Dáil debates

Thursday, 2 March 2006

Adjournment Debate.

Infectious Diseases.

3:00 pm

Photo of Caoimhghín Ó CaoláinCaoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I sought this Adjournment debate on learning of the revelations in a study that shows a significant increase in TB infection in parts of Dublin. This has been highlighted and has caused serious concern. The increase shows the inadequate hospital treatment provision for TB patients in the wake of the grossly irresponsible closure of the chest and respiratory unit, commonly known as the TB unit, at Peamount Hospital. The Government facilitated that closure. There is an urgent need for the Tánaiste and Minister for Health and Children to outline the measures she will introduce to address this threat to public health.

According to the study carried out by Dr. Margaret Hannan, consultant clinical microbiologist at the Mater Misericordiae Hospital, young working Irish men are increasingly at risk of contracting TB. The research looked at all of north Dublin and found evidence that people who had recently picked up the infection were young Irish-born males who were in employment and living in urban parts of Dublin. Margaret Hannan stated: "One of the things we found was that they were all living in certain areas and all drinking in certain pubs. That is indicative of poor TB control in the country and that could be the beginning of an epidemic outbreak."

There were 437 cases of TB provisionally notified in 2004. In 2003, 407 cases were notified and the figure for 2002 was 400. This is a very worrying trend and this is underlined by this latest study. Dr. Hannan has warned that there is a danger of an epidemic outbreak if urgent steps are not taken to control the disease. She says there is poor infrastructure in Ireland for the management, control and prevention of TB. She also said: "The closure of Peamount has taken away a service that was essential."

When the threat to close the TB unit at Peamount first arose, I wrote to the then Minister for Health and Children, Deputy Martin as follows:

I write to convey my concern at the decision of the Board of Peamount Hospital to discontinue Chest/Respiratory Services. I understand that it is intended that all chest hospital activity will cease from January 2004 and the services will be transferred to St. James Hospital.

You will already be aware that there is grave concern among staff and patients at the proposal to close the long-established and specialised TB ward at St. Ita's, Peamount. I have received very worrying representations from nurses' representatives and from a patient at Peamount. I believe they show clearly the excellent work done in this unit over many years and continuing to this day. There is particular concern that the special care provided to more vulnerable TB patients in Peamount could not be provided if the service is moved to St. James's.

I believe that this is not just a matter for the Eastern Regional Health Authority but, given the central role of Peamount in the treatment of TB in Ireland, is of national importance. Therefore I urge you to intervene directly to have the decision to cease Chest/Respiratory Services at Peamount reversed.

The Minister of State's colleague did not intervene and the unit at Peamount was allowed to close. The promised facilities at St. James's Hospital have not materialised and now we have a study showing an increased threat from tuberculosis. There is concern internationally at new and more virulent strains of tuberculosis. This is a very worrying situation and we are less well equipped today to deal with it than we were three years ago. I call on the Minister responsible to restore the unit at Peamount and to provide a national action plan to combat tuberculosis.

5:00 pm

Photo of Brian Lenihan JnrBrian Lenihan Jnr (Dublin West, Fianna Fail)
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Gabhaim buíochas leis an Teachta. Tá mé ag tabhairt freagra ar son an Tánaiste agus Aire Sláinte agus Leanaí, an Teachta Harney.

Deputy Ó Caoláin has called upon the Minister to act but she would have to embark on consultations with the Health Service Executive to address the issue. The Department has not, as yet, received the report referred to by Deputy Ó Caoláin. The Minister has asked the Health Service Executive to furnish a copy and it will be examined by the chief medical officer of the Department upon receipt. However, I understand from the executive that the data used in the report referred to by the Deputy is a number of years old. I and the Health Service Executive would like to reassure the public that there is no outbreak of tuberculosis in the north inner city area of Dublin and that there are no major concerns in this regard.

The Health Act 1947 and the Infectious Diseases Regulations 1981, as amended, provide the legislative basis for the control of infectious diseases, including tuberculosis, in Ireland. The Department's strategy in the prevention and treatment of tuberculosis is guided by the recommendations of the report of the working party on tuberculosis, published in 1996, which covers a wide range of issues, including epidemiology, surveillance, screening, preventative therapy, clinical management and laboratory diagnosis. Responsibility for the implementation of the recommendations rests with the Health Service Executive.

The future organisation and delivery of respiratory and tuberculosis services was examined by Comhairle na nOspidéal in a report published in July 2000. This report found that, in line with major advances in medical treatment, the optimal inpatient care of patients with respiratory diseases, including tuberculosis, is more appropriate to acute general hospitals, staffed by consultant respiratory physicians and other consultants and supported by an array of investigative facilities. While recognising the valuable role which Peamount Hospital had played for many years in the delivery of respiratory services, Comhairle na nOspidéal did not regard it as an appropriate location for the future treatment of tuberculosis patients, especially those requiring ventilation and specialised treatment for other illnesses, for example heart disease, HIV and so forth.

Comhairle na nOspidéal subsequently appointed a committee to advise on the implementation of the 2000 report. The report of this committee endorsed the recommendations in the 2000 report and it was adopted by Comhairle na nOspidéal in April 2003. Specifically, the committee recommended that Peamount Hospital should play an active role in the provision of a range of non-acute support services, including pulmonary rehabilitation, within the Health Service Executive south-western area. For example, it recommended that patients who have been treated in the nearby St. James's Hospital and other major acute hospitals and who require ongoing rehabilitative care could be transferred to Peamount Hospital for completion of their care. In addition, three specialist tuberculosis beds for multi-resistant and complex tuberculosis patients are due to open in the coming weeks in St. James's Hospital.

The Health Service Executive eastern regional area established a working group on tuberculosis services in the eastern region and respiratory services in the Health Service Executive south-western area. The group examined the options for the future management of tuberculosis, both acute and non-acute, in the eastern region. It also addressed and identified other respiratory services that might be appropriately delivered in Peamount Hospital, taking account of best practice. The group consisted of a respiratory physician, a specialist nurse and the director of nursing from Peamount, a management representative from the hospital, general practitioners, a public health specialist and an accident and emergency representative. The group reported to the Health Service Executive eastern region in early 2005. It endorsed the recommendations of the working party report of 1996 and the subsequent Comhairle na nOspidéal report.