. In addition, the co-ordinator would be responsible for all staff employed by the network.

I urge the Minister to allocate the necessary funding to the Kerry Network of People with Disabilities in order that it can employ a project co-ordinator and thus deliver a more focused and enhanced service to its members. I insist the Minister give this ship a captain.

An Ceann Comhairle

I imagine there should be no problem in that regard.

Deputy Pat Carey

I thank Deputy McEllistrim for raising this important matter. The community development programme was established in 1990 in recognition of the role of community development in tackling the causes and effects of poverty and disadvantage. The programme is one of a number of programmes operated by my Department as it seeks to enable communities identify and address issues in their areas. Central to this approach is the involvement of members of the community working together in assessing needs and identifying the changes necessary to improve conditions and making such changes happen.

Approximately 182 community development projects and organisations are funded under the programme at a cost of €24 million in 2007. These projects and organisations are located in recognised disadvantaged urban and rural areas across the country. Projects are expected to operate as a resource for the communities in which they are located. In general, projects are concerned with the needs of women and children, lone parent families, the unemployed, the elderly, young people at risk, Travellers, those with disabilities, new communities and other disadvantaged groups. They provide facilities such as meeting rooms, crèches, office facilities and training or education projects designed to meet the needs of disadvantaged groups in these communities.

Projects are funded on a multi-annual contract basis to employ development staff and to cover the costs of overheads and administration. Posts covered under the programme include co-ordinators, development workers and administrators. Projects are encouraged to use the funding provided by the programme as seed funding to attract other funding and resources in responding to the community's identified needs.

As Deputy McEllistrim said, the Kerry Network of People with Disabilities, KPwDI, is one of 30 such networks which together form the national organisation known as People with Disabilities in Ireland, PwDI. PwDI received funding in the region of €1.4 million in 2007 from the Department of Justice, Equality and Law Reform to support its activities and those of its network members. The network's primary aim is to promote the human, civil, social, economic, political, cultural and recreational rights and freedoms of people with disabilities. The Kerry branch of the network is unique in that it is the only one of the 30 networks nationally that receives funding under the community development programme of my Department. KPwDI was established by local volunteers in 1996 following the publication of the report of the Commission on the Status of People with Disabilities. At that stage the network was part of the Irish Council of People with Disabilities, ICPD. The Kerry network's catchment area is all of County Kerry, as Deputy McEllistrim pointed out.

The project has been funded as a core-funded group within the community development programme since 2001. In 2007, my Department provided €57,500 in core funding to meet the salary cost of one full-time community development worker and certain administrative expenses. In addition to the community development worker, there are a number of other staff employed within the project, namely two part-time finance administration workers funded by the HSE and three community employment workers seconded to the project from Partnership Trá Lí.

In May 2007, the board of management of the project submitted a request to my Department for additional funding to meet the cost of employing a full time co-ordinator within the project. While acknowledging the excellent work being undertaken within the project, my Department did not recommend that additional staff resources be funded pending the outcome of a review of elements of the programme and the introduction of new programme arrangements for the period to the end of 2013. I expect that a new strategic framework for this programme will be put in place in early 2008 and the provision of additional resources to projects such as this one will be considered in that context.

Fire Services.

Deputy Liz McManus

I acknowledge the truly horrific tragedy suffered by the McElhill family in Omagh yesterday. I regret the fact that I am again compelled to raise in the House the issue of a full-time fire service in Bray. On 26 September in Bray, two brave firefighters lost their lives. Last Friday, another fire occurred on the same site. It is reported that the fire brigade arrived 28 minutes later and that it was the Greystones brigade, rather than the Bray brigade, that dealt with the fire. I understand that due to their depleted numbers only four members of the Bray brigade turned out, and they were unable to proceed to the site of the fire, resulting in the delay and the use of an outside brigade. Subsequently, when a fire occurred in a nursing home in Bray early this week, Bray Fire Brigade did turn out, and the event ended with three fire fighters and a number of gardaí suffering smoke inhalation which was sufficiently severe that they had to attend hospital.

Both of these events are a cause of serious anxiety. The case has been made for a full-time fire service and the evidence is now mounting that the current retained service is experiencing major difficulties in meeting current need. Bray is an area which normally requires a two-pump turnout, yet that appears to be not feasible at present. Ongoing concerns have also been expressed about a practice of vetting calls before calling out the fire brigade. These have never been fully allayed. The Health and Safety Authority is carrying out a report on the fire of 26 September and it is essential for the authority to review events since that date — and before that date — with reference to the fire service in Bray.

It is simply unacceptable that an essential fire-fighting service should be operated on a skeleton basis. Nor is it acceptable that fire fighters, for any reason, would not be fully protected from smoke inhalation through the use of breathing apparatus. When the tragedy in Bray was debated in this House, the Minister for the Environment, Heritage and Local Government undertook to meet the families of Brian Murray and Mark O'Shaughnessy. Since that meeting, the questions raised by the families are still awaiting answers. I would be grateful if the Minister would give the House an update on the information given to the families. So far there has been no clear indication of any change of policy with regard to the need for a full-time fire service.

I presume the publication of the three reports when completed will generate considerable discussion and assessment, both at local level and in this House. However, the essential point must be made now that it is simply impossible for a local authority to take on from its own resources an additional funding requirement to make the change to a full-time service. The Minister will have to address this issue sooner or later. In the meantime, public concern about the deficiencies in the current fire service in Bray is rising. I acknowledge yet again the contribution made by the members of the retained fire service in Bray and I ask that the Minister does not ignore the problems that now exist in meeting the safety needs of the community in the town of Bray.

Minister of State at the Department of the Environment, Heritage and Local Government (Deputy Tony Killeen)

I thank Deputy McManus for raising this matter. I pay tribute again to Brian Murray and Mark O'Shaughnessy and acknowledge the ongoing pain and loss being experienced by their families and colleagues. For most people time has passed quickly since September 26 but for the families it has been a very long and painful time. This was evident when the Minister, Deputy Gormley, and I met representatives of both families.

With regard to the incidents concerning the Bray fire service referred to by Deputy McManus, I understand that several people, including three fire fighters, were taken to hospital as a precautionary measure after the recent fire. Members of the fire services, both full-time and retained, do a very difficult job and I commend them and express on behalf of the Government our gratitude for their selfless public service. I also acknowledge that 2007 was a particularly difficult year for them. I spoke to some of the Bray crew in the aftermath of the tragedy, and the Minister and I have arranged to meet them again tomorrow night, together with the county manager and the chief fire officer. I thank the Bray crew for their dedication before and since the tragedy. One can only imagine their terrible sense of loss as they go about their business.

The Deputy will recall that the Minister and I indicated during the Private Members' debate on this issue that the provision of a fire service is the statutory responsibility of the local fire authority. In this case the local authority is Wicklow County Council. The fire authority is required under section 10 of the Fire Services Act 1981 to make provision for the delivery of fire services in its functional area, including the establishment and maintenance of a fire brigade and adequate provision for reception of and response to calls for the assistance of the fire brigade.

The provision of a full-time service for Bray has been a matter of public debate for some years. I am aware that the chief fire officer prepared a report for the local authority on options with regard to fire service provision in Bray. This report was put out for public consultation and, following further consideration by the council, I understand that its representative has written to the Minister seeking a meeting. In the meantime, however, I will take this opportunity to clarify a number of points on fire service provision.

At present, full-time fire brigades operate in larger urban areas, that is the cities of Cork, Dublin, Galway, Limerick and Waterford. The number of turnouts where a full-time service exists is more than 1,000 a year. The Farrell Grant Sparks report, Review of Fire Safety and Fire Services in Ireland, recommended the development of a risk-based approach to fire cover standards. The report envisaged that this new approach would help identify risk patterns and vulnerable sectors of the community and help local authority management in the determination of cover and allocation of resources. Under the fire services change programme the development of a risk-based approach to emergency cover was one of the areas included for advancement. During the process this was changed to a risk-based approach to fire safety management to reflect the need for integration of safety initiatives with emergency response. The procurement process is under way and when the process is completed and a contractor in place, fire authorities will have assistance in carrying out risk analysis in their functional areas in accordance with the system and determining the allocation of resources.

The Dáil adjourned at 9.40 p.m. until 10.30 a.m. on Thursday, 15 November 2007.

Dáil Éireann díospóireacht - Wednesday, 14 Nov 2007