Dr. Tracey Cooper:

I mentioned in the presentation that our increasing priority for the last year has been supporting improvement. Instead of us getting at people all the time, people are asking us to help them get better. We have reorganised HIQA and we have a directorate, led by Marie Kehoe-O'Sullivan who is our director of safety and quality improvement, to provide support. We have already had extensive meetings with all of the disability service providers. We have asked them what guidance they need to help them implement the standards. We have very good relationships with them at present and hopefully that will continue. They have identified a number of areas, such as risk management, medication management, action planning and improvement tools. We are now in the process of providing guidance to them.

We provide training and support in conjunction with an organisation called the Institute for Healthcare Improvement, which provides online quality training. We have offered a place to each of the 88 service providers to put some of their staff through quality improvement. We would prefer them to get better before we reach a point of having to enforce. It was much less so with elder persons when we started, but hopefully it will be much more supportive than it was.

I will respond on some of the other matters before discussing health care associated infections. Deputy Kelleher asked about the special delivery unit. We have engaged with that unit since it was started. While I am not aware of the exact conversations that happen in every hospital, I would be very comfortable that the approach of the SDU around service redesign, efficiency and effectiveness is absolutely consistent with what we would recommend. There are best practice approaches surrounding process mapping and ensuring that the patient journey is optimised. I would not have concerns about that at all.

The Deputy asked about the National Centre for Pharmacoeconomics. The director of that centre happens to be a former board member of HIQA. We work very closely and well with it. We work collaboratively on certain approaches. Its focus is very much on health technology assessment for drugs and the reimbursement for drugs. We do not duplicate each other, but work in a complementary fashion. Our focus to date has been more on looking at procedures and things such as vaccine programmes for cervical cancer and cancer screening programmes. There is plenty of room for both of us and the centre is involved closely with our scientific advisory groups. Both jobs need to be done, and it works very well.

I will turn now to health care associated infections. Phelim Quinn might wish to add his comments. The reason we included health care associated infections in today's presentation is that we feel as strongly about it as every member of the committee has articulated. I do some work outside of Ireland wearing another hat. Many countries are really struggling with this issue.

The issue is related to the behaviour and habits of humans and the bad rituals rather than good rituals that are put in place.

I wish to make a strong pitch today by stating the following. First, the infections are avoidable. Second, when someone contracts a health care associated infection there may be minimal harm or a person could die. Third, we cannot afford infections given that they are an avoidable acquired injury or harm caused by being in a health or social care facility, not just hospitals.

The committee saw my presentation that showed the redundant costs incurred for treating people. Notwithstanding the harm caused, the problem is not easy to deal with. To be fair, a huge amount of work has been done in the system and guidelines have been produced which are helpful aspects. However, I agree that the matter is about accountability. In my presentation I used the words "simply unacceptable" but changed them to "inexcusable". I wish to inform Deputy Ó Caoláin that it is both unacceptable and inexcusable. We have dealt with the matter for a while and there have been changes and some improvements. The first national publication that comprised all hospitals was in 2008 which is five years ago and the second was in 2009. We have also faced other challenges. People have asked us to carry out more inspections. After Mr. Phelim Quinn joined us at the end of last year we started conducting unannounced inspections. However, we would not expect to see such poor compliance in 2013.