Brendan Ryan (Labour)

This is too serious an issue for me to make the sort of speech I usually make because I could beat the Minister over the head about the delays. I think it is a pity we may well end up trying to reinvent the wheel on this matter. I would have loved to have heard in the Minister's speech why her Department thinks the incidence of MRSA is so much lower in places like the Netherlands and Sweden. Have we sent people there to find out why? Have we identified a list of things which indicate why?

Who could argue with any of the things presented in the Minister's speech? However, what evidence exists indicating that the things presented in her speech are the things we actually need to do? I am sure there is some evidence but are all of these things being implemented in other countries? If so, and if they are successful, why did it take us so long to come to them?

I do not want to go back over other issues to do with the health service, but why are our hospitals not as clean as they should be? I find it astonishing that we must launch a personal hygiene campaign directed at people working in hospitals. When our children were small, and we were dealing with bottles at one end and nappies at the other, every one of us understood, without a huge public campaign, the possibility of infection if we did not operate to high levels of hygiene. I must assume, therefore, that it is not that doctors and nurses do not realise the risks; it is a lack of the necessary time, opportunity and freedom to operate best practice because they are under such pressure. I cannot prove this and I will not launch into a big speech on the matter. I must assume that the things obvious to every parent dealing with children at their most vulnerable are obvious to those working in health care.

I have heard a great deal of talk about quality assurance in this country and I have seen it in operation in third level education where it focuses entirely on the minions, the teachers. There is no quality assurance system for senior management in third level education. Real quality assurance starts at the top, as any textbook on quality assurance will tell you. It is the example of those at the top that convinces others of the value of quality assurance and changes it from being a weapon of management to make life difficult, as it is perceived, to a necessary part of doing a job as well as it can be done.

There is a great panoply of quality assurance measures relating to academic work and none relating to management. I must assume the same applies to the health service. No process of quality assurance applies to the work of middle managers and those who are somewhat higher in the public health service. If it did, we would know who is responsible, who is being paid a salary to take charge and who has tried to organise the relevant programme. One will never find out who is responsible for what in the hospital system but one will find out a lot about cross-over infections being carried by overworked nurses and doctors. What should be the subject of collective responsibility is turned into an adversarial set of circumstances in which those who deal with the dirty job of hygiene continually feel that what they are being asked to do is not remedying the problem. They are asked to fill out more forms and produce more procedures to which they do not believe those above them are committed.

Let us consider the issue of over-use of antibiotics. I am not a doctor and do not know much about this matter but I know some antibiotics are infection specific and others are broad spectrum. The recommended method of prescription is to identify the particular micro-organism causing the infection and prescribe a specific antibiotic. If my general practitioner, who is very good, wants to do this, he must have the test done in some laboratory. If he takes blood samples or other samples from me, I must bring them to the laboratory myself to have them analysed. There is no procedure whereby a general practitioner in Cork city can send samples to a laboratory to have them analysed. Nobody collects them so the patient must bring them. In the name of heaven, does anybody seriously believe a busy general practitioner like mine will go through the process of sending every sample he takes to the laboratory to have it identified to determine which antibiotic should be used? He will do the simple thing and write a prescription for a broad-spectrum antibiotic, which is guaranteed to increase the possibility of the evolution of antibiotic-resistant micro-organisms.

I do not know a lot about this matter but it seems that if we want to use antibiotics only when they are needed and use only those that are specific to certain infections, we must have a system that ensures that general practitioners, who are at the front line, can have samples analysed appropriately. Similarly, hospitals with large numbers of old people and public and private nursing homes should have such a system in place. Where an older person has a chest infection, for example, it is important to know what prescription is appropriate. As Senator Henry stated, there is not much point in prescribing antibiotics for a viral infection. However, if an infection requires an antibiotic, it should be known what type is required.

I am somewhat intrigued by the Health Research Board's research programme but I may well be wrong about it. Some countries have managed to curtail or reduce dramatically the incidence of health care associated infections. The Health Research Board is to research "enhanced cleaning processes and their impact on infections". If one asked the public about this, they would wonder why such research is required. The board is also to examine the "clinical usefulness of the rapid detection of MRSA". Are we suggesting it might not be clinically useful to detect it rapidly? The only reason for doing research is to determine whether an alternative procedure can be adopted. The board is also to consider "more intensive efforts to improve hand hygiene to achieve near 100% compliance with best practice". This means we will get people to use materials of the best quality when washing their hands. This is what everyone wants to do.