On behalf of the committee, I welcome the delegation. I understand that each member of the delegation wishes to make a three-minute statement. I invite Ms Margaret Dawson to present the first submission.
MRSA Incidence: Presentations.
Ms Margaret Dawson
I thank the Chairman and members of the committee for inviting us to make our presentation. Before we begin, we should all think about the people who have died from MRSA and MRSA-related illnesses in the past 12 months. Eleven months ago, MRSA and Families made its first presentation to the Joint Committee on Health and Children on issues relating to the MRSA crisis in our hospitals. Despite two hygiene audits and the Clean Hands campaign, nothing much has been done to remedy this continuing crisis. The Department of Health and Children, the Health Service Executive, HSE, and management in all hospitals have failed to enforce guidelines to prevent the spread of MRSA in our hospitals.
It is human behaviour which allows infection to spread and everyone's behaviour, from that of the consultant to that of the person responsible for cleaning, matters. Hand washing is the most cost-effective means of containing hospital-acquired infection. Why did it take a freedom of information request from The Irish Times one month after a report in the Sunday Independent to reveal that the real figures for MRSA were much worse than anyone suspected? Of the 8,000 people who tested positive for superbugs, 6,000 were infected by MRSA and 500 had the serious form of blood stream infections. The Department of Health and Children and the Health Service Executive are not coming clean on health issues. People are very angry at the state of our health services. The number of people going into hospitals and picking up hospital acquired infections is rising at an alarming rate. MRSA is a potential killer and the rates of infection in our hospitals are far too high.
MRSA and Families will continue its public awareness programme. There is little need for the Government to squander €2 million to fund a new publicity campaign when our members are always in demand to participate in MRSA discussions, programmes on television and local and national radio. Eight local branches of MRSA and Families have now been established throughout the country. Last month the central council of MRSA and Families travelled to Wales with Senator Browne and visited the Cardiff and Vale Health Trust. Our meeting with Dr. Ian Hosein, director of infection prevention and control, was most beneficial and informative. Sadly, MRSA has become the real lotto in Irish hospitals. It is life-altering and life-taking. What should matter to all of us is the human condition.
Dr. Ronan Fawsitt
I am a member of this group and most members will know there has been a deafening silence about hospital acquired infection and MRSA in recent months. One wonders why that is. We have a hygiene audit, which has shown a modest improvement in the standard of hygiene in hospitals, but it is not enough. The reality is that MRSA and hospital acquired infection is rising in our country. MRSA is now also occurring in our community. Clearly, it has not gone away one year on. Some 12 months ago we came here and Ms Dawson addressed the committee in our first presentation. She listed the tragic cases she had come across.
Ms Dawson is an ordinary person whose life has been changed irreparably by MRSA. Her husband, who was here last year, contracted MRSA while a patient in a public hospital under the care of this State which has a duty of care, both legal and moral, to prevent such a calamity. She came last year with high hopes that matters would change if ordinary people would stand up and say this was not good enough. One year on, little has changed. There have been many more deaths, and many families have been damaged and bereaved by MRSA and other preventable hospital acquired infections. One year on, more people are contacting MRSA and Families for help and support in dealing with problems with their loved ones in hospitals. As a result, this group has grown. It is now a national organisation with branches in Galway, Tralee, Enniscorthy, Sligo, Donegal, etc. It is going to grow because MRSA is growing and because the political establishment and the health care system are not responding to the need. MRSA and Families is not going to go away, and sadly MRSA is in every hospital in this country.
One year ago we gave the committee a five-point plan that we had thought through and felt was right. It included a comprehensive approach, a national strategy. We wanted the committee's guidelines from 1995 acted upon. We wanted patients to be fully informed about what MRSA was when they got it. We wanted families supported in the community. We also wanted the appointment of a national director for infection control, with offices in every hospital in this State. We also asked for the mandatory reporting of all MRSA and hospital acquired infection to the director so that he or she could look at the bigger picture and do what was necessary to tackle the problem. We want a national director with coroner-type powers to bring people in, discuss matters and make changes. One year on, not one of those strategies has been accepted or acted upon.
We met the Minister for Health and Children, Deputy Harney, and she was courteous, polite and attentive, but nothing has changed. We met functionaries within the HSE, who were also courteous and polite, but nothing has changed. The HSE is being managed by the political and medical establishment. The reality is that there has been no change because no one is looking at the bigger picture and deciding what needs to be done to change it. We are trying to micro-manage MRSA and hospital acquired infection without a coherent integrated policy or a properly defined management structure to deal with it.
As a general practitioner with 25 years' experience, I still receive phone calls and concerns from relatives, nursing homes, administrators and nurses about their concerns as well as from special needs hostels, which is a growing phenomenon, as the committee may be aware, about patients who are discharged from hospitals to those institutions with MRSA-infected wounds. The carers are not being told by the hospitals or the State how to manage these patients, what to do or how to prevent further infection. We are creating a culture of fear and perhaps one of intolerance to the problem of superbugs.
Even as a family doctor I do not receive official reports from hospitals about patients who have MRSA, and that is a legal requirement of the State. We are not adhering to the 1995 guidelines, let alone what we talked to the committee about last year, which was ten years later. These are supposed to be centres of excellence.
Last year I had a patient who was summarily discharged from a local hospital having had her hospital acquired infection drained. She came to me next day for a dressing. I could not believe the state of the wound. It was a mess. I rang the hospital and the consultant to get her readmitted, and they refused. The sub-text was they did not want to re-admit her because the patient in the next bed had MRSA. What in the name of God is an MRSA-infected person doing beside another surgical patient who has an open wound? The lady concerned had to be admitted as an emergency three days later, probably with a blood-borne infection. So much for the 1995 guidelines.
Another patient had burns and I got seven discharge letters from hospitals. The patient had MRSA-infected wounds. I have seven discharge letters about my patient from eminent doctors and hospitals which are centres of excellence, both local and in Dublin. There is no mention of the fact that every problem was MRSA related. There is a one-line footnote on a copy of the nursing notes, however, which says: "MRSA positive in wounds".
That is the degree of culpability and denial that we, as a country, face. It is a systemic problem and a systemic approach needs to be taken. These are not bad people. The quality of the medical and nursing care is excellent, as is the detail, but they have missed the point. This is a hospital-acquired infection and there is no one to whom to pass on the information.
One year on, are patients any safer or better off going into hospitals? Is the risk of getting MRSA in hospitals this year higher or lower? Despite many public campaigns to highlight hand washing or promote initiatives in this regard, there is little evidence that the infection rate is reducing. In fact, I am very surprised that the official infection rates for 2004 are not yet published. My understanding was the figure for blood borne septicaemia with MRSA in 2003 was 500, and 700 in 2004. However, those figures are not in the public domain one year on and I ask why.
Despite the paper trails — copious volumes of official reports and pious statements from the HSE — of which we are sick to death, there is still no accountability regarding the problem in that organisation. No one is responsible or accountable; everyone is acting like Pontius Pilate regarding MRSA and hospital acquired infection. How many more deaths will it take before we begin to deal with this problem? How many cases of MRSA septicaemia will it take before the State, the Government, politicians and elected representatives begin to make real changes? If we had suffered an epidemic of TB, we would have solved it three years ago and there would be no discussion. If one had an STD or celebrity cancer, one would receive a great deal more public and political attention. It is clear that MRSA is not even on the public radar for the political parties, let alone the HSE. Neither is it one of the stated medical priorities of Professor Drumm, a very able man. We are only paying lip service to MRSA and hospital acquired infection. There is no medical or social will to change it. That is the blunt reality a year after we attended the committee, which Ms Dawson addressed.
Curiously, that could all change at the stroke of a pen, either that of the Minister or Professor Drumm, through the appointment of a national director. That would create a focus for change and the rest would follow, since it would be logical. If one has someone in charge, one can direct matters and accountability could arise overnight. MRSA and Families believes we need someone of the calibre of Trinity graduate Dr. Hosein in Cardiff as director, someone who has done the business with MRSA, got infection rates down 60% and achieved a hospital hygiene satisfaction rating of 99%. He has done the business, but it does not matter who gets the job; we need someone to do it. The appointment of a national director would create a climate of real change overnight and reduce the burden of MRSA in hospitals and nursing homes. That kind of attitudinal change would lead to behavioural change. Isolated initiatives, however well intentioned and well meaning, will not produce significant or sustained change to reduce hospital acquired infection.
One year on, it is clear to us that there is no political will for such a root and branch approach. Perhaps a general election might sharpen members' thoughts on the matter, since they will meet a very angry population on the doorsteps. They are angry about MRSA and the state of hospitals, access to them and the trolley problem. We require a systematic managerial approach to tackling MRSA. The problem has clearly not gone away and real change will require innovation, willingness, courage and a system that is known to work. It will not take rocket science to do this. The Minister, Deputy Harney, and Professor Drumm are people of courage willing to innovate and take on entrenched vested interests. Why will they not do this with MRSA and hospital acquired infection?
Our group finds it extraordinary that there is no national strategy or director. We are meeting real people every week. Will the committee ask the Minister and the HSE to appoint a national director? That is why we are here. If the committee will not listen to us, there is no point. It listened to Ms Dawson and the rest of the group a year ago, but nothing has changed. Will we meet again next October or the October after that? I hope not, since I know there is goodwill in the committee and on the part of the Minister, Deputy Harney, towards our group. However, goodwill and good intentions are not enough, since we need action to control the problem. Vested interests in the health service will resist the change for which we call and we ask the committee to stand up to them. When the smoking ban was introduced, people said it could not work, having previously said the same thing about smokeless fuels. However, it can work. We can do this. We have a budget surplus of €110 million a day. This is not a money issue. If the Netherlands, Australia and Britain can have better MRSA rates, we can do the same.
We have a major epidemic of MRSA in our hospitals and our approach is fragmented and unco-ordinated and lacks leadership. We ask the committee to push for the appointment of a national director to pull this together to try to solve the problem. The buck stops here.
In the presentation to the Minister and her officials, did the group make the case for the appointment of a national director?
Dr. Fawsitt
Yes; we have asked repeatedly for over a year for a national director to be appointed.
I ask that witnesses limit themselves to three minutes, if at all possible.
Mr. David Power
I wish to make a presentation on the national hygiene audits. MRSA and Families welcomes the improvement in the second hygiene audit of acute hospitals and calls for the continuation of the audits by an independent external group. In the first audit results issued in 2005 only 9% of acute hospitals audited were found to be compliant, but this rose to 60% in the second audit results issued in July 2006, a marked improvement. It was disappointing to note that four hospitals had scored a lower percentage in the second audit and failed to comply on either occasion. While the improved hygiene audit results will not translate into a reduction in the level of MRSA infection, a clean environment sets a good example. If hygiene is poor, the level of staff compliance is not good.
We were disappointed to note that only 6% of acute hospitals were compliant on hand hygiene in the first audit. Although this rose to 32% in the second audit, it is unacceptable by any standards. Hands are the most common way that bacteria are transferred from our bodies onto others. The audit results confirm what the Minister for Health and Children continually states, namely, that hand hygiene practices in hospitals are unacceptable. It is not too much to ask for hand-wash facilities to be made available and for staff to wash their hands. It is not a resource problem but one of leadership and human behaviour.
In Cardiff and Vale NHS Trust the average external audit score is 99%. On a recent visit we were very impressed to see that it was a requirement that visitors clean their hands using an alcohol gel when entering or leaving a ward. A large poster was displayed on a wall in a hospital corridor outlining the benefits of quality, focus and teamwork. The verified benefits included a reduction in costs of 50%, proving that focusing on quality reduces rather than increases costs. Five years ago the Cardiff and Vale Trust accepted that it had an MRSA problem in its hospitals. The average hygiene audit score was only 47%. It appointed Dr. Ian Hosein, a graduate of Trinity College Dublin, as director of infection prevention and control. Dr. Hosein, through his leadership, communications structure, teamwork, team-building and measurement, has reduced the level of MRSA infection in the nine hospitals by 60% and costs by approximately 50%. He states we are on a continuous journey to excellence.
MRSA and Families welcome the inclusion of hospital operating theatres in future audits. We would compare carrying out an audit of a hospital without including the operating theatre with auditing a restaurant and excluding the kitchen; one of the most critical areas would be missed. It was in the operating theatre that I acquired a hospital infection two and a half years ago, escaping death by the skin of my teeth.
While we welcome the improvement in the hygiene audit scores, we are gravely concerned about hand hygiene and that future audits will not be carried out by external groups but by the new Health Information and Quality Authority. That body, by its own admission, will not be able to audit all acute hospitals annually. There is a view that the standard of hygiene has already dropped since the external audits were carried out earlier this year. MRSA and Families strongly recommends and calls for independent external hygiene audits of all acute hospitals, at least annually, and that a system of accountability be established for the prevention and control of MRSA infection.
Ms Noleen Friel
My introduction to MRSA was due to my son Ronan, who had a diving accident in 1998 that left him a quadriplegic. He recovered well until 2000 when he became seriously ill and was admitted to hospital. In hospital he was diagnosed with necrotising fasciitis, or flesh eating bug, and had several operations to remove tissue and bone to clear out the infection. A short time later he was moved to the only isolation room on the ward owing to a positive result returning for MRSA. From this point on the staff wore gowns when dealing with his wounds.
He continued to stay in that room for eight months but owing to the expiry of his health insurance, he was moved to a public ward where no isolation room existed. The room was filthy, its floors were dirty and its windows were smeared. The bathroom had faecal matter on a toilet brush under the sink. It was then I took matters into my own hands and went to the hospital and cleaned the room myself. He spent a further five months in hospital and was discharged home to an extension in our house.
On returning home we found that there were no procedures in place for patients returning to the community. All procedures that were adhered to in the hospital seemed to be missing in the community. Staff arrived with just a pair of gloves in their pockets and that was it. No gowns were brought and we had to insist that they be worn. It was also suggested that the clinical waste bag could be kept in the room until it was full and it would then be taken away. We found this unacceptable and after much trouble we finally got the local health board to supply a bin for the clinical waste bags. At the time, the board offered us a skip. No information was given to us on how his linen should be washed, even though it had to be changed daily due to bad sweats caused by his operations.
We have heard the same stories repeated throughout the country at our meetings. No structures appear to be in place. People have told us stories of inadequate dressing disposal and of people being told to dispose of their dressing by burning them in their home fires. This is a disgraceful practice and is against health and safety regulations. For example, what procedures are in place for patients with MRSA staying in hotels? We have found it necessary to explain to hotels what is involved and what to expect. Respect must be shown to the hotel in the same manner as it is to the patient's home. The solution to these problems should be ironed out before an individual is discharged. The patient and family should not have to do the arranging and health workers in the community should have steps in place where what is expected of them is explained clearly for both the patient's sake and their sake. It is just as important that MRSA is not spread in the community as it is in the hospitals.
Ronan continues to get dressings done on his legs six years later but it has been a hard slog getting the provisions in place that one would expect to be in position from his day of discharge. Have procedures changed or has the Health Service Executive a policy for patients with MRSA who are discharged to the community? The feedback we have received from our meetings throughout the country would suggest that things have not improved and in some cases have deteriorated.
Mr. Tony Kavanagh
My background is in quality management and performance management. The thrust of my submission in 2005 dealt with the abdication of ethical, moral and corporate responsibility by vested interest groups, incompetent hospital managers who failed to implement their own 1995 MRSA management guidelines and who are to date protected by the establishment. I was given a 30% chance of surviving an MRSA blood stream infection in 2004. My questions at that time were left unanswered and were met with a wall of silence and secrecy. Today, 5 October 2006, the great Irish tradition of secrecy is promoted and actively alive in our hospitals and is still tolerated by the Minister, the elected representatives of this State and the Health Service Executive.
The method of Irish management Dark Ages practices is secrecy, usually applied when a hospital has something to hide. The method of quality management is democracy, or best international practice, which is usually found outside the State.
The question to be asked is why and who is responsible for Irish patients in the 21st century being subjected to Irish hospital management's Dark Ages practices, which is in keeping with the great Irish hospital administration tradition. Bad administration, to be sure, can destroy good policy.
In November 2005, the Minister for Health and Children launched two policy documents, the hand hygiene guidelines and the control of MRSA in hospitals and in the community, promoting best international practice in the hope of restoring public confidence and reducing the number of MRSA hospital-acquired infections. In 2006, the chief executive officer of the HSE stated to this committee that hospitals were very dangerous places in which to be, which is an attitude not shared by the executives of the Cardiff and Vale NHS Trust in Wales. In August 2006, a statement from the health protection surveillance centre stated that €5 million was to be made available to combat hospital acquired infection. Dr. Cunney went on to say that there is no corporate responsibility, that he wants commitment from top to bottom to implement the strategy for the control of antimicrobial resistance in Ireland, or SARI, and how most hospitals had not got enough money to implement the hand hygiene guidelines. That was a reality check.
The HSE and health care managers failed to supervise the implementation of SARI and the hand hygiene national guidelines for 2005, thus failing to reduce incidences of MRSA infections acquired in hospitals. Natural science, as previously stated in the informed opinion of the NHS trust, is necessary but not sufficient when it comes to infection control. It is human behaviour that allows infection to spread. It is what everyone does from the consultant to the cleaner that matters. As in 1995, management failed to implement its own management guidelines and history repeated itself.
Have we witnessed the comprehensive failure of human resource management and of the nine assistant national directors, all highly qualified professionals in their chosen human resources field, who have failed to link the strategy to people? This is in marked contrast to the Cardiff and Vale NHS Trust which managed to bridge the gap between corporate policy and a system of management accountability at operational level. The best method of management democracy is openness and transparency. On a visit to Cardiff and Vale NHS Trust hospitals in September 2006, we witnessed the provision of quality health care service in a clean environment. There was a 60% reduction in MRSA infection, delivered through a system of management accountability which we do not have in this country. The infection prevention and management control team in Cardiff and Vale NHS Trust promotes a process of continual quality improvement through an integrated approach, which does not separate hygiene from patient medical care.
What has changed for the patient in Ireland since 10 November 2005? The reality is that patient safety in 21st century Ireland is a matter of chance. Patient safety has been compromised by politicians and sacrificed on the political altar of health service reform. The root cause of the problem is weak leadership in dealing with vested interest groups.
To answer Dr. Cunney's question on corporate responsibility and accountability, we need to take a look around this room and, to quote Professor Drumm, the buck stops here. It stops with the elected representatives of the people, especially the Minister for Health and Children who believes the setting up of the HSE absolved her and her Department of all responsibility in the control and prevention of hospital-acquired infections. The trend in our hospitals throughout the country, according to our members, is for doctors and nurses to walk away from MRSA patients in the knowledge and belief that they will be protected by their institution. When all else fails, they will blame the non-existent system rather than their own antiquated work practice and human behaviour. This and previous Governments have failed to show leadership or challenge the vested interest groups who control the provision of patient health care in this State.
In the absence of corporate leadership and a system of management and accountability, patient safety will continue to be compromised in hospitals and in the community. No single party has the solution or the character to follow through alone on health service reform. Every citizen knows there is no openness or transparency in the health service. In 21st century Ireland, the days of fooling the people are over. Abraham Lincoln observed that one can fool some of the people all of the time and all of the people some of the time, but one cannot fool all of the people all of the time. A civil rights revolution in the field of MRSA prevention is knocking on the door of Government and we hope our submission will advance that cause.
Ms Theresa Graham
Like my colleagues, I am grateful for the opportunity to make a presentation to the committee. However, I do not believe that either the political or medical establishment understands the anger, frustration and occasional despair felt by we in MRSA and Families, our members throughout the country and everybody who has been affected by this. The message is not getting through. I have been observing the political scene since the summer and there is no evidence that hospital-acquired infections even feature, let alone take priority, on anybody's agenda. Inclusion on the agenda would not create progress of itself but it would at least provide some evidence that the issue is being taken seriously. We do not believe it is.
I wish to deal with the spin that is being put on this issue by the Health Service Executive and the medical establishment. We have heard from the HSE that hospital-acquired infections or, as the latest spin would have it, health care acquired infections, are an "unfortunate side effect of medical care". That is the case. The question, however, is why, given that medical care in the developed world is fairly uniform, we in Ireland have 70 times the rate of infection found in Holland and the second highest rate in Europe. I have supplied members with a map which sets this out in stark terms. Tá ceist agam daoibh: why?
We have also been told by the HSE that only the elderly and those suffering from a debilitating illness die as a result of getting MRSA. I become so angry when I hear this and I often shout at the television and radio. Sometimes I get an opportunity to shout at Dr. Kevin Kelleher, the person who made this statement. Being elderly is not in itself an illness. We may conclude, therefore, that any seriously ill person is in danger of dying if he or she contracts MRSA. Ceist eile: Who do we expect to find in our hospitals but those who are ill, including those with debilitating diseases? These are the people dying from MSRA.
The provision of health care is supposed to rely on evidence-based medicine, as stated in several places in the HSE booklet. Why then has there been no attempt to collect data on MRSA related deaths? We do not even have the necessary codes in place to collect that data. Another attempt at spin is the claim that MRSA is in the community. The blame for bringing it into our hospitals is now being put on the patient. How could we avoid having MRSA in the community when, according to figures I obtained from the ESRI, there are 4,500 discharges per annum of patients with MRSA infections? As members have already heard, these patients are given no instruction on how to prevent the spread of the infection in their homes and communities. Some of them do not even know they have contracted an infection. On the evidence of the HSE itself, hospital-acquired infections are not even contained, let alone prevented.
The sad, frustrating and maddening aspect of all this is that, as we pointed out the last time we were here, the measures needed to reduce the incidence of these infections are already known. The recommendations of the 1995 SARI report to which Dr. Fawsitt referred were not enforced. Other reports whose recommendations have been ignored include the following: the antimicrobial resistance plan, 2002; the guide for hand hygiene, 2005; Control and Prevention of MRSA in Hospitals and in the Community, 2005; the report on national acute hospitals and so on. The same applies to the two hand hygiene audits. There is also the report on the incidence of MRSA in Ireland, issued this summer, and the regional policy on control and prevention. These are only some of the reports on this issue. I would need a wheelbarrow to carry them all. In MRSA and Families, we are members of a report club rather than a book club.
If we did prevention as well as we do reports, we would not be here and members would not have to listen to us. It seems the spirit is willing but the flesh is weak. In other words, we have no way of ensuring that any or all of these recommendations, encapsulating all the knowledge and expertise in these reports, will be enforced. There is no accountability and no sanctions. There are some hospitals which use best practice but there is no nationwide system to ensure compliance. This is why we seek a national director of policy.
On page 4 of yet another report, entitled Prevention of Transmission of Blood-Borne Diseases in the Health Care Setting, it is stated:
The code of practice set out in this document is not optional, and must be followed by all health care workers. There exists a moral and legal obligation on both health service providers and health care workers to ensure the protection of workers and patients alike.
The legal obligation appears to be a reference to section 30 of the Health Act 1947. Section 52 of the same Act says that any breach of these protocols must be prosecuted by what were the then health boards and is now the HSE. There is little likelihood that the HSE will prosecute itself as a health care provider.
An cheist deireanach: What do we want from the committee? As my colleagues said, the buck must stop somewhere, and we are suggesting that it might be here. As legislators, members might take responsibility for instigating change. They have talked the talk, as recorded in the records of this committee, and they must now walk the talk. Members can bring influence to bear to ensure the 1947 legislation is updated to provide effective sanctions for those who refuse to follow their own guidelines.
I thank the delegates for their contributions. That is easy to say and I do not wish to waste time in saying what the delegates want to hear if we cannot follow through. When they attended a meeting of this committee 11 months ago, the issue of MRSA was prominent in the public mind. The sparse media coverage of this meeting speaks volumes about the change in this regard. I give a commitment on behalf of this committee to ensure we make progress on this issue.
I attended the presentation in the Gresham Hotel at which Dr. Hosein spoke of his work in this area and the agenda he followed. In particular, he spent some time explaining his observations on the importance of the washing of hands. He showed clearly the dramatic effect of his input in this area. The most important action we can take to assist the delegates is to promote the concept of a national director and national policy. Everything will fall into place if that objective can be secured.
I take the point about the buck stopping here. I am not overwhelmed by the suggestion that a general election might change the situation; we should not operate on that basis. However, the buck stops with us. It is also incumbent on the joint committee to deliver on the delegation's request for the appointment of a national director. I am certain the installation of a national director would bring all the other issues into the mix. It is up to the committee to set that agenda. It will seek another meeting with the delegation within three months to report on progress. I suggest this as Chairman and I am sure members will support the proposal. The committee should promote the concept of a national director. It would be a simple measure which, together with the amendment of the Health Act 1947, would be a move towards a resolution of the issue. While members could talk forever and say nice things to the delegates, the committee must set targets if the delegates are to believe in it.
Ms Friel made one of the most important points when she referred to the discharge of patients back into the community. It is alarming to note that while the incidence of MRSA in institutions is recognised and understood, the figures pertaining to the incidence within the community are not as clear. The latter problem will become a greater issue than the former. Those who have studied the reports and the comparisons with European figures — those from Holland, in particular — will be aware that we are second in Europe. Hence, as a committee, rather than being seen to be doing something, we must try to do it.
I do not usually intervene at the beginning of a discussion and normally allow members to make their contributions first. However, in this case, while this may annoy the delegates, I believe they have lost the plot. Although their demands are proper, they have been unable to bring media attention to them. This is obvious. As for their proper comments to the joint committee, the most important aspect of their presentation is that they have personal experience. They have not come before the committee to speak on behalf of people they do not know or with whom they are not associated. While most delegations appearing before the committee speak on behalf of groups, they tend not to be attached to the issue in a personal capacity. In that context, we must promote the idea that this has been one of the most important presentations heard by the committee to date. Hence, I give a commitment that it is up to the committee to promote the idea of the appointment of a national director by next January or February. In that context, I propose to invite the Health Service Executive, HSE, to an early meeting in order that members can reiterate the points made by the delegates. I must say they are fallible. Sometimes I formed the impression that the points made were somewhat over the top. However, after a second glance, I am obliged to recognise that while the delegates may have been over the top, they have good reason to be so. I have given this commitment in public to the delegates on behalf of members.
I must apologise for a number of members who, with good reason, were unable to attend this morning. Other events that they must attend are taking place in the House. This does not suggest in any way that the joint committee has lost interest in this issue. However, it is up to it to get the issue back on the national agenda and it will do so. It will be in contact with the delegation in January or February to invite it to a return appearance. I hope we will be able to report progress in the meantime. Some members such as Deputy Gormley were obliged to leave. Deputy Connolly was also obliged to do so because he had business to attend to in the Dáil. I will invite contributions from Senator Browne and Deputy James Breen who have both maintained a continuous interest in the MRSA issue and sought to highlight the committee's activity — or lack of it — in this regard.
I again welcome the delegation before the joint committee and compliment it on its work. While one can become despondent at times, it was great to see an article on MRSA appear in the Sunday Independent last May or June for which it carried out a vox populi on the street. I was surprised to find that all the people who had been polled on Grafton Street were aware of MRSA, which gives great encouragement. An article on MRSA also features in today’s issue of the Irish Independent.
I will be critical of the joint committee. There may be fewer members of the media in attendance today because representatives from neither the HSE nor the Department of Health and Children are present. No one has any difficulty with MRSA and Families which has done tremendous——
Before the Senator goes any further, I did not say that. I was trying to say it was a pity that we did not have the follow-on in terms of media focus.
I know that. My point is that I had assumed that representatives from the HSE and the Department of Health and Children would be in attendance today in order that the charges made by MRSA and Families could be put to them and that they would have the right to reply. Perhaps that would have made for a better media attendance. Nevertheless, this meeting is worthwhile. I suggest the transcript should be forwarded to the Department and the HSE. I hope the committee will invite the HSE to deal specifically with this issue in the near future.
I fully agree with the idea of having a national director. I visited the Cardiff and Vale NHS Trust and it is worth pointing out that problems continue there. Dr. Ian Hosein, the trust's director of infection prevention and control, amazed me by stating there were ongoing problems. I was surprised to find that while he had a small team, it had had tremendous success. The figures quoted by Dr. Fawsitt refer to a reduction of 60% and it also receives 95% ratings in external audits. Hence, a small team can continually improve matters.
I am appalled that in 2006 people can enter hospital with a simple injury such as a broken finger or arm and emerge with something worse. That is the basic point regarding MRSA. If this had happened 100 years ago, one might say things were different then. While we can send someone to the moon and do other remarkable things, people can enter hospital with a simple injury and come out with something far worse. It is not unrealistic for the joint committee and the Government to insist that a hospital is a place of care in which at the least one should maintain one's health, without emerging in worse condition, having contracted something while there.
Members are frustrated. The joint committee held a meeting with the Minister for Health and Children, Deputy Harney, at which I was impressed. I impressed on her the point that people had the right to be informed. There is a great degree of snobbery to the effect that if patients have a condition with more than four letters, they should not be informed because they would not understand a word. While the patients might not understand, they or their families can consult dictionaries or log onto the Internet to find out quickly.
Last week I put a question to the Minister and Professor Drumm asking how many patients had been tested for MRSA in the public hospital system in the past year; how many had tested positive and how many had been told formally that they had MRSA. I have not yet received an answer but hope to do so in the coming weeks. I heard a story in Kilkenny concerning a lady who was informed she had MRSA by a contract cleaner who had shouted it to her. One should not be informed in such a fashion. Moreover, I have met the children of people who only discovered their parents had MRSA after they had died.
It is important that the joint committee should follow through with a meeting with the HSE and the Department of Health and Children on this issue. The delegates may be unable to answer the following question. While a sum of €5 million has been allocated, do they have any idea how much of it has been spent? What is the cost of treating a patient with MRSA? Dr. Kelleher made a commitment that the HSE would push for a reduction in the use of antibiotics in hospitals and community settings. I am unsure whether there is any proof of this happening.
As for the idea of putting someone in charge in each hospital and institution, there must be clear lines of accountability. This point emerged clearly in Cardiff. While no single person is in charge, there is co-ordination and everyone is involved from the cleaning staff to the top medical staff in the hospital. However, a fragmented and disjointed approach is taken here.
There is a working group within the Department of Health and Children that is examining the control of infectious diseases. The attendance record of some of its members is open to query. The joint committee should ask the Department to clarify what is the purpose of the working group and who substitutes for those who are absent. The people whom one might expect to attend such a group regularly do not do so. Perhaps they are represented elsewhere.
I wish to raise the issue of the health and safety of employees in hospitals, which should not be forgotten. Patients have a right to enter hospital without being adversely affected in the hospital setting; the same is true for employees. Have the delegates encountered any cases in which employees working in the hospital sector have picked up MRSA, as they are prone to it?
I take the delegation's point regarding the need to update the £50 fine. I should investigate the issue. If there was ever a case for the index-linking of fines in legislation, this is it. The Health Act 1947 should be re-examined. While it is not scheduled to be amended during this term, I am interested in tabling a Private Members' Bill on the issue and working with others on it. No one has been prosecuted. Moreover, even if someone was to be prosecuted, a £50 fine is no deterrent to bad practice.
I thank the representatives for their attendance and for their presentation. They asked whether anybody was taking the problem seriously. This committee takes the problem seriously, evidenced by the fact that the delegation has been invited to give it an update within 12 months of their last appearance before it. We politicians also observe the lack of progress that has been made.
Dr. Fawsitt asked whether we will seek the appointment of a national director. I will table a question directly to the Minister on that issue. Without a national director, it is very difficult to implement a national strategy. We will not hesitate to ask the question but we will have to consider the reply once it has been given.
It was said earlier that hospitals do not have enough money to implement an MRSA policy. If anybody has ever carried out a costing on how MRSA drains health service resources, it will show that failure to address it head-on is a hugely false economy. Strategies exist and reports have been published and there is no mystery as to how the issue can be addressed. We hear often from the Minister for Health and Children that nurses or doctors are too lazy to wash their hands but more is needed. A strategy is required which includes a means of accounting for the level of MRSA in a hospital and in society and an estimation of what it costs.
Professor Drumm came before the committee some time ago. We asked him about MRSA but his response was to stick his head in the sand. He said he did not want to be accused of scaremongering because he does not like scaremongers. That was not an adequate response from the chief executive of the HSE. He should have agreed that it was a serious problem and come forward with a strategy for dealing with it. The witnesses have proposed a five-point plan which is capable of being implemented and realistic. I do not know if the costs would outweigh the benefits of its implementation. We talk about benefits in monetary terms but there is a human element to the suffering as well. It is reasonable to assess the monetary cost, but one cannot put a price on the human cost.
When MRSA is mentioned it seems there is a cult of secrecy. It is not good enough for a hospital to send a patient home because the patient in the next bed has MRSA. People with the bug should be nursed in isolation or using a form of barrier nursing, but that is not happening. It is almost as if they recognise the problem is out of control and feel the only way to control it is to discharge people early, without telling them or those next to them to be careful. There is much contact between patients, such as when they pass things to one another. If a person who has MRSA is informed they can take it on board and resolve to be careful by showering or avoiding contact with relatives who visit. It seems hospitals are afraid to inform people. The patient should be one of the first informed although I understand that is not always the case. Relatives should also be informed and there should be an information campaign. If we do not want patient interaction or people bringing fresh fruit into a hospital, perhaps we should consider other options. There should be more alertness, not just when there is a problem.
If something works in Cardiff, there is no reason it should not work in Cork, Monaghan or Dublin. I wish people would look at the Cardiff model more seriously. The witnesses may come back in another 12 months and accuse us of doing nothing but all we as politicians can do is raise awareness and ask the right questions of Professor Drumm and the Minister. Hopefully, awareness will filter down to HSE level and a national director will be appointed so that we can make progress.
I welcome the delegation and agree with everything they said. Nothing has changed. As a victim of the MRSA superbug myself, I am damaged for life. My health is good at the moment but I am permanently damaged. I am told my immune system functions at approximately 50% as a result of all the antibiotics I took when I contracted MRSA. Senator Browne asked about the cost of treating someone with MRSA. I was put on a six-week course of tablets, the €5,000 cost of which was borne by the health board, yet we cannot install proper hygiene facilities in hospitals.
I was in Ennis recently and met a gentleman who had an operation last March. He has had MRSA since then but was only told last week. He had been in houses where there were children and visited old people in hospital carrying the bug, but was not told until last week. I tabled a question in the Dáil asking the Minister if visiting hours in hospitals would be curtailed and visitors limited to two per day. Our hospitals are like train stations or airports with people going in and out of them all hours of the day with no controls. They have introduced alcoholic gel outside hospitals but there are no notices advising visitors to wash their hands.
During the foot and mouth crisis, every farmer had to have a notice at his gate telling people to disinfect their boots before entering but there is nothing at hospital entrances to warn us of the dangers. When I raised this matter in the Dáil in 2003, after contracting the superbug, I was threatened with expulsion on three different occasions as I tried to get my point across about MRSA. Eventually I was listened to and a week later seven Deputies from seven different parts of the country tabled questions to the Minister on the superbug. I brought the awareness of the bug into the Dáil and I will keep it there until such time as we get the action we require, which we are not getting at the moment.
I did not contract MRSA in a hospital but in a doctor's surgery so we need to take further precautions. The medical profession will also have to clean up its act in regard to doctors' surgeries. A survey carried out by the former Eastern Health Board on the frequency with which doctors washed their stethoscopes after examining patients found that some never did it. More only changed their coats once a week yet continued to treat patients. Any person who goes to a doctor should ask the doctor or nurse to wash his or her hands before examining them. Nobody should be afraid to do so. If a doctor who has seen nine or ten patients does not wash his or her hands before taking a person's blood pressure, the doctor can pass the disease to him or her. By asking the doctor or nurse to wash hands we can help combat the disease.
I agree with the speakers today that little or nothing has happened. That has to change. Prevention will cost money, but failure to prevent the spread of MRSA will cost more.
Ms Graham
Senator Browne asked if we had instances of hospital employees contracting MRSA. Nurses, care assistants and people working in laundries have contracted MRSA. A care assistant who contracted MRSA was excluded from work and not allowed back. This is a health and safety issue for the trade unions that represent those workers in addition to an issue affecting patients. This has not been taken on board at all.
The situation in nursing homes is unmentioned. Dr. Fawsitt said he receives cries for help from such institutions. I am informed that people in nursing homes are not screened for MRSA and are not treated when they contract it. A neighbour of mine in a nursing home is being treated for MRSA with tea tree oil.
The day we visited Cardiff we found that the recommended number of infection control nurses per patient is one to 250. We were told that they regularly have one to 500 patients. On the day we visited, because of certain circumstances, they had one per 1,000 patients. However, they said this was not an excuse for doing nothing. They felt that, as one goes about seeking extra money and resources, one continues with the work that needs to be done.
The Health Service Executive will spend €2 million encouraging people to use fewer antibiotics. We seek an integrated approach. There are pharmacists in every hospital and if there was a proper policy on all of the drugs used in hospitals, then antibiotics would be included in that. If the HSE approached this matter properly there would be no need for a separate programme relating to antibiotics, it would be included in an integrated approach to health care. Infection control is part of this.
Dr. Fawsitt
I thank the members for their contributions. As stated, a national director would pull all of the strands together including getting GPs to wash their hands, dealing with nursing homes, addressing the issue of antibiotics requirements and so on. We must look at the bigger picture before we begin to micro manage. I ask the members present to do whatever is necessary to have a national director installed. If this is achieved we will no longer bother the members and they can get on with other work.
I thank Dr. Fawsitt for his presentation and invite him to join us here in February. In the meantime we will do what we can by having the HSE address the committee and then, if necessary, meeting the Minister for Health and Children. Many issues have been raised and the way to solve them is through a national policy and a national director. The committee wants to make progress on this issue. I accept, as an elected representative that the buck must stop somewhere and this committee will take responsibility. I do not mean this as a cosy response. We will try to ensure that the visit has been worthwhile.
The joint committee went into private session at 10.55 a.m. and adjourned at 11 a.m. until 9.30 a.m. on Thursday, 12 October 2006.