Olwyn Enright (Laois-Offaly, Fine Gael)
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Question 10: To ask the Tánaiste and Minister for Health and Children the procedures which are in place to protect patients and visitors to hospitals under the health and safety regulations; if her Department has had discussions with the health and safety authority regarding the possible exposure to litigation by patients or visitors under the Safety, Health and Welfare at Work Act 2005 if they feel they have been exposed to hazards by the action of Health Service Executive employees; and if she will make a statement on the matter. [8370/06]

Mary Harney (Dublin Mid West, Progressive Democrats)
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All employers, including the Health Service Executive and hospitals, are obliged to adhere to the requirements set out in health and safety legislation and to ensure the safety, health and welfare of their staff. Hospitals must also ensure that patients and visitors are not exposed to risks to their safety, health and welfare.

Under existing legislation any hazards must be risk assessed and appropriate control measures put in place to eliminate the hazard or, where this is not possible, reduce it as far as reasonably practicable. It is also open to the Health and Safety Authority to make the necessary inquiries or carry out such inspections as it deems necessary to verify the compliance of any employer with existing legislation.

In 2005 the HSA wrote to the chief executives of all hospitals with A&E departments. This letter required the hospital chief executives to ensure that a comprehensive written risk assessment was prepared, in accordance with the Safety, Health and Welfare at Work Act. The Health and Safety Authority has urged all those working in hospitals to have due regard for their own safety and that of others and to liaise with their safety representative and management to ensure all risks have been addressed. The national hospitals office of the Health Service Executive has in place a standard operating procedure for risk assessment in A&E units. This procedure deals with any hazard that could cause harm to staff, patients, clients or visitors occurring at any time and in any location within A&E units.

The Health Service Executive is responsible for implementing procedures to protect employees, patients and visitors to hospitals under all the health and safety legislation. I understand that in 2006 the Health and Safety Authority is continuing its work relating to the potential risks to safety, health and welfare of hospital workers and has written to the Health Service Executive recently in this regard. There are obvious synergies between employee health and safety and patient safety. The issues involved cut across a number of agencies including the Health Service Executive, Health and Safety Authority and possibly the health and information and quality authority, HIQA, when it is established. My Department will have a role in ensuring a coherent approach has been taken at a national level by the various public agencies involved.

Liam Twomey (Wexford, Fine Gael)
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This refers to a recent parliamentary question which stated the Health and Safety Authority is focusing on the existence and implementation of a comprehensive infection control policy. I seek a bit of background on this. What we are focusing on here is the significant increase in cases of MRSA, the increase in cases of tuberculosis — a recent report stated there were 300 cases in Dublin alone — and the increase in cases of hepatitis B. While we have identified there is a problem to some to degree, has the HSE any plans to help hospitals, nursing homes and other care settings to draw up these site-specific risk assessments for their institutions and to identify and correct the problems because the road the HSA is going will either close these institutions or expose them to massive amounts of litigation?

We know the biological agents within the health service that have gone out of control. We are not talking only about the baseline hospital acquired infections but about how they have gone out of control. Apart from the hygiene audit, has the Tánaiste and Minister for Health and Children any plans in place to assist facilities within the health service to draw up these risk assessments and to give the resources to correct the difficulties identified? For example, a decade ago hospitals stopped swabbing hospital workers to see if they had MRSA and therefore workers and patients have been probably more exposed to MRSA. I want to know what progress she has made in moving this matter of hygiene on a little.

Mary Harney (Dublin Mid West, Progressive Democrats)
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First, by way of clarification, there is no outbreak of tuberculosis. The report mentioned in newspapers today is three years old and the figures mentioned are for a five-year period.

I recently communicated with Professor Drumm on MRSA in hospitals and on informing patients and putting strategies in place. It is the intention of the HSE — it is currently doing this in some cases — to work with hospitals one by one on the issues that arose in hygiene. Of course hygiene has a part to play and hand-washing has a part to play, and so too has appropriate prescribing of antibiotics and isolation facilities. A host of issues arise. The intention is that the HSE will work with the hospitals on these issues.

This morning Deputy Ó Caoláin asked me about visiting hours. It is not a matter for me to decide hospital visiting hours and we certainly will not introduce legislation in that regard, but the best hospitals in the world restrict visiting, except in the case of terminally or seriously ill patients where clearly one would want their families to have access. Many hospital employees, and indeed patients I know from my circle of friends and acquaintances, have told me that if one is sharing a room with others in hospital and there are visitors constantly in the ward, it is difficult to get the required rest. The more we can control visiting times in hospitals, the better. In addition to the issues for staff and patients, there are also significant issues from a hygiene perspective.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I welcome the reference by the Tánaiste and Minister for Health and Children, Deputy Harney, to the earlier question I put to her. While that may be the experience in the circle of acquaintances to whom she has spoken, would she recognise that others may have a very different experience and that the visiting opportunities of people is an integral part of the curative process of those who are ill and hospitalised? Real concerns are being expressed, particularly, in the cases I have noted, by family of older long-stay patients. This is causing great concern.

There is every argument for particular straightening of visiting opportunities but restrictive curtailment on the back of the MRSA issue — the two are linked — suggests that visitors were the cause or the most significant contributing factor to the presence of MRSA in hospitals. That is not the case, and it is dumping on visitors. Visitors are an integral part of the address of any illness that a hospital patient may present with. It is simply not acceptable to look to that as the panacea for MRSA or to distract from the other major contributory causes such as the standards of cleanliness, upkeep and maintenance. I appeal to the Tánaiste and Minister for Health and Children to look again at this. It is the wrong course to take.

John Gormley (Dublin South East, Green Party)
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The Tánaiste and Minister for Health and Children mentioned the necessity for isolation units. Would she agree with the assessment of Dr. Sam McConkey, an infectious disease consultant at Beaumont Hospital, that the facilities are just not adequate? Can she comment on the fact that two of Dublin's biggest hospitals, St. James's Hospital and Beaumont Hospital, have no isolation units at all?

Mary Harney (Dublin Mid West, Progressive Democrats)
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I am not familiar with Dr.McConkey's observations. First, to refer to Deputy Ó Caoláin's comments, of course I am not suggesting there would not be any visiting but it is unreasonable to have virtually open door visiting from maybe 10 a.m., and sometimes earlier, until 10 p.m. That is difficult for staff but particularly for patients. Certainly in places where patients are sharing rooms, it is extraordinarily difficult.

Policy on patients differs. I remember as a child being in hospital and my parents were told not to come and see me until the end of the treatment, and apparently they looked in the window. Nowadays parents are encouraged to come and stay with the children. In the period since I was born the position has changed.

Seán Power (Kildare South, Fianna Fail)
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Deputy Harney has got over it.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I have got over it. I have forgiven them.

John Gormley (Dublin South East, Green Party)
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I had a similar experience.

Mary Harney (Dublin Mid West, Progressive Democrats)
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Policies change. The new paediatric facilities must provide for parents to stay with the children. Policies change in this area all the time.

Certainly I am told by many people at hospital level, and I know from patients, that there can be difficulties if there is open access. Confining visiting times to particular hours, if that is possible, is in everybody's interests.

Clearly we must do more about isolation facilities. They say the hospital of the future will have single rooms. One can imagine the cost, both in terms of the provision of hospitals of that kind and of the staff implications of such hospitals. I understand that will be the global norm a number of years from now for issues to do with infection and appropriate patient treatment. We are providing increased isolation facilities in new facilities being built and that must be the norm in new facilities.