Adjournment Matters

Medical Indemnity Cover

I raise the matter of home births and related midwife indemnity issues because I have been contacted by a number of constituents. The Minister is familiar with the issue and I am interested to hear his reply.

I thank the Senator for raising this matter.

Subject to overall Government policy, staffing of the health service is primarily a matter for the Health Service Executive, HSE. However, there are issues concerning the provision of midwives for home births and I welcome the opportunity to comment on these.

There are a number of areas of the health service where staffing shortages exist, including certain categories of consultants and non-consultant hospital doctors, NCHDs, theatre nurses and community midwives. The fact that there may be shortages of certain staff categories does not mean that the HSE is not committed to providing the relevant service. Regarding home births, I have recently stated and wish to reaffirm my view that pregnancy is not a disease but a physiological condition. There was a time when practically all births took place at home. There is no reason women with a normal low-risk pregnancy should not have their babies delivered at home by a community midwife or in a midwife-led unit. It should be a mother's choice within safe guidelines. It is the policy to respect an individual's choice in childbirth.

Currently in Ireland there is a national domiciliary midwifery service available to eligible expectant mothers who wish to avail of a home birth service. This service is provided by self-employed community midwives on behalf of the Health Service Executive. The midwives concerned enter into a contract or memorandum of understanding with the HSE. Each self-employed community midwife who agrees to be bound by the terms of this contract or memorandum of understanding is covered by the clinical indemnity scheme, operated and paid for by the State Claims Agency. This scheme covers clinical negligence or medical malpractice arising from the provision of community midwifery services.

The latest memorandum of understanding came into operation on 1 March 2014. The criteria for eligibility for individuals to provide a home birth service on behalf of the Health Service Executive were drafted by a group of experts including midwives and obstetricians. The new governance arrangements for the home birth service are designed to provide a safe service for both mothers and babies availing of this service and provide clarity in the contractual arrangements between the HSE and midwife. There are currently 18 self-employed community midwives who have signed a contract of employment with the HSE. The delivery rate by these midwives reduced from 288 births in 2002 to 161 births in 2012. The figures for 2013 have not been published yet. Their work is supported by designated midwifery officers in each HSE region. These officers act as advocates for women opting to have home births and provide professional support for self-employed community midwives practising on behalf of the HSE.

Ultimately, midwives choose whether to become self-employed community midwives and many have chosen not to take up this role, preferring security of employment with the HSE. The expansion of midwife-led units and greater availability of home births as an option is among the issues that the general review of maternity services being carried out over the course of the next twelve months will consider.

I thank the Minister for his comprehensive reply on a matter that we will return to in this House in due course.

Hospitals Inspections

I am asking the Minister to outline the response of his Department to the report on the unannounced inspection of Tallaght hospital, which was published by the Health Information and Quality Authority, HIQA, last Thursday. The report summarised the results of two unannounced inspections of Tallaght hospital in July and August this year. The findings were disturbing and raised serious concerns relating to infection control, patient safety, basic hygiene and hospital maintenance. What is the Department of Health doing to ensure these matters are addressed efficiently, effectively and quickly? This is not the first HIQA report to flag health and safety concerns at Tallaght hospital. In 2012 an investigation highlighted issues relating to quality, safety, governance and care and, consequently, Tallaght hospital implemented many significant changes but I wonder whether the concerns have been addressed fully. The new report suggests more effort is required.

The July 2014 inspection found that Tallaght hospital had "insufficient clinical microbiology resources in place to routinely enable a timely response in the treatment of patients with serious infections". That HIQA report also stated that frequently used patient equipment was found to be unclean, thereby posing a potential risk of inter-patient transmission of infective material. Hand hygiene has proven essential to patient safety and the prevention of hospital-acquired infections, as the Minister knows, but Tallaght hospital has failed to meet the national targets for hand hygiene set by the HSE for 2012, 2013 and those of the most recent audit of May 2014. According to the HIQA report, records provided to the authority after the July inspection show only 26% of all staff had attended hand hygiene training.

How will the Department ensure patients do not leave hospital sicker then when they arrived? Many people living in Tallaght and surrounding communities cannot afford to opt out of the public system and pay for private health care. How will the Department ensure such people do not hesitate to seek necessary medical care and guarantee a basic standard of patient safety for all those treated in public hospitals? We must address these problems before it is too late - patients and medical professionals are facing high risks and high costs. There is global anxiety relating to Ebola. Does the Department believe we can afford to wait to fix these issues that plague Tallaght hospital and the local community? Can we expect hospitals to cope with outbreaks if basic, routine standards of hygiene are not met?

I have discussed this matter with HIQA and the Irish Nurses and Midwives Organisation, INMO, and I feel the situation at Tallaght hospital is urgent. Basic hygiene issues can be efficiently solved with increased training, higher educational standards and routine environmental audits. Has the Department done anything to help Tallaght hospital meet hygiene standards? We must reinvest in Tallaght hospital after a long period of Government austerity as there are chronic staff shortages among medical professionals and in administration. These shortages must be addressed and I commend the hospital on its recent efforts to recruit staff following the report. The current demand in the local community for health services far exceeds the hospital's capacity to deliver - some wards are operating at 105% capacity when that figure should fall between 80% and 85%. Is the Department supporting the hospital to alleviate the burden of under-staffing and over-capacity?

I thank the Senator for raising this important matter and for the opportunity to update the House on the response to the recommendations of the HIQA report on the unannounced inspection of Tallaght hospital.

As Minister for Health, I take the prevention and control of health care associated infections very seriously and I welcome the publication of this report. Health care associated infections represent a major cause of preventable patient harm and, in some cases, death and increased health care costs. Since late 2012, HIQA has been carrying out a monitoring programme based on the national standards for the prevention and control of health care associated infections in hospitals throughout the country. On foot of these inspections, HIQA's reports provide an independent assessment of hospital hygiene and identify areas where hospitals need to improve.

On 17 July the Health Information and Quality Authority carried out an unannounced inspection of Franks Ward and the William Stokes Unit in Tallaght and several non-compliance issues were identified, including compliance with hand hygiene regulations, in maintenance work programmes in the two wards and certain processes relating to infection control monitoring. I understand the hospital responded speedily to clarify the issues raised by HIQA and outline the remedial actions taken in response to the non-compliance issues identified.

On 28 August the hospital was reinspected by HIQA to examine the progress made in the two clinical areas inspected in July. The recently published HIQA report acknowledges that, overall, significant improvements were observed during the reinspection in August, indicating that the hospital in Tallaght was working towards addressing the issues raised in the first report. Positive steps include: hand hygiene training; a refurbishment and repair programme for the two wards subject to the inspections; commissioning a Legionella risk assessment; recruiting to fill a specialist post to re-establish the surgical site surveillance programme; a local policy for the prevention of nosocomial invasive aspergillosis and the recruitment of a full-time locum microbiologist to enhance the hospital's clinical microbiological services. I understand the application of these measures will be monitored as part of Tallaght hospital's ongoing quality improvement plan to ensure consistent progress. The hospital has further committed to resolving in the coming weeks any outstanding issue relating to HIQA's report. I am confident that the hospital remains fully committed to ensuring the highest level of compliance with the national standards for the prevention and control of health care associated infections.

The role of the Department of Health is to put in place the correct policies, legislate for them and drive the programme for Government. Some years ago inspections such as this never took place. When I was working in the health care sector, there was no HIQA in place or the authority was just starting off and hospitals were left to their own devices. Now, we have a far better situation because we have legislated for HIQA, the authority is in place and its staff go in to hospitals to carry out inspections unannounced and hold them to account. Sometimes people read in the newspapers about these reports and may think it is a sign of a bad health service. In many ways, it is actually a sign of a good health service because we now have a regulator, the staff of which go into hospitals, institutions for the disabled and mental health institutions to find out what is wrong, document it and then require hospitals to act on the problems identified before going back to reinspect. This is a major improvement in the health service, albeit perhaps some might not see it that way.

The Minister has outlined how Tallaght hospital is responding to these reports and identified that it is good that they are being produced. It is helpful for him to outline the way in which the hospital is responding, as this will offer support to members of the local community when they think about the hospital. The inspections do not necessarily cover staffing capacity issues; they do not examine the problem or comment from that perspective. However, I appreciate, in particular, the Minister's comment on the recruitment to fill the specialist post, as well as the other things the hospital is doing. I trust the Minister's response will be part of a process in communities rediscovering their positive connection with the hospital, which is important.

I have worked in Tallaght hospital where I undertook some of my training. It is a hospital of which I am very fond. I have worked in the medicine for the elderly services; therefore, I know the William Stokes Unit well. I was in it last month.

That the hospital has hired a new microbiologist and put in place additional resources is welcome. It is important to say good hand-washing and hygiene procedures cost nothing. In fact, they save a considerable amount of money. We should never allow lack of resources to be used as an excuse for bad hygiene - it is not an excuse, a point on which I know the Senator will agree with me. In my local hospital, Connolly hospital, doctors are not given a parking permit until they have undergone training in good hygiene and hand-washing procedures. There is a 90% success rate. Perhaps the idea might be pursued in other hospitals.

Reference was made to Ebola. Many groups have expressed concern about our level of preparedness to deal with cases of Ebola and highlighted the need to be prepared. The situation is evolving. However, there is one thing of which I am absolutely sure: if we have a case of Ebola in Ireland - there will be one or maybe two cases - it will be dealt with in one hospital. Unfortunately, between now and the end of the year, many more people will get sick or possibly even die as a result of hand hygiene and medication errors and senior decision-makers not being on the floor when they are supposed to be. I call on all those who have expressed concerns about how prepared we are to deal with cases of Ebola to ensure they are doing all they can do in their workplaces to prevent damage caused by common infections, rather than worrying excessively about one that is very rare.

That is noted and well said. I thank the Minister for his leadership.

The Seanad adjourned at 5.45 p.m. until 10.30 a.m. on Thursday, 23 October 2014.