Seanad debates

Wednesday, 22 October 2014

Adjournment Matters

Hospitals Inspections

4:00 pm

Photo of Katherine ZapponeKatherine Zappone (Independent)
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I am asking the Minister to outline the response of his Department to the report on the unannounced inspection of Tallaght hospital, which was published by the Health Information and Quality Authority, HIQA, last Thursday. The report summarised the results of two unannounced inspections of Tallaght hospital in July and August of this year. The findings were disturbing and raised serious concerns relating to infection control, patient safety, basic hygiene and hospital maintenance. What is the Department of Health doing to ensure these matters are addressed efficiently, effectively and quickly? This is not the first HIQA report to flag health and safety concerns at Tallaght hospital. In 2012 an investigation highlighted issues relating to quality, safety, governance and care and, consequently, Tallaght hospital implemented many significant changes but I wonder whether the concerns have been addressed fully. The new report suggests more effort is required.
The July 2014 inspection found that Tallaght hospital had "insufficient clinical microbiology resources in place to routinely enable a timely response in the treatment of patients with serious inspections". That HIQA report also stated that frequently used patient equipment was found to be unclean, thereby posing a potential risk of inter-patient transmission of infective material. Hand hygiene has proven essential to patient safety and the prevention of hospital-acquired infections, as the Minister knows, but Tallaght hospital has failed to meet the national targets for hand hygiene set by the HSE for 2012, 2013 and those of the most recent audit of May 2014. According to the HIQA report, records provided to the authority after the July inspection show only 26% of all staff had attended hand hygiene training.
How will the Department ensure patients do not leave hospital sicker then when they arrived? Many people living in Tallaght and surrounding communities cannot afford to opt out of the public system and pay for private health care. How will the Department ensure such people do not hesitate to seek necessary medical care and guarantee a basic standard of patient safety for all those treated in public hospitals? We must address these problems before it is too late - patients and medical professionals are facing high risks and high costs. There is global anxiety relating to Ebola. Does the Department believe we can afford to wait to fix these issues that plague Tallaght hospital and the local community? Can we expect hospitals to cope with outbreaks if basic, routine standards of hygiene are not met?
I have discussed this matter with HIQA and the Irish Nurses and Midwives Organisation, INMO, and I feel the situation at Tallaght hospital is urgent. Basic hygiene issues can be efficiently solved with increased training, higher educational standards and routine environmental audits. Has the Department done anything to help Tallaght hospital meet hygiene standards? We must re-invest in Tallaght hospital after a long period of Government austerity as there are chronic staff shortages among medical professionals and in administration. These shortages must be addressed and I commend the hospital on its recent efforts to recruit staff following the report. The current demand in the local community for health services far exceeds the hospital's capacity to deliver - some wards are operating at 105% capacity when that figure should fall between 80% and 85%. Is the Department supporting the hospital to alleviate the burden of under-staffing and over-capacity?

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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I thank the Senator for raising this important matter and for the opportunity to update the House on the response to the recommendations of the HIQA report on the unannounced inspection of Tallaght hospital.
As Minister for Health, I take the prevention and control of health care associated infections very seriously and I welcome the publication of this report. Health care associated infections represent a major cause of preventable patient harm and, in some cases, death and increased health care costs. Since late 2012, HIQA has been carrying out a monitoring programme based on the national standards for the prevention and control of health care associated infections in hospitals throughout the country. On foot of these inspections, HIQA's reports provide an independent assessment of hospital hygiene and identify areas where hospitals need to improve.

On 17 July last the Health Information and Quality Authority carried out an unannounced inspection of Franks Ward and the William Stokes Unit in Tallaght and several of non-compliance issues were identified, including hand hygiene compliance, maintenance work programmes in the two wards and certain processes relating to infection control monitoring. I understand the hospital responded speedily to clarify the issues raised by HIQA and outline the remedial actions taken in response to the non-compliance issues identified.

On 28 August the hospital was re-inspected by HIQA to examine the level of progress made in the two clinical areas inspected in July. The recently published HIQA report acknowledges that overall significant improvements were observed during the reinspection in August, indicating that Tallaght is working towards addressing the issues raised in the first report. Positive steps include: hand hygiene training; a refurbishment and repair programme for the two wards subject to the inspections; commissioning a Legionella risk assessment; recruiting a specialist post to re-establish the surgical site surveillance programme; a local policy for the prevention of nosocomial invasive aspergillosis and the recruitment of a full time locum microbiologist to enhance the hospital's clinical microbiological services.

I understand that the application of these measures will be monitored as part of Tallaght hospital's ongoing quality improvement plan to ensure consistent progress on improvement. The hospital has further committed to resolving any outstanding issues relating to HIQA's report in the coming weeks. I am confident that Tallaght hospital remains fully committed to ensuring the highest level of compliance to the national standards for the prevention and control of health care-associated infections.

The role of the Department of Health is to put in place the correct policies, legislate for them and drive the programme for Government. Some years ago inspections like this never took place. When I was working in health care there was no HIQA or the authority was just starting off and hospitals were left to their own devices. Now, we have a far better situation because we have legislated for HIQA, the authority is in place and it goes in to hospitals and carried out inspections unannounced and holds them to account. Sometimes people read about these reports in the newspapers and may think it is a sign of a bad health service. Actually, in many ways it is a sign of a good health service because we now have a regulator that goes into hospitals, institutions for the disabled and mental health institutions to find out what is wrong, document it and then requires hospitals to act on the problems before going back to re-inspects them. This is a major improvement in our health services, although perhaps some people do not see it that way.

4:10 pm

Photo of Katherine ZapponeKatherine Zappone (Independent)
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I thank the Minister for his response. The Minister outlined how Tallaght hospital is responding to these reports and identified it as a good thing that these reports are being produced. It is helpful for the Minister to put on the public record the way in which the hospital is responding. This will offer support to the local community when they think about the hospital.
The inspections do not necessarily consider staffing capacity issues, they do not examine the problem or comment from that perspective. However, I appreciate in particular the Minister's comment on the recruitment of the specialist post as well as the other things that the hospital is doing. I trust the Minister's response will be part of a process of the communities re-discovering some of their positive connection with the hospital, and that is important.

Photo of Leo VaradkarLeo Varadkar (Dublin West, Fine Gael)
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I have worked in Tallaght hospital in the past and I did some of my training there. It is a hospital that I am very fond of. I have worked in the medicine for the elderly services and therefore I know the William Stokes unit well. I was there last month.
The fact that the hospital has hired a new microbiologist and has put in place additional resources is welcome.
It is important to put on the record that hand-washing and good hygiene cost nothing. In fact they save a considerable amount of money. We should never allow resources to be an excuse for bad hygiene - it is no excuse - and I know Senator Zappone will agree with me on that point. In my local hospital, Connolly Hospital, doctors do not get a parking permit until they have gone through training for hygiene and hand-washing. This has had a 90% percent success rate. Perhaps the idea could be pursued by other hospitals.
Reference was made to Ebola. Many groups have expressed concern about our preparedness for Ebola and the need to be prepared for it. We need to continue to respond to the evolving situation. However, there is one thing I am absolutely sure of: if we have Ebola in Ireland it will be one case or maybe two and it will be dealt with in maybe one hospital. Unfortunately, between now and the end of the year, many more people and patients will get sick, sicker or possibly even die as a result of hand hygiene, medication errors and senior decision-makers not being on the floor when they are supposed to be. I call on all those who have expressed concerns about how prepared we are for Ebola to ensure they are doing all the things they can do their workplaces to prevent damage due to common infections, perhaps, rather than worrying excessively about one that is very rare.

Photo of Katherine ZapponeKatherine Zappone (Independent)
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That is noted and well spoken. I thank the Minister for his leadership.

The Seanad adjourned at 5.45 p.m. until 10.30 a.m. on Thursday, 23 October 2014.