Margaret Cox (Fianna Fail)

I wish to speak about my experience when I was a member of the former Western Health Board. A number of the hospitals in the Western Health Board region which are old and have poor facilities are open territory to allowing the spread of MRSA or encouraging it to develop even further. Merlin Park Regional Hospital, the acute orthopaedic hospital for the region, was built in the early 1930s or 1940s at which time it treated TB patients. The facilities have not been improved since the hospital was built. Private and semi-private rooms and wards in the hospital do not have ensuite bathroom facilities. In the long wards or even private rooms, where patients are isolated if MRSA is detected, patients have to use the toilet facilities available or a commode, in which case they have to wait for it to be taken away, emptied and disinfected. To tackle the problem of MRSA, it is vital to identify the accident blackspots in terms of facilities in our hospitals and to put in place a radical plan immediately to address these needs.

While I am only familiar with the facilities in Merlin Park Regional Hospital, I am sure there are many other hospitals with similar facilities where commodes are used and a cleaning and disinfectant regime is in place. The facilities in such hospitals need to be upgraded as a matter of urgency and from a health and safety perspective not only for the staff but most especially for the patients. The Minister said it is important to ensure that people do not go into a hospital and become sicker in hospital than they were before they went in. It is within our remit to deal with that and to ensure patients are treated properly and this bug is contained.

Examples of best practice in other places on the Continent and in the UK were mentioned and there are many lessons to be learned. I had a conversation only yesterday evening with a person who is working at the coalface in a hospital. This person spoke about the difficulty of dealing with MRSA, managing cleaning and, importantly, the huge burden on staff of paperwork involved in the carrying out of hospital audits. Staff spend increasingly more time dealing with paperwork. There is more paperwork, plans and fancy words but hospitals are not any cleaner and we are not eradicating the bug. Therefore, we are not solving the problem.

From a cost point of view, the focus in hospitals over the past ten to 15 years has been on outsourcing non-essential and non-core activities. Cleaning has been outsourced to cleaning companies. We are attracting many non-nationals, many of whom do not have good English, and many of them work for contract cleaning companies where the rate of pay is quite low. This is the only type of work many of them can find to survive. These people often do not understand the instructions they are given, the importance of the work they must do and the fact that they are operating in a life-threatening environment if they do not do their work properly.

The Patient Focus website provided some advice on MRSA. It stated that if there is dust or dirt under a person's bed, that person should ask for the area to be cleaned. The problem is that patients are dependent on the people around them and they can feel very vulnerable. It is very difficult for them or their visitors to request that areas be cleaned around them. They do not want to be seen as moaners by the nursing staff. It is difficult to have the courage to say to the nurse that the area around one's bed is filthy and disgusting or that the bathroom is just not clean enough. It is difficult to deal with that situation and we must push the responsibility back to the providers of the service, be they the internal management or the contractors if it is outsourced. They are responsible for the quality and they must ensure it is 100% all of the time.

It will also be necessary for the Health Service Executive to provide a central training budget for the training and education of people working in this area, especially those who provide the service and clean the floors. Nobody can work on a building site without a FÁS Safe Pass. No cleaning contractor or staff employed directly by the HSE should be allowed to provide a cleaning and hygiene service in a hospital without having undergone a certified training course similar to the Safe Pass. In this way, they would understand the implications of not doing the job properly. If people knew that not doing their job properly could cause the death of a person, they would recognise their responsibility. If we do not show people their responsibility, we cannot expect them to understand how important it is that they do their job to the highest standards.

As the Minister said, the focus must be on education but also on training and development for those doing the job. We all agree it is about hygiene and cleanliness. I was recently in the Mater Hospital and there were gel containers everywhere for cleaning one's hands. However, I felt at one stage that I was the only person using them as I went from one department to another. It certainly did not seem as if they were being used by the porter staff, the nursing staff, the contractors or the people delivering the food. I spent up to three hours sitting in the outpatients department with someone, and this opened my eyes to the inattention that people displayed to the possibility of cross-infection.

We have a big job to educate the public, patients and management within hospitals. We also need to give them resources because they cannot do anything otherwise. Providing resources is vital in controlling and limiting this disease. If lessons are to be learned from best practice abroad, we need to learn them. There is no point in re-inventing the wheel.