This morning, I felt we were at an extended press conference for the Minister for Health and Children, her Department and the HSE. Everything positive was highlighted. It is good to see Government representatives in election mode and clarifying good things for their constituency. Unfortunately, it does not lead to much critical analysis of what is going in the health services. We are not really discussing the issues and being more critical, as we should be. What has gone on so far has involved backslapping.
There is a time limit in respect of questions. Unfortunately, I must focus on Professor Drumm because the Minister comes before me every day. She might try to guillotine the legislation she is discussing. The legislation on medical practitioners will be guillotined. The Minister spoke about the issue of nursing homes yet the legislation dealing with this was guillotined last night. The Minister has also put a guillotine on the legislation dealing with the Health Information and Quality Authority. There will not be the proper debate we need, but I sense the Government does not want a proper debate on HIQA and the Medical Practitioners Bill purely because of the impact it will have on patient care. Some of this legislation is significantly faulty, but I will get to this quickly if I can.
I received an answer from the Minister for Enterprise, Trade and Employment, Deputy Martin, to a parliamentary question on MRSA. He said that in 2006, the Health and Safety Authority carried out 148 inspections in the health care sector. As part of these inspections, 13 hospitals were targeted nationwide, focusing on the spread of MRSA. Enforcement action was taken in 12 incidents. Could Professor Drumm indicate what sort of problems the Health and Safety Authority had with regard to these 12 hospitals to lead to enforcement relating to the spread of MRSA within those hospitals, considering that we were supposed to have a hygiene audit and to be moving much further in inspecting these hospitals? As Professor Drumm knows, the Health and Safety Authority only deals with the threat to workers or where workers might be a threat to patient care. I would like Professor Drumm to answer this question because it is extremely important.
I also received a letter. This is becoming very important because we are all aware of the significant concerns about the lack of occupational therapists in primary care. Some patients cannot get improvements in disability grants because they cannot get a report from an occupational therapist so, in some respects, this report is almost a limiting factor in respect of what patients can get in the community. We are talking about taking care into the community, but it is not happening on the ground. There is a significant lack of community physiotherapists. Professor Drumm mentioned that 97 primary care teams were established and that another 107 teams are in development phase. With many of these primary care teams, the only development that has taken place is that the HSE has written to GPs inviting them to join these teams. In my constituency, where I would be more aware of such developments, I am not aware of any primary care teams being established under the HSE.
There is another concern with regard to private home care packages. We are all aware of Leas Cross, the total lack of supervision of nursing homes in recent years and all the concerns that were consistently raised, with Leas Cross being, more or less, the pinnacle.
The Minister and I received letters from an 82 year old lady concerning her 86 year old sister. As the former had her hip replaced and the latter was a stroke patient, it was suggested that they should get private home care. In her letter, she wrote that the care provided at great cost was inadequate, the agency did not know whether carers were trained, it had difficulty in providing care for the time suggested, time-keeping was unpredictable, bathing was unsatisfactory, cleaning was hit and miss, washing was unsatisfactory and there were a number of question marks over hygiene.
Are we moving the types of problem found at Leas Cross into the private sector? I do not know whether the HSE's mandate allows it to enforce its strict regulations on home help services, which comprise part of its brief. When we move patient care into the private sector, are we removing our responsibilities?
I know of a case of a gentleman in his 80s whose wife was sent home from hospital requiring per endoscopic gastronomy, or PEG, feeding. For those who do not know, this involves stroke patients who cannot feed themselves being fed via a tube into their stomachs. The man was told to get private nursing care and that it would be paid for by the home care package. A man in his 80s with a sick wife was expected to become an employer, advertise for a private nurse and run services for his wife. The package is not a success and is a despicable way to treat people. We must be more honest about what is happening in the community.
I was scathing of one of two recent reports dealing with a CAT scanner in Louth County Hospital and, crowning that, the DEXA scanner in Sligo General Hospital. The equipment has not been used for two years because the health service cannot determine who is supposed to use it.
Regarding the survey referred to, it is not satisfactory that 7% of people presenting at accident and emergency received treatment without care and dignity. We must not give ourselves or the Government credit by jumping on the back of the hard work done by doctors and nurses in hospitals and the community. The role of the Government and Professor Drumm is to identify and solve problems. The survey shows good results because hospital staff work flat-out, but when patients are lying on trolleys or waiting to be admitted or when there is a considerable number of delayed elective procedures, it is important to make those problems known.
Some of what was said was contradictory. For example, it was stated that there might not be a need for additional beds. I deal with Wexford General Hospital. Letterkenny General Hospital is at the other end of the country. While both have experienced significant difficulties in terms of trolleys in the past 12 months, they received additional funding from the HSE under the case mix programme, which showed that they were efficient in their elective work. I was a general practitioner in Wexford and I know that a considerable number of patients are having their procedures cancelled. In a 12-month period, a consultant at Wexford General Hospital cancelled all endoscopy procedures every second week, but the Minister is holding up the hospital as the gold standard for the health services. The real standard is St. Luke's Hospital in Kilkenny, which was penalised under this system.
The Minister pointed to a significant increase in the number of day cases in the system, which indicates it is working well, but in recent years inpatient and day case discharges have not increased dramatically. There is a range of contradictions. Does the figure on lengthy bed-stays in hospitals take into account the sizable number of patients who are better suited to accommodation in long-term care?
I jotted a few notes down regarding the Minister's comments, particularly in respect of the legislation. Second Stage of the Medical Practitioners Bill 2007 will be guillotined in a four and a half hour debate next Friday when no one else will be around. There will be no vote. We have waited 30 years for the legislation, but it will fly through Dáil Éireann on Second Stage and be guillotined in the select committee. Despite many discussions, no one has told me what competence assurance system the legislation will put in place. Whether there is a lay majority or professional majority is immaterial. This is a matter of protecting patients from a minority of poor doctors, not one of spin and telling the media what we are doing.
Regarding the HIQA, there is no whistleblower legislation. The Bill has the potential to gag doctors. The Minister stated that no doctor stepped forward to speak out about Dr. Neary. We know the treatment he received after he was exposed and the three consultants who bailed him out are a disgrace to the profession. They were sent to Louth by their representative body, not a statutory organisation like the Medical Council.
The Minister must be more honest with people. For example, Fine Gael and the Labour Party proposed a patient safety authority to protect patients while the Minister discussed setting up a commission. Why can she not go all the way and set up a patient safety authority? There is a bit of "Micheálitis" in establishing a commission, as the Minister for Enterprise, Trade and Employment, Deputy Martin, published reports when he could not make decisions.
Concerning last night's guillotined legislation, the issue of private nursing home packages was not debated on the floor of the House because the Minister hindered the discussion. A section addressed registering private nursing home operators, but we could not find out what the Government plans on doing to protect private patients. The private nursing home sector became so annoyed with the Government that it introduced its own standards, but those in the sector are being tarred with the same brush. Whenever a nursing home closes, there is a sense out there that every nursing home is the same. Ministers and, to some degree, Professor Drumm state that the Opposition is criticising doctors, nurses and allied health care professionals when we criticise the health services, but there is a perceived taint because the Government and the HSE have not done their jobs.
Will Professor Drumm cast his eye over another issue? If the HIQA was structured properly, would it not be more appropriate to separate the Social Services Inspectorate, which is concerned with protecting patients, from issues of whether patients should receive treatment or whether the HIQA should investigate information technology and combine it with the Mental Health Commission as a patient safety authority? I do not understand why the HIQA, which will operate like the National Institute of Clinical Excellence in the UK, will be able to deny patients treatment. The institute believes that certain patients should not receive a breast cancer treatment drug, but the Government is giving the same function to the HIQA, which is supposed to protect patients.
Before this meeting, I tabled a question on what will be done about MRSA in hospitals and asked for the guidelines to be given to me today. I was told the guidelines are still in draft form. I received a document a few weeks ago about a national influenza pandemic plan. We have three books on chickens and wild birds yet with regard to MRSA, which is a serious problem in our hospitals, we have a draft plan. That demonstrates the response to the media driven agenda as opposed to what is happening in our health services.