Tim O'Malley (Limerick East, Progressive Democrats)

I am glad of the opportunity to speak in this debate. Improving the infrastructure of acute hospitals has been and will continue to be a priority for this Government. In the past five years alone capital funding of some €80 million has been invested in new accident and emergency departments around the country. New departments have been provided at Cork University Hospital, Connolly Hospital in Blanchardstown, Naas General Hospital and Roscommon General Hospital. A new 25 bed accident and emergency admission unit for the Mater Hospital is expected to be operational by the end of the year. The commissioning of a new accident and emergency unit at St. James's Hospital is almost complete while new hospital developments are being provided at St. Vincent's Hospital in Dublin and at Tullamore.

There is a particular onus on individual hospitals to ensure the care of patients through the hospital is regularly reviewed. Attention must be given to looking at the profile of patients attending accident and emergency and to examining alternative care pathways for people who may not be in need specifically of accident and emergency services but who undoubtedly require treatment, intervention or advice. The HSE has arranged for the assessment and analysis of clinical and organisational processes in ten hospitals nationally. This exercise has been completed and draft individual hospital reports have issued to relevant hospitals. A draft overview HSE report on the findings from the ten hospitals, drawing out the wider system messages and potential for best practice, is being prepared. The Department of Health and Children expects to have the final report shortly.

General practitioner out-of-hours services are particularly lacking for the population of north Dublin. As a result, particular difficulties are being experienced in the accident and emergency departments at Beaumont Hospital and at the Mater Hospital with an apparent high level of clinically inappropriate attendances. In order to address the situation the HSE has commenced the procurement process for the provision of general practitioner out-of-hours services on the northside of Dublin.

As soon as difficulties with PPARS were brought to the Tánaiste's attention, she acted quickly and decisively. The Secretary General of the Department met with the HSE and this led to a review of the system by the HSE. On 6 October the HSE decided to put on hold further development and to maintain the system in the four current live sites, namely, the north western area, the midland area, the mid-western area and St. James's Hospital. The HSE has set up a high-level group to establish the long-term value of PPARS. The Department of Health and Children and the Department of Finance are represented on this group. The Comptroller and Auditor General is also carrying out a value-for-money examination of PPARS.

On 11 October the Government decided on a new system for the management and control of major ICT projects and on new measures to improve the management of consultancies. Over 32,000 members of staff are covered by the full PPARS solution which covers organisation, management, personnel administration, time management and payroll. In addition approximately 40,000 staff in the HSE western, eastern and north eastern areas are covered by phase 1 of PPARS, which covers organisation management and personnel administration. So far this year a total of 560,000 payroll slips have issued. The Department of Health and Children and the Department of Finance are working with the HSE to ensure an effective central governance structure for ICT is put in place in the HSE. It will be up to the HSE to decide on the future of the project taking all relevant factors into account.

An Agreed Programme for Government includes a commitment to expand public hospital beds in line with the health strategy commitment to increase total acute hospital bed capacity by 3,000 by 2011. Substantial investment in additional bed capacity in acute hospitals has already taken place. Funding has been provided to open an additional 900 inpatient beds or day places in public acute hospitals throughout the country. The HSE has informed the Department that as of 14 October 2005 some 806 of these beds or day places were in place and the remaining 94 beds will come on stream over the coming months. In addition, a further 450 acute beds or day places are in various stages of planning and development under the Capital Investment Framework 2005-09.

In July of this year the Tánaiste announced an initiative that will provide up to 1,000 additional beds for public patients in public hospitals over the next five years. The HSE has been asked to begin to develop an implementation plan and to prioritise proposals with reference to the public hospitals' requirement for additional bed capacity. Initial discussions have already taken place between my Department and the HSE on this matter. These additional beds or day places will go most of the way to achieving our commitment in the programme for Government to increase total acute hospital capacity.

The health strategy acknowledges that a significant proportion of additional capacity in the acute hospital system will be supplied in future by private providers. The Department of Health and Children, in conjunction with the HSE, will be reviewing public capacity requirements in the acute hospital sector in the light of developments since the health strategy was published and the progress of the initiative announced in July.

MRSA is one of the most well known antimicrobial infections present in hospitals, not alone in this country but internationally. It is also seen increasingly in community health care units such as nursing homes. These infections pose significant challenges for clinicians and hospitals and the Health Service Executive is working to combat hospital acquired infections, HAIs.

There are two types of MRSA cases: colonisation, which can refer to any person who has simply been in contact with this common bacteria but has no symptoms, and blood isolates, which refer to patients who have an infection with symptoms. Data on bloodstream infection are collected by the Health Protection Surveillance Centre. There were 550 cases of bloodstream MRSA infection in Ireland in 2004. The increase in the reported number of cases of MRSA in recent years is mainly due to increased surveillance as a result of more laboratories participating in the reporting process.

Effective infection control measures, including environmental cleanliness and hand hygiene, are central to the control of hospital acquired infections, including drug-resistant organisms such as MRSA. Good hand hygiene is one of the simplest and most effective measures that can be used to stop the spread of MRSA and other infections.

The national hygiene audit, arranged by the HSE, has been completed and a report presented to the director of the National Hospitals Office. This involved visits to each of the 54 acute hospitals in the country by a team of independent consultants. The purpose of the audit was to assess the standards of environmental hygiene and cleanliness in each hospital and to provide baseline information. The Tánaiste has already given a commitment that the results of the hygiene audit will be published.

The HSE will also publish national infection control standards and national cleaning standards — a consistent and robust set of hygiene standards for our hospitals. Where previously standards may have depended on the approach of a particular hospital or health board, the HSE can now ensure every hospital will share and meet the same high standards of cleanliness and infection control.

The HSE has published guidelines on hand hygiene and guidelines on the control of MRSA for hospital and community settings. These two significant documents give clear policy and practice guidance to health care workers on the control of hospital acquired infections, including MRSA. The Department of Health and Children is continuing to engage with the HSE to agree a series of actions over the coming period to ensure that MRSA can be effectively dealt with and that we can achieve a reduction in the incidence and effects of these infections.

I am confident that the actions being taken by the Tánaiste, supported by the Government, will generate an appropriate multi-faceted and multi-dimensional response to the accident and emergency service problem. I trust I have demonstrated that improving the delivery of accident and emergency services is our priority. We will continue to work in the best interests of patients and staff. That is reflected in the response under development to hospital acquired infections, including MRSA. I am confident that we can and will improve the delivery of accident and emergency services so that patients receive the appropriate treatment as quickly as possible.

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