I wish to point out that members are involved with legislation going through the House and may have to leave at various intervals during this morning's presentation.
This morning we will have a discussion with MRSA and Families on issues relating to MRSA. I welcome Ms Margaret Dawson, Ms Noeleen Friel, Mr. Tony Kavanagh, Dr. Ronan Fawsitt and Ms Theresa Graham. I ask the representatives to begin their presentation and then the committee members will pose questions.
I wish to describe to the committee my family's MRSA nightmare and explain how our lives changed in the past 20 months. In March 2004, my husband Joe was admitted to the Mater spinal unit for surgery. Two operations were performed within seven days. Steel rods were inserted into the back and front of Joe's spine and despite the obvious discomfort, the operation went well. The week before he was discharged, Joe was told he had an infection and that he would have to stay in hospital a week longer.
Eight days after he came home his wound burst open and I rushed him to St. Luke's Hospital in Kilkenny, where he had his wound cleaned. There was no ambulance available to take Joe to hospital in Dublin, where he should have been treated, so with the help of his carer, we wrapped him in a blanket and I drove him the 80 miles to the Mater Hospital. That is when our nightmare really began.
There was much suffering and pain in the seven months that Joe spent in the Mater Hospital. During the first 12 weeks, he was permanently connected to a back pump but his wound would not close. Muscle was taken from his shoulders to make a flap to cover his wound. This was a very worrying time for my family and me. We thought Joe was dying. His body was swollen and lesions were applied to the wound. He spent ten days in the Mater high dependency unit. During all this time he was on very strong antibiotics and had to learn how to walk again after so much suffering and pain.
During all this time, my family and I repeatedly asked to speak to the doctors who were treating Joe to find out why he was so ill. Another member of staff had already told us that Joe had MRSA but his doctors would not confirm this. Instead, they told us that Joe's infection was down to the fact that he was a smoker and had arthritis. My family was left completely in the dark about Joe's condition. At no stage did a senior member of staff in the hospital inform us that he had MRSA. The person who eventually informed us did so out of empathy with our situation. I was grateful for the knowledge because I was afraid that Joe was dying of cancer. It was the only peace of mind we received throughout the entire affair and it is disgraceful that the person in question is being branded as a whistleblower.
Joe returned home after seven months but his wounds remained open and had to be dressed daily. They eventually dried up, 11 months later, following the application of acromycin, a high powered antibiotic and last resort against MRSA infections. Despite the healing of his wounds, Joe began to suffer even more and, because the bug had entered his lungs, spent the following eight months in and out of hospital. Despite this, my family has not yet been given his diagnosis.
This lack of information and our feeling that we were being left in the dark while Joe was sick caused us to found MRSA and Families in May 2005 to give support to families dealing with or bereaved by MRSA, to break down the wall of silence and to tell the public how bad conditions are in our hospitals. We know of hundreds of patients and their families who are suffering without support, adequate information or proper guidelines from the Government.
It is unbelievable that €150 million per annum is being spent on the treatment of MRSA, yet patients and their families are not informed when this avoidable hospital infection is acquired. We have a right to know what happens to our loved ones. This right was not upheld with regard to my family and I call on the committee to ensure that nobody else should endure the continuing nightmare that we and others are living through.
I want to express my sympathy on this matter. A dear friend of mine died from MRSA and, to this day, her family remain distressed about the experience. I warmly welcome Ms Graham because her presentation was one of the most significant heard by this committee for a long time. The fact that people attend hospital to be cured but find that their health is severely affected and that their families are traumatised is a matter we must urgently confront.
Ms Graham made strong points with regard to information. Has it been a universal experience for families that hospitals are defensive and do not want to provide the truth?
I wish to note that we each want to make presentations.
I am conscious that members must also follow debates in the House. I ask the delegates to make short presentations.
This is my son's story. In January 1998, Ronan left Dublin airport to travel to Phoenix, Arizona, where he was to be trained for his new position at Intel as a technician trainer. On 13 March, Ronan suffered a fracture of a vertebrae in his neck from a swimming pool accident that left him quadriplegic. He retained movement of his arms and shoulders but was paralysed from his upper chest down and lost the use of his fingers. He was rushed to the neurological unit at St. Joseph's Hospital, Phoenix, where he was operated on and spent the following week in a high dependency unit there. We returned to Ireland with Ronan after that week because we could no longer remain in Phoenix. We had high hopes that he would be able to make the most of his abilities. He retained strength in the areas that were not paralysed, which gave therapists confidence that he would be allowed a great deal of independence.
On his return to Ireland, he spent a further week in the spinal unit of the Mater Hospital before being transferred to the National Rehabilitation Hospital in Dún Laoghaire, where he spent eight months. After this stay, Ronan was discharged and returned home but no provision had been made for toiletry or bathing, although simple appliances such as a shower chair and commode would have been sufficient for these purposes. Once a week, his older brother helped his father give Ronan a bath. No physiotherapist was available for him in the Kildare region.
He returned to Dún Laoghaire on two occasions during the next year to allow his physiotherapist to determine whether more independence could be obtained my means of a chair appropriate to his level of disability. He managed to regain more independence as a result and was in the process of returning to work. However, he became sick at this stage and was eventually diagnosed with necrotising fasciitis, also known as flesh-eating bacteria. He was operated on to remove a small part of his upper thighs and the top of both of the fibia bones in his hips. Shortly after his operation, he was informed that he was infected with MRSA and was placed in the only isolation room on the private ward.
When his 133 days of private health care expired, Ronan was taken from isolation and placed in an ordinary room in a public ward. That evening, my eldest son rang me to say that Ronan should not remain in his ward because it was filthy, with smeared windows, dirty floors and a soiled toilet brush. I went to the hospital with cleaning supplies and gloves and spent the remainder of that night cleaning the room. Ronan spent a further five months in this ward, which made for a total of 13 months in Tallaght.
We discovered other inadequacies after Ronan's return home and the onus was on us to cater for his needs. We had to put in place a waste disposal plan under which daily dressings are placed in clinical waste bags and disposed of in a clinical bin, which is collected every week. His sheets have to be changed daily for infection control reasons and because he has sweated profusely at night since his operation. As his dressings must be changed every day and this takes until late morning to complete, he has been unable to work for the past five years. It is now out of the question for him to return to his former position. He has to visit Tallaght Hospital regularly for check-ups.
These issues make it difficult for us to continue with our lives. Not long ago, Ronan had his first break from the routine of dressing changes, when nurses in Lourdes replaced his local public health nurses to care for him for one week. Recent swabs show that MRSA is still prevalent in his wounds, which means that he will continue to suffer slow healing and complications for some time to come.
After nine months of intense physiotherapy, he was discharged into the community without any provision being made to allow him to continue his healing; nor was suitable equipment made available. He has lost much of his independence and has been unable to return to work. We worry about his future care because we will not always be around for him. He has lost a huge part of his life due to his experience.
Following an operation on 5 September 2004, I contracted MRSA courtesy of the State. To save my life, my surgeon had to repeat the operation, which involved a number of visits to the theatre because of complications arising from MRSA. During the following months, I fought for my life and was eventually discharged from hospital on 11 January 2005.
I have been mentally and physically scarred by my hospital experience. My career, as I knew it, is finished. For a total of 16 years, I was employed in a managerial capacity in the health service. In addition, I have a further 15 years' experience in the private sector as an international performance auditor and hygiene inspector in the Republic of Ireland, Northern Ireland, the UK and Japan.
On 10 November 2003, I returned to the health service in the belief that the national health strategy document would radically change existing work practices and management, thus delivering openness, fairness, transparency and a quality health service of patient care.
I refer to the 2001 document, Quality and Fairness — A Health System for You, under the national partnership agreement, Sustaining Progress 2003 to 2005, from HSE management and trade unions. Never in the history of the State has so much money been made available to hospitals, and an additional €20 million is on the way. Never in the history of the State have so many been employed by the health service or has there been such management ineptitude at operational level in our hospitals. This culture will not change until the Government, the Opposition, the HSE and trade unions face up to their moral and legal responsibility to protect the citizens of the State. Sanctions should be imposed on incompetent hospital managements and staff members who have abdicated their responsibilities to ensure the health and safety of their patients. This committee is either part of the solution or part of the problem. I ask if there is one member willing to recommend and support the imposition of management sanctions.
I welcome the national hygiene audit report and congratulate the management and staff of the top five hospitals on their achievements. Analysis of the report reveals a situation more critical than it seems. There is a national epidemic of MRSA infection caused by non-compliance on the part of hospital senior management with HSE policy. In April the Minister announced that the national hygiene audit was to take place between July and August. Thus hospital management was given five months' notice to prepare for the audit. It received the Infection Control Nurses Association audit tool document in advance. Infection control nurses and other staff responsible for hygiene and infection control are familiar with this audit tool. Despite this, 91% of hospitals failed a basic hygiene audit. This is a measure of management's own personal and professional standards and reflects poor quality management, negligence and a lack of commitment on the part of management and staff employed by the State to hygiene, infection control and the health and safety of patients. What was the standard in hospitals before the announcement of the 2005 audit?
Statistics show hospital compliance with standards would account for a figure of 70% in terms of infection prevention and that hand washing is the most cost-effective means of containing hospital-acquired infection. The response to the appalling hygiene audit results is the same as it was to the Second World War. As Europe burned, the 1939 Government and Opposition named it the "national emergency". The response to the national hygiene audit results and the MRSA epidemic is, "I am disappointed but not surprised". According to the president of the INO, nurses have been complaining about poor hygiene standards for years. This is a wake-up call. MRSA is killing and maiming citizens, while the Government, the Opposition and health service unions stand idly by, head in the sand, in denial.
Members should take no pride in the silent condemnation behind closed doors. Today we need men and women to stand up and be counted. As a modern trade unionist, I ask where is the voice of the health service unions? What is their view on the lack of performance by their own members? Where is the voice of the Irish trade union movement? Does anybody speak for citizens? Is there a willingness to enter into a cross-party commitment to manage change effectively? Where is the Government, the Opposition and trade union partnership and the national health strategy to sanction the incompetence of those privileged, negligent managers of the State where non-compliance with Government-HSE policy is clearly evident? At best, I ask for the resignation of the general managers or chief executives of Waterford and Beaumont Hospitals. What action will be taken against these two public servants? Knowledge alone is not guaranteed to alter behaviour.
My contribution will make no difference to the plight of MRSA victims or their families. "Performance management" is defined as a group of people working together with a unity of purpose and direction to achieve a common aim or objective. The time has come for the citizens of this State to perform, take action, organise, make their voices heard inside and outside every hospital in the country and unite with a common aim of the provision of a quality health care service, even if we have to take to the streets to achieve it. MRSA is everybody's problem — patients, parents, the old, the young, the employed and unemployed. The people of this State, including public representatives, are entitled to a quality health care system.
On the 2003 Brennan report on performance management, I managed the implementation of a performance management system in one of 15 private hospitals chosen to evaluate the proposed system. To quote Mr. Brennan: "We believe that an effective performance management system is essential if the organisation as complex and the health service is to be managed effectively." One of the seven themes of the overall plan published in 2002 was to develop performance management. A management group was set up under the leadership of the HSE to advance the initiative. Now is the time to roll out a nationwide performance management system which was validated on 15 hospital pilot sites in 2003. Without such a system, the four-point action plan to improve hygiene standards in hospitals will fail. It will be another lost opportunity. I look to the action plan to move hygiene standards forward. One of the key points is to finalise a set of national standards for infection control and hygiene. It is ironic that such standards are being piloted and tested in Tullamore, Tallaght and Roscommon when those hospitals failed miserably in the overall basic hygiene audit.
I thank the committee for inviting us to the centre of our democracy. Democracy is about listening to the needs of ordinary people. Delegates have spoken succinctly about how MRSA affects ordinary people. This is not a pie in the sky issue but affects thousands of people. A hospital close to my home reported 78 new cases of MRSA between January and August. We need to wake up. This is a huge issue. It is bigger than that of tuberculosis. In the 1950s we isolated and solved the problem of tuberculosis but we are not doing the same for MRSA, which has been around a long time.
I am PRO for the Irish College of General Practitioners and have been in practice for 25 years. For 15 years I have presented a local community radio show. Two or three months ago the hospital cleaning figures were reported while I was on air. When I was asked if spending €3 million on cleaning services in St. Luke's Hospital was all right, I said it was okay and that the hospital was doing its best. I was savaged on air that day and subsequent days over hygiene standards in our hospitals. Let me quote some text, e-mail and telephone messages we received that day:
€3 million on cleaning at St. Luke's hospital over the last two years. Not doing a great job at MRSA. Still huge concern at this hospital. Management must be questioned.
How much has been spent on cleaning in the hospital in Kilcreen?
My father died from MRSA in a local hospital last year. 50% of patients in ICU had the infection.
I am mad at Dr. Fawsitt for saying that. I witnessed a food worker in hospital handling rubbish, then serving dinner without washing her hands. Disgusting.
I contracted MRSA ten years ago at St. Luke's Hospital. I am concerned about ICU where I spent three weeks.
The infection has been around for ten years. Somebody from the HSE should be appointed to tackle MRSA but the silence is deafening. These are real people. The answer to the question of what has happened to our hospitals is that the nuns left. I will not continue with examples but I have pages of them. It is our duty in a democracy to hear and take on board the message.
We addressed MRSA in 1995 and produced guidelines. I do not recall getting a copy of them, though I probably did. Appendix 3 of the guidelines from 1995 suggests a letter be sent to a general practitioner for every patient who is discharged from a hospital with MRSA. I am a GP with 25 years' experience but have never once received such a letter from any hospital. We are putting our heads in the sand by not obeying our own guidelines. Something is very wrong. We spend €150 million treating patients with MRSA and €68 million treating our hospitals yet 91% of hospitals fail a hygiene audit. We have lost the plot. It is scandalous because the incidence of MRSA can be reduced. It is not rocket science. It is a preventable infection and the State has a duty to protect its citizens in hospitals, which are supposed to be sacred places. Some hospitals should carry a health warning.
The problem with MRSA is it is no longer just in our hospitals. I made a midnight home visit to a lady three weeks ago. She had been booted out of a regional centre of excellence. They had not been informed that she had a peg tube in her stomach and had MRSA for two months. Her family were in an annexe of the nursing home in the roof of the building, wearing masks and gowns, and were terrified as they nursed their mother. They did not know whether to wash every time they went in and out of the room. It looked like something from a science fiction movie. These ordinary people have not been given the information they need to deal with an epidemic of a hospital-acquired, State-induced illness. We can all act like Pontius Pilate but MRSA is the price society is paying for 50 or 60 years of antibiotic use, which has saved millions of lives worldwide. We have known about it for years but have done absolutely nothing about it since 1995 when we issued guidelines which are not being followed. It is causing a human tragedy on an epidemic scale.
Last year 500 patients contracted MRSA septicaemia, which is not trivial. All of us, whether we are individuals or representatives, should be outraged. We should dance on tables and complain about hygiene standards in our hospitals because there is a direct link between hygiene in our hospitals and MRSA. This group has been saying it and individuals have been saying it for years but we are not being heard, until today. Today Mr. Smith is coming to Washington and these witnesses are three Mr. Smiths who need to be heard.
There are solutions. We cannot put our heads in the sand and say we are doing our best, because we are not doing our best. I will submit five suggestions. First, we do not need to reinvent the wheel because we already have guidelines. We need to enforce them. It is no use for these bits of paper to gather dust in HSE offices around the country. They need to be before my nose and before the noses of every nurse, doctor and porter in the country. We need to stop treating our hospitals like Busáras and Dublin Airport, with unnecessary throughflows of thousands of people. When foot and mouth disease arose, politicians tackled it. They closed down the country and isolated the problem. They even cancelled St. Patrick's day but we eliminated foot and mouth disease. They need to act similarly with MRSA. We need to treat our hospitals as sacred places of isolation. We should stop, even temporarily, the unnecessary throughflow of visits into hospitals and we should enforce visiting hours.
Second, MRSA patients and their families need to be properly informed and given clear advice and instructions on what to do in the hospital and the home. There is a deafening silence. They need leaflets, websites, telephone numbers and dedicated people to help them because they are our citizens.
Third, we must put support structures in place to deal with the problem at community level. Many people go home from hospital with MRSA. Many are seriously injured, have lost limbs or are paralysed and need supports to stay at home. We need a liaison officer to work through the HSE and the hospitals to treat people at home. People may need bedding, linen or heaters. They should not be demoralised, demonised or marginalised as pariahs. If they go to hospital for any reason they are sent into a corner. That is the attitude of health workers because they have not been given clear guidance either. They must also be invited to family case conferences to discuss their needs. Like in child abuse cases they should have the right to be present at case conferences that decide their own and their families' futures.
Fourth, there needs to be a mandatory duty to inform patients when MRSA is found and to report it to a designated State body. This is a medical accident involving a noxious biological agent, an infectious disease.
The fifth suggestion is for a process that is accountable. Instead of reporting to a nurse or junior employee who would not have the authority, experience or knowledge to deal with the information, somebody needs to lead an organisation within or, preferably, independent of the health services, such as a director of hygiene and infection control. It needs to be a national post with regional posts staffed by people with the power to enter hospitals, assess a unit and point out deficiencies. They need to be able to acquire hospital equipment such as scrubs and linen to deal with the problem. It is possible to buy linen that is free of MRSA. It costs €2 more per yard but uniforms and bedding can be made from it. We do not buy it because no official in the Department has the power to increase the budget to do so.
A powerful national director of hygiene and infection control is required. I refer here to a person who can stand up to consultants, matrons, bureaucrats and managers. The post would be akin to that of an ombudsman and would be filled by someone who could empower people and enable them to be heard. Such an agency exists in the UK, so it would not be pioneering. An article by Patricia Redlich in last weekend's Sunday Independent referred to a doctor from a certain trust who has managed to reduce the incidence of MRSA by 60%. This doctor had the leadership skills to keep people onside. We need an organisation working within our health service that can give people a voice when they have a problem. If a person visits a relative in the hospital, he or she could, for example, inform this organisation that the toilets were not clean. The process must be accountable.
There are basic points to this issue. Guidelines must be enforced; patients and families must be empowered and supported in the community and incidences of MRSA should be reported to a statutory body that has power which should be mandatory. The issue is an appalling human tragedy that will get worse unless we do something about it. We are the "Mr. Smiths" before the joint committee and we demand undivided attention for this problem. It is an everyman issue and will be one of the more serious issues in the next general election.
I am Theresa Graham from Tramore in County Waterford and I am an MRSA widow. We have not come here seeking sympathy for ourselves or the people we represent throughout the country. We have come to demand justice and action. It is easy to talk the talk and we have heard enough of that; now we need those who have the power in the community to walk the walk and do something about this matter, which has already got out of control.
In the coming weeks, representatives of the HSE and the Department of Health and Children and perhaps the Tánaiste herself will come before the joint committee. They will state that they are disappointed about the recent disgraceful hygiene audit. I can afford to be disappointed because I am not being paid a large amount of money to be in charge of the sector. Those people cannot afford to be disappointed because it is their responsibility. They must be ashamed and accountable and they must take action on the matter immediately.
One of the more maddening reactions to the problem is a shrugging of shoulders and statements to the effect that the infection is affecting all countries. This is not true because it is no longer in western Australia and has almost disappeared in the Netherlands, Finland, Denmark and Iceland. This is a result of those countries taking the infection seriously, with the people in power deciding to do something about the problem. We are seeking similar action.
These people from the HSE and the Department will also tell the joint committee that they have answered all the questions of other witnesses who have come before the committee on the issue. They will argue that they have produced this and that report and that the problem has been solved. The joint committee will be assured that these reports will satisfy any demands that we, and other people like us, are making. We have been here before. I have do doubt that these people are sincere in their intentions and I have spoken to them as a representative of a patients' forum in the regional hospital in Waterford. I realise that they do not like the current situation any more than we do. However, I share Mr. Kavanagh's pessimism and, based on what I have read in these reports, not much will be done about the issue.
The former Minister of Health, Deputy Noonan, is record as stating:
National guidelines on the care of patients and staff identified as carrying MRSA have been drawn up by a panel of experts including representatives from those concerned with the areas of infection control both in hospital and community. These will be widely circulated throughout the country and will give invaluable advice on prevention of spread of MRSA in a variety of health care settings. It is hoped that these guidelines, when implemented, will reduce the presence of MRSA and will ensure an even safer environment for the care of the sick.
This statement was made in 1995, a full ten years ago. In that year, 55 cases of MRSA blood infections were reported and a set of expert-produced guidelines was published, after two years deliberation. This closely resembles the latest set of guidelines. If the 1995 guidelines had been implemented, as the Minister of the day had hoped, MRSA and Families would have no need to exist.
More importantly, much of the physical and psychological suffering of people in the intervening ten years would have been prevented. This is a tragedy and a cause for the justifiable anger that our group feels. The suffering and trouble we experienced only merited one sentence in the most recent expert report. Can our group be blamed for its anger?
As already stated, there were also financial costs involved in terms of the provision of additional staff and the extra time patients were obliged to spend in hospital. I spoke to one young woman who was expected to spend eight days in hospital but who actually spent 18 months there before her parents gave up and took her home. There is also the factor of the expensive drugs required to fight the infection. Representatives of the HSE and the Minister for Health and Children will not quantify this cost because they do not know it. A study in UCC estimates that the treatment of MRSA costs approximately €150 million per annum.
We have seen that the problem was known and that solutions were proposed ten years ago. It has been allowed to fester. I use the word "fester" advisedly and any member who has witnessed an MRSA blood infection will know that it offers an appropriate description. What assurances are now in place to enable change in light of the new information? We do not know how much these reports cost to produce but there is no evidence that anything will change. The new HSE is engaging in window-dressing and there is one person in charge who has stated that he will take responsibility. We have seen no evidence of a change in ethos or hospital practice. In light of these reports, this is where we should be looking for change.
The day before yesterday, a woman whose husband has suffered from MRSA for three years contacted me. The man is in and out of hospital because he also has other conditions. The woman tells the hospital authorities every time he is admitted that he has MRSA but on each occasion he is placed in a ward with people who do not have the infection. He is tested, which proves to the hospital authorities after three days that he has MRSA, and he is then placed in isolation. The woman complained on the most recent occasion that this happened because she has heard this group's opinion on the matter and she was told that her husband would be placed next to a sink. I was not aware that sinks had any magical properties, although they can be effective for hygiene control if used properly. This matter beggars belief and would be funny if it were not tragic. The strategy for the control of antimicrobial resistance in Ireland, SARI, document is attractive, with nice colours but I draw the attention of members to the following paragraph, which is highlighted in the event that people who receive the report do not get the point:
It is acknowledged that in many healthcare settings in Ireland, it will not be possible to implement much of what follows despite the best efforts of healthcare professionals, because of inadequate resources, sub-optimal infrastructure and a lack of access to relevant expertise locally. Nonetheless, these are guidelines that all healthcare facilities should aspire to implement. Where it is not possible to implement some or part of the recommendations, the reasons for this should be highlighted to senior management. In this way, it is hoped that these guidelines, in tandem with other measures, will heighten the profile of infection control and prevention, and also facilitate the provision of the appropriate resources.
The paragraph contains phrases such as "it is hoped" and "healthcare facilities should aspire". If my self-development students submitted an assignments containing such language I would hand them back and ask them to change these phrases to "I am doing". How high do these people wish the profile of infection control to be? What are we doing? I make no apology for sounding angry. I am angry on behalf of people who are suffering needlessly.
The national hygiene audit report recommended setting up two more bodies, a national working group and a working group in each of the hospitals. I worked in local government for a time and I know as well as members how long it takes to set up working bodies, receive recommendations from them and put these into practice.
I am a member of a patient forum at Waterford Regional Hospital, which I was asked to join in order to keep me quiet, a strategy that did not work. When we first met last February, we identified 13 items that needed to be rectified in the hospital. I highlighted hygiene standards, which I described to the Tánaiste and Minister for Health and Children, Deputy Harney, this time last year as horrendous. Much needs to be done on this matter. We also highlighted two simple items which one would expect to be implemented within weeks. The signs in the foyer of the hospital were not clear and people did not know where to go on arrival. Extra parking for disabled people was needed outside the main entrance and the accident and emergency unit. At the next meeting we were told that a committee of the users of the foyer had been set up. This occurred in February and the committee has still not reported. At the most recent meeting the general manager approved of the idea of extra parking and she proposed it to the medical consultants, who agreed that it had merit. The finance committee of the hospital will have to include this in the budget for next year and then the parking facilities might be supplied. This is what is recommended in the national hygiene audit. If we were producing cars or furniture, we could afford to wait for this. In dealing with people who are being infected, suffering and dying, however, we cannot afford to wait.
I have provided members with a sample of a leaflet produced by MRSA and Families. I presented this to the Waterford Regional Hospital and the HSE in Kilkenny and suggested that copies be provided to every patient and his or her relatives on admittance to hospital. Their response was positive but they stated that they would await the recommendations of the report. They will not implement the proposal but we will. As Dr. Fawsitt stated, we need the guidelines to be statutory and for sanctions to be available.
The Minister for Agriculture and Food implemented two statutory instruments to force poultry owners to register. We recognise that the agriculture industry is more important than the pain and suffering endured by patients but if a Minister for Agriculture and Food can introduce a statutory instrument, surely the Minister for Health and Children can do likewise. We need guidelines to be enforced and sanctions to be applied. Those who express their disappointment at the results of the audit benefitted from benchmarking. Did they deserve it and will they deserve it next year?
In response to Deputy McManus's question, people from places such as Donegal, Galway, Limerick, Sligo, Kerry and Cork have indicated to us that they are not being informed. Some are being told lies, such as a woman who was informed that her husband did not have MRSA because the bacterium was not present in the hospital. He died two weeks later and MRSA is listed as the cause of death on the death certificate. We are being misled, lied to and fobbed off. This practice is universal and I second the points made by Dr. Fawsitt.
Those who have suffered from MRSA and their families need counselling. A panel of counsellors exists for those affected by hepatitis C and those who suffered from MRSA should be entitled to this service. We do not want any more reports, inquiries, or consultants. We want action now.
I thank the representatives of MRSA and Families for their presentation, which is powerful, scarifying and challenging. When the Secretary General of the Department of Health and Children, the chief executive of the HSE and the Minister of Health and Children come before the committee, we will raise this matter with them. The committee is important but is limited in what it can do because it cannot implement policy. Could the committee take the unusual step of publishing the testimony of today's presentation as one of our reports? It is important that this testimony, rather than dedicating one meeting of the committee to it, be widely disseminated and put on the record in a more appropriate manner.
The delegation suggests that there is a need for legislation and that guidelines be made mandatory. Does the delegation suggest that individuals, such as a national director or a hospital manager, need to be identified and made responsible? The multidisciplinary approach proposed in the audit——
The legislation is already there.
Can Dr. Graham elaborate on this?
The legislation dates from 1947 and deals with mandatory reporting, treatment of patients and informing patients. The legislation needs to be revived and enforced.
On the last question I asked, a change in the law would be required because MRSA is a relatively new phenomenon. Legislation is promised on a health information and quality authority which should have been put in place when the HSE was established. It was to counterbalance the HSE, act as a watchdog and ensure the right actions were taken. Has this been examined in terms of how it might meet the needs of MRSA and Families? We have not seen the legislation but it seems to be the obvious location for the national director of hygiene. A statutory-based system would then be in place.
We desperately need somebody with authority, gravitas, power and the force of law to enforce such a position and enable it to happen. It would be pointless to appoint a junior person. This person must understand infection and have a certain level of knowledge and people skills. We need a chain of accountability. People make a complaint which goes to the hospital manager and they may receive a letter. There is no accountability. That is the great flaw in our society in general. If we were to use the hospital hygiene audit wisely, we would learn from those mistakes and realise we need more visibility about this problem. That is what shames people into taking action. As Dr. Graham stated, we have Acts and guidelines. We do not need more committees; we need action and somebody to enforce the law. We need to fill the vacuum in order that those involved in the hospital service can take whatever action is necessary by whatever means on whomever it needs to be done. MRSA is a community problem. We are all to blame. I do not point the finger. Within communities we must tackle our own hygiene issues.
I thank the delegation.
I assure all committee members they will get a chance to speak. Those who have indicated they wish to speak are Deputies Devins, Breen, Connolly and Gormley.
Like other members of the committee, I welcome the delegation. We have all been impressed and astounded by the presentation. Each story is equally tragic. I welcome Deputies Breen and McGuinness to the committee. I know both of them have a great interest in this subject, particularly Deputy Breen, as a sufferer of the condition. I am struck by the fact that this is a hidden disease and there is a lack of information on it. For some unknown reason, patients are frequently not told they have it. I hope this has changed. I am astounded by the lack of information on each individual hospital. Does the delegation have information that could clearly identify the incidence of MRSA in each hospital? Will this be brought to the attention of the committee in order that we can publish it? Members of the public who use hospitals should have that information before being admitted.
A couple of months ago the Irish Farmers’ Journal conducted excellent research and published a table of hospitals for which information was available. Beaumont and Mallow Hospitals did not give information but the others canvassed did. I rang the Irish Farmers’ Journal this week to ask if it would do a comparison between hospitals with a high instance of MRSA and last week’s hygiene audit.
Is Dr. Graham stating the Irish Farmers’ Journal contacted every hospital in the State and received information from most of them?
It received information from most of them. Beaumont and Mallow Hospitals did not give information. Mallow Hospital scored the highest in the hygiene audit.
The committee could examine this.
The Irish Farmers’ Journal has information.
I hate the concept of league tables, but the general public, particularly patients' GPs, have a right to know the danger of contracting MRSA in the local hospital. I welcome the group's leaflet. MRSA has many causes and many solutions could be offered. We will not address all of them today. The group's presentations will go a long way to help us find a solution. Like Dr. Fawsitt, I was in practice in 1995 and never received guidelines. There is a large communication gap. I cannot understand how a patient who contracts MRSA is not told by the consultant in charge. A consultant can inform a patient when he or she has any other condition. The marked reluctance to inform a patient that he or she has contracted MRSA is beyond belief. I thank the delegation. I do not want to take up any more time. The committee will do everything it can to be of assistance.
As an unfortunate victim of the MRSA superbug, I want to make it categorically clear that I did not get the superbug in a hospital. I received an injection in my shoulder and ten days later I could not move my arm. I was admitted as an emergency case to a hospital in the west. When emergency surgery was carried out and my shoulder was drained, it was found that I had the MRSA superbug. I was given literature to explain what it was, but I was never told the pitfalls or how contagious it was, despite the fact that I was placed in isolation. I know exactly what people who contract it suffer. My position is that my consultant has told me I will only recover 60% of the use of my right arm. I am right-handed.
Guidelines were issued in 1995. During the foot and mouth disease crisis, if a person bought a beast from an infected farm, when he or she should not have done so, a case would have been pursued through the courts. Will this committee call before it the chief executive officer of each health board since 1995 and ask why he or she did not implement the direction given by the Minister in 1995? If the committee does so, it will be taking action. Someone from the health boards must be held accountable to those of us who suffer. Since I contracted MRSA I have had to attend counselling. It has affected me mentally and physically. I was told I would live the rest of my life without the full use of my arm.
I raised the matter in the Dáil last October and created awareness of the MRSA superbug. Is it good enough when we see an article in a Sunday newspaper stating €2 million designated to fight MRSA has disappeared? Where did it go? The article states some of the money went to make up the shortfall created by the closure of Monaghan Hospital in the north east. The Eastern Regional Health Authority could not spend €1.6 million because specialist staff could not be employed. In the Dublin area €270,000 remains unspent. The North Western, Midlands and Southern Health Boards were not allowed to spend the money. Who is fooling whom?
I continually ask the Minister, as has Deputy McGuinness, to meet MRSA victims, but she has refused to do so. What is she afraid of? Who is responsible to the people when one goes into hospital to be cured and leaves with a disease? It is not good enough. I will reiterate my point. Will the committee call before it the chief executive officer of every health board since 1995 and make him or her accountable where he or she did not implement the directive handed down by the Minister in 1995? Surely somebody must be responsible. The buck now stops with the Health Service Executive. We cannot tolerate this fiasco.
I am sorry I am emotional about this but the representatives here have described part of my life, part of my summer. I spent six months going in and out of hospital with the MRSA superbug, which I should not have contracted. Who will compensate me for the rest of my life? What will happen to me if I have to go for a hip or joint operation in the next year or two? I am afraid that the MRSA superbug will come back and kill me or make my life a misery, as it has for many of the people I have met since I became one of the unfortunate victims.
Before I move on to anybody else I wish to clarify a few points. This committee agreed to hold hearings so that it could do something specific about this issue. However, we do not formulate policy within the committee. I appreciate what has been said by Deputy Breen and by the witnesses here today. This is the first part of the hearings that we intend to conduct. We will make it very clear within two or three weeks what we intend to do as a committee, as soon as we have concluded the second part of the hearings with the professionals.
This committee also agreed that it would invite the HSE, the Tánaiste and any others with direct responsibility in this area to attend hearings. This is not a talking shop but, at the same time, I do not want to give the witnesses the false impression that this committee can formulate policy or make changes. It cannot do that. What it can do, however, is ensure that the MRSA issue is put on the top of the agenda and try to make sure that change is brought about.
I have listened to what the witnesses have said and have learned a great deal, particularly with regard to legislation that is in place and which could have been implemented and used. It is also vitally important to take into account what Dr. Fawsitt said, namely, that there should be local accountability. Each hospital should have an office to which issues are reported directly and responsibility is attached. Overall responsibility should be further up the chain, and we, as a committee, can hold those at the top accountable.
I will take on board Deputy Breen's suggestion. I cannot definitively say that the committee will go that particular route but if it is to examine the issue of accountability, then quite clearly the people with responsibility since 1995 should be held accountable for the MRSA problem. I cannot give an immediate response but it is something that this committee will deliberate upon over the next two weeks.
I welcome the delegation and compliment it on an excellent presentation. There is little room left for questions, but I have a number of comments on the matter.
It is clear that there is much anger surrounding this issue, particularly because the infection that people contracted was, and is, entirely preventable. That fact adds to the hurt, as does lack of communication. People were not told the truth and were given so-called mushroom therapy and that is not good enough. MRSA is as serious as TB but is not being treated similarly.
Cost factors must be taken into account on this issue. I have heard that €150 million has been spent on dealing with MRSA. I would like to see a breakdown of how that money was spent because €150 million would wash many hands. There is no point in saying that hospitals are spending part of their day-to-day budget on MRSA because it is clear that they are not. We should carry out a cost-benefit analysis on MRSA prevention because we could potentially save a fortune. The witnesses also mentioned that guidelines are in place already and none of them would be particularly costly to implement.
Several contributors mentioned an article published in a Sunday newspaper recently which described how a doctor in Wales has managed to bring about a 60% reduction in MRSA there. That doctor trained in Trinity College in Dublin, so the expertise to deal with this problem is here. We should employ someone like that doctor. Our Executive should talk to that doctor in Wales because the figures are incredible. He managed to bring about a 60% reduction and all we are doing is reading about it and treating it as a story. We should do more than that. Some form of action is required.
We should not tolerate a situation where 91% of our hospitals fail a basic hygiene audit. People from the bottom up are screaming about this. The patients, the frontline staff and the general public are screaming. If hospitals are businesses then the managing directors of those businesses are the ones who should scream. They should look for accountability. If, for example, we know that the south-eastern area has a high incidence of MRSA, the person responsible for that area should be asked to account for this. We need to take stock of what is happening and examine the percentages across the country.
It is ironic that the Irish Farmers' Journal had to resort to a freedom of information request to get the figures on MRSA levels. The quest for information was led by the Irish Farmers' Journal. Why was it not led by the Executive or by the people who should try to prevent MRSA infection? I compliment the Irish Farmers' Journal for doing what it did but that kind of work should be done within the health system. It is totally unacceptable that two hospitals had the nerve to say they would not respond to the freedom of information request. There is no accountability in evidence here. We are hunker-sliding along, pretending that this is not happening and that is not good enough.
There are other issues that should be examined, including the increased turnover of patients and higher bed occupancy rates. There are situations where two patients could occupy one bed at different times in a single day. In that context, we must consider systematic sterilisation of beds. Perhaps we could have a system whereby if a bed has been used by X number of patients at the end of three months, it is taken apart and fully sterilised. There is no evidence that this is happening. The space between beds is another concern. Basic infection control measures are lacking. Measures that are not costly, such as proper hand washing and attention to basic hygiene, must be implemented immediately.
I welcome the delegation and thank them for their presentations. The witnesses spoke about 1995 and the 55 reported cases of MRSA infection. At that time I was working with FÁS and the father of one of my colleagues died. That colleague overheard a conversation among nurses to the effect that her father was "the MRSA patient". His death was not reported as being MRSA-related and I believe there was an enormous level of under-reporting. I simply do not believe there were only 55 cases of MRSA in 1995——
Or 550 last year. We do not believe that either.
We must get the reporting right. That is the first requirement.
The most fundamental hygiene standards are still not being followed. I was shocked to hear from an intern who has just started working in a Dublin hospital that he saw no hand-washing and no use of sterile gloves by staff there. We are dealing with abysmal hygiene standards in the midst of a crisis that has been so eloquently outlined to us today.
Bugs do not become superbugs unless there is real antibiotic resistance. I have raised the issue of antibiotics a number of times in the House and it is directly related to this discussion. I am concerned about doctors handing out antibiotics to patients. Antibiotics are being handed out far too freely. Can Dr. Fawsitt comment on that point? There seem to be no standards in this area. We have talked about standards in other areas but they also seem to be lacking when it comes to antibiotics. Some GPs do not hand out antibiotics willy-nilly but others hand them out like Smarties. That is part of the problem.
There have been moves by GPs over the past 20 years, nationally and internationally, and very successfully in the United Kingdom, to reduce antibiotic prescribing. Since the mid-1980s we have recognised that there is an emerging problem of antibiotic resistance. The Irish College of General Practitioners has taken the lead in trying to reduce prescription rates. However, GPs are not the only prescribers of antibiotics. For example, God only knows what is in a MacDonalds burger. At least, we are regulated and audit our members. Improvements have been made in the United Kingdom, where antibiotic prescriptions have decreased by 20% to 30% in recent years. That trend is beginning to be followed here. While we accept we have contributed to the problem, the issue should be seen as a societal one. Antibiotics have brought so many benefits during the years that problems such as MRSA were bound to arise. Unfortunately, we have known about the issue for a long time but not taken steps to address it. People are not being isolated in hospitals and we are neither washing hands nor observing EU demands to ensure beds are 2 m rather than 2 ft. apart.
MRSA is probably present in my surgery and, if not, will be before long. I have to exercise vigilance by performing risk assessments and informing my practice nurse and staff on the issue. The problem is no longer confined to hospitals but affects the entire community. How many wash their hands after using the toilet? Hygiene is a societal issue. We could complain about CEOs and standards but we are all responsible for changing our culture when it comes to hygiene. While I accept GPs have had a role in this problem, but we are not the only culprits and are doing our best to resolve it.
I compliment the group on its work in the past few months in getting the recognition it deserves. It is shocking that an abattoir is more hygienic than a hospital or that an ill person could enter hospital and leave with an unrelated illness. Serious questions are raised by the fact that an environmental health officer can inspect a hospital kitchen but there is no such oversight for the remainder of the hospital.
Last Saturday I attended a conference in Waterford where I learned that MRSA was classified as a biological agent in 1994 and listed as an infectious disease in 2003. The Health (Provision of Information) Act 1997 clearly specifies the steps involved in controlling infectious diseases. Dr. Graham has correctly noted that the necessary measures are in place but not being enforced. Updating may be required but nobody is seeking a revolution — merely that existing legislation be enforced.
The message which should be sent from this committee meeting is that MRSA can be avoided or eliminated. It was noted at the conference, in the context of the SARS crisis in Canada, that the rate of infectious diseases had been reduced by 85% because draconian measures were taken. This proves that the issue can be addressed. We should not roll over and say MRSA is bound to become endemic to hospitals and surgeries.
We have a problem in Ireland with regard to the bed occupancy rate, which stands at 100%. During recent discussions among Fine Gael members on the potential avian flu pandemic, Avril Doyle, MEP, noted that the bed occupancy rate in France was 85%. That country could not cope when it experienced a major heatwave and the collapse of hospital services meant that many died. It must be asked whether this country could manage avian flu. I worry when I hear Professor Drumm say he will not increase the number of beds, even though we have a 100% occupancy rate.
I read a report which recommended that half the number of acute beds should be in isolation units. While I am unsure of the exact figure, Ireland is nowhere near that proportion. I am neither a doctor nor a scientist but it is common sense, if a patient has an infectious disease, that he or she be placed in quarantine or isolation. How can this be done in wards of five to seven patients? It cannot. As politicians, we can impress on the Tánaiste the need for more isolation units in hospitals.
The issue of the Coroners Act was raised during the conference on Saturday. When someone dies from natural causes, there is no need for a coroner's inquest but families may exercise this option in the event of an unnatural death. As far as I am aware, no coroner's inquest has yet been held with regard to deaths resulting from MRSA.
No, not yet but we are working on it.
People should insist on inquests being held. I presume the reason they are not held is people are not aware of their entitlements under the Coroners Act. MRSA might be brought to the fore if inquests were held into deaths suspected to result from the infection. We cannot rely on the current figures, which range from 500 to the 8,000 reported in The Irish Times last summer. The presence of MRSA on the skin of babies has also been reported in the Rotunda Hospital.
The National Maternity Hospital reported five cases of babies with MRSA on their skin. It has been recently revealed that a baby died 12 months previously from septicaemia. Such cases reveal how the problem of MRSA is being addressed. It is crazy that such a situation obtains in the National Maternity Hospital, where babies are being born into the world.
There is an information deficit in that regard. People should be aware of the standards of hospitals in the context of MRSA, as well as the entitlements and procedures involved for a person who contracts the infection. Dr. Fawsitt has noted that a significant backlog might be caused if every patient had to be swabbed. More importantly, chaos might ensue if every hospital employee had to be swabbed because it is more than likely 30% would fail the test and, therefore, could not be permitted to work. I am not sure what solution could be applied. What has been the reaction of hospital employees to the group?
The Senator's question is interesting because it concerns health care workers and, such as Mr. Kavanagh, I do not know why the trade unions did not become involved. Our meetings in Cork and Waterford have been attended by health service employees who contracted MRSA in the workplace. One attendee was infected while working in a hospice, while the other was infected in the laundry of an acute hospital. This should be an issue of concern to the trade unions because their members are being put at risk in working in areas that contain improperly managed biological agents.
We have criticised cleaners on their poor standard of work but that is only one element of an entire system. As a sociologist, I am interested in the sociology of work and, as my students would attest, have always emphasised the value society places on jobs. Whereas a footballer may be paid €120,000 per week, a cleaner only receives a tiny fraction of that amount. If every footballer disappeared tomorrow, there would be a few broken hearts but nobody would die. If cleaners were to disappear or not properly directed, people would begin to die. We need cleaners to be part of the care team within hospitals and to be given the same respect, training and pay as physiotherapists and dieticians because they are equally, if not more, important. It requires a societal change to implement it and I appealed for that even before I became involved in MRSA. It is an issue for workers, patients and their families.
I recently met a hospital worker in Galway who was resigned to the fact that she probably had MRSA and accepted it. That struck me following comments made in Waterford last weekend. It is realistic to expect that when a person is admitted to hospital their condition is at least maintained, and hopefully improved. If a hospital contributes to worsening a person's condition, it breaches its duty of care. I have already specified that MRSA is classified as an infectious disease. Section 30(2) of the Health Act 1947 states:
A person having the care of another person and knowing that such other person is a probable source of infection with an infectious disease shall, in addition to the precautions specifically provided for by or under this Part of this Act, take every other reasonable precaution to prevent such other person from infecting others with such disease by his presence or conduct or by means of any article with which he has been in contact.
The Act speaks of a summary conviction and a fine "not exceeding £50". That must be updated rapidly. Nobody has ever been convicted under this Act. Obviously a token £50 is not a deterrent.
I welcome members of the delegation. They are at the beginning of a long campaign to turn our health services around. This is not new to me, and I am sure Dr. Fawsitt will agree. When I was a hospital doctor in 1992 and 1993 doctors and nurses were swabbed for MRSA. Employees carrying MRSA were given Bacteroban, an ointment one puts up one's nose, and Hibiscrub to wash the MRSA from one's body, and sent home for the day. So many staff had MRSA that the swabbing was stopped. The solution to the problem was to stop looking for it. Now, 14 years later, one can see why this problem exists. Guidelines were published in 1996 but have not been enforced.
We spoke about the UK doctor who reduced MRSA levels by 60%. The audit report issued last week contains many interesting facts if one looks at individual hospitals. Some hospitals are very good at hand washing and some hospitals are useless. There is little or no MRSA in Kilcreene Orthopaedic Hospital, Kilkenny because no patient is admitted until he or she has been swabbed and examined for MRSA in a separate department. Nearby Waterford and Wexford hospitals are overrun with MRSA. Kilcreene is an elective hospital and can therefore control its admissions unlike accident and emergency hospitals. However it indicates that MRSA control begins in the community. I have never checked whether I am MRSA positive, but it would not surprise me.
When I was a medical student at Trinity College the matron of the old Meath hospital could be heard screaming the length of the hospital when doctors did rounds with stethoscopes around their necks. She said MRSA was most likely to be transmitted by stethoscopes and was insistent about how they were dealt with. Each ward sister made doctors wash their hands between patients. There was a greater hygiene ethos. All hospital-acquired infections have gone out of control in the past decade.
One should not lay too much emphasis on hand washing or guidelines. The report states that the problem is also caused by lack of resources. One can blame the Government or the HSE for that but there are five categories of people who can control MRSA. It begins with patients and their visitors, although nobody wants to mention this publicly. Ten years ago a patient was allowed two visitors, not eight or nine people sitting on MRSA infected beds. Hand hygiene of doctors and nurses is an issue but hospital porters, caterers and cleaners could probably do more to control hospital-acquired infections, but we do not give them the opportunity to do their best. The breakdown of hospital management is also an issue. In the past there was a person in charge of each ward. There is a sense that nobody is in charge. I have seen patients' toilets in hospital wards that would be unacceptable in pubs or to any of us and yet patients are expected to use them. The excuse given is that they are cleaned only once a day. Patients have cleaned the toilets themselves. Ms Friel cleaned her son's ward. We must face up to this management issue.
The Minister said some of the hospitals with high occupancy and contract cleaners are among the cleaner hospitals, but the cleaner hospitals such as St. James' and the Mater have more resources. Some of the hospitals that have hygiene problems are overcrowded and have inadequate storage space for clinical waste. I advise the delegates to continue their work. This issue has not just come to the fore in the past two or three years. It has been growing for the past decade.
We will inform the delegates of the position of the committee at the end of the meeting.
I will be brief, as I am anxious to facilitate my colleague Deputy McGuinness, who has taken an interest in this subject. I have often said that I bring my life experiences to my politics. I am not a doctor but I have been a patient and a family member of a patient with experience of this issue. I often say that the Oireachtas joint committee hearings are important. This morning's meeting has been particularly significant. My colleagues have said, thankfully in a non-party political way, that this is a serious issue that needs to be dealt with. I had serious surgery six years ago. I do not mind talking about it. I am happy to be here. I spent some time in the Mater hospital. I have no complaint about the Mater but it gave me experience of some of the issues, which helps me in my public life. My father died ten years ago, and his death was accelerated by the issues under discussion today. I do not want to be dramatic, but my family often discusses it. I can see how people are affected and I am very impressed by the way it has been articulated. It amazed me that simple actions cannot be taken. I have listened carefully to the presentations by the doctors and their colleagues. A friend told me during the week that there seems to be more hygiene on a cruise liner than in hospitals. I do not understand how these simple things cannot be implemented. Deputy Twomey made a point which is often made to me about open visiting. I remember being in large adult ward in a general hospital at ten years of age and my parents were only allowed to visit me two days a week. I wish to stress that I have not been sick all my life. Perhaps there is something wrong with a system where visiting seems to be allowed from 8 a.m. Do we need to recommend serious decisions on simple issues like that, even if we inconvenience people to save their lives?
I was impressed with the way my colleague Deputy Breen explained his case. It is important to do so. I do not wish to be flippant but it is worth remembering that Deputies are ordinary people like everybody else. They live normal lives and are affected by health issues like everybody else. If there is a difference, we try to represent and articulate what witnesses such as those here today say to us.
I will call for a Deputy McGuinness and Deputy Breen to be installed in every county and town in Ireland because they have given us great support.
There may be a vote at 1.30 p.m. so I want to allow as many members as possible to speak.
I must leave shortly to attend the Committee of Public Accounts. I welcome the MRSA and Families group here this morning. Despite what has been said it is a significant meeting and represents a start to bringing about change. Much has changed over the past few months since the first public meeting was held in Kilkenny. I was asked by Ms Dawson, who along with other witnesses here this morning is from Kilkenny, to chair that meeting. At the time I thought it was an exaggerated issue, like many other things politicians are asked to become involved with. However, I did so and was taken aback by the number of people at the meeting who came forward to tell their story of MRSA, in some cases showing their wounds. I realised the extent of the problem that night. Having investigated it more deeply and asked in the Dáil about the extent of the problem, I learnt that hospitals keep their information in different ways, with a different methodology in each. It is therefore difficult to get an absolute figure for numbers contracting MRSA at any given hospital. People with MRSA, some of them elderly, are being pushed from pillar to post for their care. A patient with MRSA in Waterford was discharged from hospital back to a nursing home but once there was told return to the hospital because they had MRSA. That person was pushed all over the place.
I wish to focus on the management of MRSA. I do not excuse the Minister or the Government because they provide the wherewithal for the isolation units, the washing facilities, cloth costing an extra €2 and other things that make a difference. However, if there is MRSA in every hospital, as indicated by the stories this morning — and I appreciate how difficult it must have been to relate such stories where they involve family suffering and bereavement — the HSE management must declare war on it, as the Department of Agriculture and Food did with foot and mouth disease. The 1995 report must be adopted and decisions taken on foot of it. Its conclusions were arrived at over a number of years and are obvious management functions of a hospital. I do not want this committee to debate the issue further and ask for another report. Discussion should be had with the Department of Health and Children but this committee must demand that the report be implemented in its entirety.
Visiting hours must be addressed. It was only because the public was confronted by issues affecting their lives such as mats at the airport, screening and straw at farm entrances that foot and mouth was dealt with. The public was made to know it was part of the problem and part of the solution. The same should be the case with MRSA. I cannot put it any stronger than Dr. Fawsitt put it this morning in describing the action that is now needed. When that action is taken the public will become aware and the need for moneys to implement the report will manifest itself. Requests can then be made to the Department for real action and real change.
We are too casual about MRSA because nothing has changed in the hospitals. I asked the Secretary General of the Department where it spent the €20 million it said it had spent on an MRSA public information campaign. I have never seen a leaflet, been stopped in a hospital or asked to wash my hands or tread carefully when visiting an MRSA patient. I do not believe frontline staff are encouraged to do so either. In view of this there are doubts about putting MRSA as the cause of death on a death certificate. Until we look this problem in the face and call it what it is we are doing nothing but sitting on our hands.
When a patient is discarded by a hospital, because that is what it is, they are cared for at home. People are well cared for at home but get little or no support from the State. A patient was in a Dublin hospital for 15 months. The estimated cost for the care of that person at home is €5,500. To decide whether to come up with that amount they have virtually had to establish a committee. I ask Ms Dawson how much it costs to care for family members at home. The State is ignoring those people. The matter has been raised in the House but to no effect. I have seen Deputy Breen ask a question with little or no response. There is now responsibility on this committee to liaise directly with the Minister to deal with this issue today. No more reports, please.
I compliment the members of the group on visiting the committee today to tell their stories. Despite what has been said here and in the Dáil it has been very worthwhile. This is an issue in which management can make a big difference. We pay these people well and their salaries are benchmarked. The time has come for serious change in the health services, and this joint committee has an important role to play in it.
I thank Senator Browne for the policies he has helped us with.
I point out that all parties are represented on this joint committee and I emphasise that its members wish to be actively involved in the issue, whether the witnesses believe it so or not. We are fortunate to have Deputies with medical experience in Dr. Jimmy Devins, Dr. Liam Twomey and Dr. Dermot Fitzpatrick. I will not fob the witnesses off with kind words, as I am sure they have experienced much of this up to now. However, this has been one of the more important and awakening meetings that has taken place in my year and a half as Chairman of this joint committee.
The witnesses should not depart believing that today's trip has been an idle journey or only part of the process of making this a real issue. It is not my function to decide for the full joint committee, but I am sure I will get full support from it on the basis of members' statements this morning. I intend to have discussions with party members and the secretariat to examine the work agenda, which is prepared months in advance. I will endeavour to place MRSA at the top of the agenda. This may require changes to programmes and previous arrangements but we should confirm to the group before the joint committee today that we recognise the case that has been made.
MRSA is life threatening but something can be done about it. Presentations are often made before us that are so far from the joint committee's remit that change cannot be made. Dr. Fawsitt has clearly indicated that we can bring about change on this issue. The comparison with the attitude during the war years sums the matter up. This country referred to the time as the Emergency, and to the rest of the world it was a matter of life and death. We wish to change this thinking to make people realise that this MRSA problem is even more urgent than an emergency.
I will put the matter to the committee in the manner suggested by Deputy James Breen. Until the impression is created among those with responsibility that they must act, no great change will come about. The only way this can occur is for people with responsibility to come before a forum such as this joint committee. This would not be a witch hunt but rather an act to ensure that what has occurred in the past will not be repeated. It will also ensure that the public is made aware that people are held accountable. Until such a perception is held by the public, the issue will not change. Over the coming weeks we will seek to invite people from each of the former health board areas, now the HSE, before the joint committee in an effort to pin down the issue, see what is defective and ensure that responsible people are held accountable.
We have invited the HSE and the Tánaiste and Minister for Health and Children, Deputy Harney before us, and the committee clerk has informed me that Mr. Paul Barrow, who has responsibility for the MRSA issue in the Department of Health and Children, will appear before the joint committee in the coming weeks. The joint committee will respond to today's presentations within three or four weeks. The witnesses would prefer it to be sooner but that is not the manner in which these matters are processed. We will take into consideration the point made on existing legislation, and that if it was in place it would have immediate effect.
Other more mundane issues should also be highlighted, such as cost-effectiveness through a simple change of material. I received notes recently from a professional person operating in the construction of new hospitals. He contended that as it stands, construction of new hospitals is not taking into account ways to deal with MRSA. He pointed out that surfaces — especially in bathrooms, toilets and kitchen areas — are being used that are attractive to MRSA growth, and even if proper controls were put in place now, such building practices could be eliminated in further construction. Even as we discuss the MRSA issue, we fail to implement proper procedures that could easily be put into effect. I call to hospitals on a regular basis. Some time ago there were restrictions on people visiting but they have been relaxed. Perhaps it is part of the hospital ethos to show a more caring and friendly attitude, but it appears to have bad consequences.
Rather than having the witnesses believe this meeting is part of the political process, I emphasise that an Oireachtas committee does not create policy, and there is little use in the group before us believing so. This joint committee can prioritise what has been stated, ensure that proper change comes about and invite people with responsibility in these areas before it. It can also make the relevant people aware that the joint committee intends to make MRSA a priority over the coming years. I will conclude as I wish to return to the Dáil by 1.30 p.m.
Will the joint committee go into private session?
The joint committee has invited medical experts and professionals in the field of dealing with MRSA. I promise the witnesses that they will hear from this joint committee.
The new infection control and cleaning standards to be launched in January 2006 are currently being piloted in Tullamore Hospital, Tallaght Hospital and Roscommon County Hospital. With scores of 73%, 78% and 65% respectively, these hospitals have performed poorly in the recent national basic hygiene audit. Will the new standards continue to be piloted in those three hospitals? If so, the standards have already lost credibility.
Those were the hospitals I was thinking about in my earlier references. When we have people with the relevant responsibility before the joint committee, we will present facts regarding what is occurring in those hospitals. In prioritising the MRSA matter, we are not doing so on the ground, as hospitals under construction have not had their methods of controlling MRSA changed. The witness can make a written submission on the points he wishes the joint committee to make to representatives from the HSE and medical experts.
The joint committee went into private session at 1.28 p.m. and adjourned at 1.50 p.m. until 9.30 a.m. on Thursday, 17 November 2005.
