Tuesday Volume 34 14 October 2008 No 2 OFFICIAL REPORT (HANSARD) CONTENTS Ministerial Statement: Independent Review of the Outbreak of Clostridium Difficile in Northern Trust Hospitals [p47] Executive Committee Business: Social Security (Students Responsible for Children or Young Persons) (Amendment) Regulations (Northern Ireland) 2008 [p55] Private Members’ Business: Financial Pressures Impacting on Public Spending [p56] Private Notice Question: Teachers’ Strike at Movilla High School, Newtownards [p72] Private Members’ Business: Climate Change [p74] Omagh Bombing [p91] Adjournment: Promoting the Tourist Potential of East Antrim [p102] £5.00 Suggested amendments or corrections will be considered by the Editor. They should be sent to: The Editor of Debates Room 248 Parliament Buildings Stormont Belfast BT4 3XX Tel: 028 9052 1135 E-mail: [email protected] to arrive not later than two weeks after publication of this Report. This document is available in a range of alternative formats. For more information please contact the Northern Ireland Assembly, Printed Paper Office, Parliament Buildings, Stormont, Belfast, BT4 3XX Tel: 028 9052 1078 ASSEMBLY MEMBERS Adams, Gerry (West Belfast) McCarthy, Kieran (Strangford) Anderson, Ms Martina (Foyle) McCartney, Raymond (Foyle) Armstrong, Billy (Mid Ulster) McCausland, Nelson (North Belfast) Attwood, Alex (West Belfast) McClarty, David (East Londonderry) Beggs, Roy (East Antrim) McCrea, Basil (Lagan Valley) Boylan, Cathal (Newry and Armagh) McCrea, Ian (Mid Ulster) Bradley, Dominic (Newry and Armagh) McCrea, Dr William (South Antrim) Bradley, Mrs Mary (Foyle) McDonnell, Dr Alasdair (South Belfast) Bradley, P J (South Down) McElduff, Barry (West Tyrone) Brady, Mickey (Newry and Armagh) McFarland, Alan (North Down) Bresland, Allan (West Tyrone) McGill, Mrs Claire (West Tyrone) Brolly, Francie (East Londonderry) McGimpsey, Michael (South Belfast) McGlone, Patsy (Mid Ulster) Browne, The Lord (East Belfast) McGuinness, Martin (Mid Ulster) Buchanan, Thomas (West Tyrone) McHugh, Gerry (Fermanagh and South Tyrone) Burns, Thomas (South Antrim) McIlveen, Miss Michelle (Strangford) Burnside, David (South Antrim) McKay, Daithí (North Antrim) Butler, Paul (Lagan Valley) McLaughlin, Mitchel (South Antrim) Campbell, Gregory (East Londonderry) McNarry, David (Strangford) Clarke, Trevor (South Antrim) McQuillan, Adrian (East Londonderry) Clarke, Willie (South Down) Maginness, Alban (North Belfast) Cobain, Fred (North Belfast) Maskey, Alex (South Belfast) Coulter, Rev Dr Robert (North Antrim) Maskey, Paul (West Belfast) Craig, Jonathan (Lagan Valley) Molloy, Francie (Mid Ulster) Cree, Leslie (North Down) Morrow, The Lord (Fermanagh and South Tyrone) Dallat, John (East Londonderry) Moutray, Stephen (Upper Bann) Deeny, Dr Kieran (West Tyrone) Murphy, Conor (Newry and Armagh) Dodds, Nigel (North Belfast) Neeson, Sean (East Antrim) Doherty, Pat (West Tyrone) Newton, Robin (East Belfast) Donaldson, Jeffrey (Lagan Valley) Ní Chuilín, Ms Carál (North Belfast) Durkan, Mark (Foyle) O’Dowd, John (Upper Bann) Easton, Alex (North Down) O’Loan, Declan (North Antrim) Elliott, Tom (Fermanagh and South Tyrone) O’Neill, Mrs Michelle (Mid Ulster) Empey, Sir Reg (East Belfast) Paisley, Rev Dr Ian (North Antrim) Farry, Dr Stephen (North Down) Paisley Jnr, Ian (North Antrim) Ford, David (South Antrim) Poots, Edwin (Lagan Valley) Foster, Mrs Arlene (Fermanagh and South Tyrone) Purvis, Ms Dawn (East Belfast) Gallagher, Tommy (Fermanagh and South Tyrone) Ramsey, Pat (Foyle) Gardiner, Samuel (Upper Bann) Ramsey, Ms Sue (West Belfast) Gildernew, Ms Michelle (Fermanagh and South Tyrone) Ritchie, Ms Margaret (South Down) Robinson, George (East Londonderry) Hamilton, Simon (Strangford) Robinson, Mrs Iris (Strangford) Hanna, Mrs Carmel (South Belfast) Robinson, Ken (East Antrim) Hay, William (Speaker) Robinson, Peter (East Belfast) Hilditch, David (East Antrim) Ross, Alastair (East Antrim) Irwin, William (Newry and Armagh) Ruane, Ms Caitríona (South Down) Kelly, Mrs Dolores (Upper Bann) Savage, George (Upper Bann) Kelly, Gerry (North Belfast) Shannon, Jim (Strangford) Kennedy, Danny (Newry and Armagh) Simpson, David (Upper Bann) Lo, Ms Anna (South Belfast) Spratt, Jimmy (South Belfast) Long, Mrs Naomi (East Belfast) Storey, Mervyn (North Antrim) Lunn, Trevor (Lagan Valley) Weir, Peter (North Down) McCallister, John (South Down) Wells, Jim (South Down) McCann, Fra (West Belfast) Wilson, Brian (North Down) McCann, Ms Jennifer (West Belfast) Wilson, Sammy (East Antrim) NORTHERN IRELAND hamper the efforts to contain the outbreak. For that reason, its first phase review concentrated on the other ASSEMBLY four trusts. The review team produced an interim report at the end of May 2008, which I presented to the Assembly Tuesday 14 October 2008 on 3 June 2008. I have now received the final report, and I am making that available to Members today. The review included the following key elements a The Assembly met at 10.30 am (Mr Deputy Speaker review of extensive documentation provided by the [Mr McClarty] in the Chair). Department, the Northern Trust and the Northern Health and Social Services Board; a review of the Members observed two minutes’ silence. actions of the Department and the Northern Board on policy development, performance management, accountability and guidance provided to the Northern Trust; a review of all surveillance reports; and a MINISTERIAL StateMENT root-cause analysis of the outbreak. That analysis included an examination of the Northern Trust’s Independent Review of the arrangement for governance, infection control, prudent Outbreak of Clostridium Difficile in antibiotic prescribing, clinical care, and environmental Northern Trust Hospitals cleanliness and communications. That analysis covered three periods. First, the period Mr Deputy Speaker: I have received notice from up to 16 June 2007 — the day on which a positive the Minister of Health, Social Services and Public toxin sample for clostridium difficile was taken from a Safety that he wishes to make a statement on the patient in Antrim Area Hospital. A second sample that independent review of the outbreak of clostridium was taken from the same patient on 16 July 2007 was, difficile in Northern Trust hospitals. later, sent for culturing, and it was confirmed as The Minister of Health, Social Services and clostridium difficile ribotype 027 on 14 September 2007. Public Safety (Mr McGimpsey): I wish to update the Secondly, ribotype 027 was present from 17 June Assembly on the outbreak of clostridium difficile in 2007 to 7 January 2008, but that was before the Northern Health and Social Care Trust hospitals and clostridium difficile outbreak was declared. Thirdly, on the independent review of that outbreak. Members the period of the declared outbreak was from 7 January may recall that I made a statement to the Assembly on onwards. the review team’s interim report on 3 June 2008. The methodology consisted of two main parts: the I am pleased to advise Members that the outbreak is investigation of what happened, and the analysis of over and that the Northern Trust was able to declare why it happened. In its examination of the first period, that that was the case as of the end of August. the review sought to establish the level of preparedness From the outset, my top priority was to bring the for such an outbreak across Northern Ireland and in the outbreak to an end as quickly as possible and to ensure Northern Health and Social Care Trust. Members will that every effort was made to achieve that. That is why recall that the Northern Health and Social Care Trust I brought in the NHS’s cleaner hospitals team to assist was established in April 2007, following the merger of the trust. I am grateful to that team for its contribution, Homefirst Community Trust, Causeway Health and and, indeed, its support will continue well into 2009. Social Services Trust and United Hospitals Health and Social Services Trust. I also pay tribute to the staff in the Northern Trust who worked extremely hard over a long, difficult The review team found that the Northern Trust’s period to bring the outbreak under control. lines of accountability for infection, prevention and control were clear. The team did not consider that the The outbreak was declared in January 2008. In merger was detrimental in that respect, as there was February, I asked the Regulation and Quality significant continuity in staffing. Infection prevention Improvement Authority (RQIA) to carry out an and control were high on the agenda across Northern independent, rigorous review, the purpose of which Ireland. That was evidenced by the range of policies was to identify, as quickly as possible, the lessons that that were in place, such as the Changing the Culture needed to be learned from the outbreak so that they strategy, the antimicrobial resistance action plan and could be acted on. cleanliness audits. The Northern Trust was proactive in I made it clear from the outset that the review adopting those policies. It was the first of the new trusts should be conducted in such a way that would not to identify an infection prevention-and-control lead. 47 Ministerial Statement: Independent Review of the Tuesday 14 October 2008 Outbreak of Clostridium Difficile in Northern Trust Hospitals The review team found that clostridium difficile was provided support to the trust when the outbreak was being taken seriously across Northern Ireland. However, declared. A decision was quickly taken to manage the review found that