Dear Joe

Three years ago, cystic fibrosis (CF) campaigner Anita Slowey first contacted Joe Duffy on Liveline to stress the need for a purpose-built CF unit at St. Vincent’s Hospital* which would provide en-suite single rooms, to prevent cross-infection from other patients.

In October 2010, having endured a further 3 years of broken promises from the HSE, Anita again emailed Liveline to describe the hospital conditions that she was still in. Her deeply moving email was highly successful in drawing attention to the plight of CF sufferers in Ireland.

Anita wanted to be a journalist, she lived as normal a life as she could but the odds were stacked against her. She died in St. Vincent’s Hospital last Monday, aged just 24 years.

The conditions in which Anita was treated, directly contributed to her death. Cross-infection and multiple infections resulted in the bugs that caused the infections in her body, becoming stronger and harder to fight.

Out of the hundreds of antibiotics used to treat her disease, she ended up only sensitive to one. This is as a direct result of being exposed to other patients and their germs.

The HSE’s abject failure to provide proper isolation facilities, directly cost Anita her life. Yet another failure of our grossly mis-managed health service yet no-one in the HSE will ever be held accountable.

The contract to build a €20m specialised CF unit at St Vincent’s Hospital, with en-suite single rooms for 34 patients, was finally signed last October and the promised unit is due to be completed in April 2012.

While this is too late for Anita, her brave decision to campaign on behalf of CF patients, has ensured that others will not have to suffer the conditions which she endured.

May she rest in peace.

Below is an extract of the email that Anita read out on ‘Liveline’ last year, which has now been put to a piece of music that she loved…

*St. Vincent’s University Hospital, Dublin  is the national referral centre for adult patients with cystic fibrosis.

A National Disgrace

I can’t remember when I last felt so passionate about something.

I don’t have cystic fibrosis (CF) nor am I related to someone who has, but that hasn’t stopped me feeling very angry about the lack of government commitment to the cystic fibrosis community in Ireland. While the Celtic Tiger roared in this country, young adult CF patients were left to suffer in conditions which continue to be described as dangerously inadequate. Many have died prematurely because of the failure of our government to provide them with the care and facilities needed. The plight of the adult cystic fibrosis sufferers in Ireland, is a national disgrace.

Ireland has the highest incidence of cystic fibrosis in the world and should have facilities and services that reflect this unenviable position. Instead of being a world leader in CF care, we fall way below the European recommended standards. The average life expectancy for a CF person in Ireland is the lowest average in a first world country.

The needs of the CF community are straight forward. They need funding to be provided for a dedicated cystic fibrosis unit with fully-trained staff who are knowledgeable about the disease; they need isolation in en-suite rooms where they don’t have to worry about the risk of cross-infection; but perhaps most of all, they need reassurance that when they require hospital care, they will be provided with the means to survive. Is this not the right of every citizen of Ireland?

Cystic fibrosis sufferers are some of the pluckiest people you will ever meet. Why? Because they have been born with a life-threatening inherited condition which leaves them fighting to breathe. CF primarily affects the lungs and the digestive system and becomes more severe with age. They are very susceptible to serious infection and as a result, they require frequent hospitalizations for treatment.

In other countries, CF in-patients are treated in single en-suite rooms to reduce the risk of cross-infection. In Ireland, adult CF sufferers risk potentially life-threatening infections every time they are admitted to hospital as we do not have a purpose-built unit in which to isolate them from other patients, as well as from each other. CF patients are not supposed to interact because of the risk of cross infection.

The plight of adult cystic fibrosis sufferers was laid bare on Liveline last week as outrage mounted about the appalling services provided for those affected. One CF patient after another and their relatives, described the appalling conditions to which they are subjected while waiting for a specialist unit to open at St. Vincent’s Hospital in Dublin, the national adult referral centre for CF patients in Ireland. A common thread to all the stories was that while CF patients are receiving excellent medical and nursing care at St. Vincent’s hospital, the conditions are far from ideal. They are being admitted to 6-bed wards where the nurses are not specifically trained in CF care and where they are exposed to cross-infection and constant exhaustion from being in a shared room. Rest and sleep are paramount when fighting a serious chest infection.

An independent review of CF services in Ireland by Dr R.M. Pollock, published in 2005, found that most adults with CF were being treated in facilities that were understaffed and dangerous. The Health Services Executive (HSE) responded by establishing a multidisciplinary Working Group to undertake a wide-ranging review of the current infrastructure for CF in Ireland. It took the Working Group until 2009 to publish it’s own Report on Services for People with Cystic Fibrosis in Ireland which simply endorsed many aspects of the Pollock Report.

Five long years have now passed since the conditions for CF patients were described as dangerously inadequate and very little has changed. Is it any wonder that they are demoralised about their plight and cynical about the many false promises from the HSE?

Following the public outcry last week, it was announced that building work on the long-delayed cystic fibrosis unit at St Vincent’s Hospital, is expected to start next Monday following the signing of the contract on Friday. The unit, which will be in a five-storey, 100-bed hospital block of which two storeys and 30-35 beds in individual ensuite units, will be developed exclusively for cystic fibrosis sufferers. It will be mid-2012 at least before the doors are opened. I won’t believe it until I see it happen.

Meanwhile, the wait goes on…

Further information:  The Cystic Fibrosis Association

Patients are a nuisance

Whatever savings and cutbacks are having to be made in these harsher economic times, curtailments in the treatment of sick children are not something that most of us are prepared to tolerate. As the HSE continues to push for efficiencies in the public system, many children in this country are being denied treatment and more and more problems are arising in terms of patient care.

Our hospital system is breaking down as the basics simply aren’t happening. The embargo on staff recruitment has resulted in operating lists (elective surgery) being cancelled without warning, out-patient appointments being cancelled and phones not being answered in many departments. Frontline staff are fed-up and disillusioned and many of the consultants are no longer advocating for their patients. The bottom line is… patients are suffering and it seems that even sick children, don’t count anymore.

If you think I’m exaggerating, have a listen to this interview with Professor Michael O’Keeffe, Consultant Ophthalmic Surgeon in Temple Street Hospital (a children’s hospital in Dublin). Thankfully, he’s not afraid to speak out.

Interview Credit:  ‘Today with Pat Kenny’ on RTE Radio 1.

Photo: Steph’s theatre gown, captured on mobile phone.

Red Alert

A new campaign to raise awareness among women of how to protect themselves from the risk of heart disease and stroke, begins this September led by the Irish Heart Foundation and supported by the Health Service Executive.

The campaign will focus on specific issues for women including healthy lifestyle behaviours, recognition of signs and symptoms of heart attack, stroke recognition and appropriate management of high blood pressure and high cholesterol as well as the impact of menopause on women’s heart health.

Dr Kate McGarry, Consultant Physician and Chair of the Irish Heart Foundation’s Council on Women and CVD said: “Every two hours a woman dies in Ireland from cardiovascular disease (heart, stroke and blood vessel diseases). When it comes to health issues, women are more concerned about breast cancer even though seven times as many women die from heart disease and stroke in Ireland each year. Our goal is to alert women that especially after the menopause, they are at risk of heart attack and stroke, as much as any man. But the good news is that a positive lifestyle can alter risk factors for cardiovascular disease. Go Red for Women is a wake-up call to every woman in Ireland to take care of her heart health.”

Medical Director of the Irish Heart Foundation, Consultant Cardiologist, Dr Angie Brown said: “The campaign also aims to highlight that the signs and symptoms of heart attack may be different for women to those of men. A woman may experience more vague symptoms such as nausea, tiredness, shortness of breath, rather than the more usual crushing pain in the chest. Unfortunately this may mean that women delay in getting to the hospital and therefore lose valuable time for the necessary treatment.”

Maureen Mulvihill, Health Promotion Manager from the Irish Heart Foundation said: “Throughout the month of September our charity, supported by the Health Service Executive (HSE), will promote healthy lifestyle behaviours so more women will know how to reduce their risk of cardiovascular disease (CVD) and will recognise the signs and symptoms of heart attack and stroke.

Red Alert – Key Message

* Enjoy life. Take time out for yourself and keep in touch with friends
* Be active – at least 30 minutes of aerobic activity 5 times a week
* Eat more fruit and vegetables and less fat and fries. Eat more fresh food and less convenience foods
* If you smoke, try to stop
* Go easy on alcohol –  no more than 14 standard drinks per week
* Have regular blood pressure and cholesterol checks with your family doctor
* Know your family history and know the signs and symptoms of heart disease

Information Source: Irish Heart Foundation

Failure To Diagnose

Headaches are a common symptom of many conditions and almost everyone will experience headaches at some point in their lives. Normally the average headache is nothing to worry about, despite the discomfort you might be experiencing. However, if you get a severe/sudden headache unlike any you have had before, you should always seek medical advice. Sometimes, a headache can be a warning of something serious that needs to be investigated so don’t delay in seeking help.

As I have a long history of chronic sinus infection, I’m well-used to getting headaches. I don’t panic when a headache occurs as I’m familiar with the signs and symptoms of acute sinusitis and have the necessary prescription medications to relieve the pain. However, if I develop a severe headache that I’m not familiar with/it continues to worsen, I will always seek medical advice. If the headache is considered a cause for concern, my GP/specialist will refer me for an urgent CT/MRI scan in order to rule out any serious cause. As I hold private health insurance, I rarely have to wait longer than 24 hours to undergo a scan. If, however, I had no health insurance and was a patient in the public health service, the story could be very different…

THE HSE has apologised before the High Court to the family of a young woman over deficiencies and failures which led to her death from a massive brain haemorrhage. The apology was part of a settlement of court proceedings.

“Louise Butler (21), Cappa Lodge, Sixmilebridge, Co Clare, died at Limerick Regional Hospital on November 16th, 2006, from a large subarachnoid haemorrhage, the court heard. She had worked as a security guard at Shannon airport.

Her family claimed the HSE had failed to properly diagnose she was suffering from the condition when she presented at the hospital just weeks earlier suffering with a serious headache.

Had she been properly diagnosed and referred for treatment after being admitted on October 6th, she would probably have survived, they alleged.

As part of the settlement yesterday of the family’s action for mental distress, the HSE apologised for the anguish and distress caused to the Butlers due to Louise’s tragic death.

The HSE also acknowledged there were failures and deficiencies which led to Ms Butler’s death and accepted her family did everything it could in the circumstances.

The settlement also includes a payment of €40,000 to Ms Butler’s family and was approved yesterday by Mr Justice Michael Peart. The action was brought by her brother James, Cappa Lodge, Sixmilebridge on behalf of the family.

They claimed they suffered mental distress and injury arising from their older sister’s death due to the HSE’s alleged negligence and breach of duty of care. The HSE had denied the claims.

The family claimed Ms Butler’s attended the hospital between October 6th-12th. It was claimed she was ill with a very substantial headache, which she had described as like “a hammer blow” to the back of her head, and photophobia.

She was discharged on October 12th without a CT scan being carried out. She was due to have a CT scan subsequently as an outpatient.

Despite the best endeavours of Ms Butler’s mother and the family GP it was claimed the scan was not arranged until November 13th. It was claimed Ms Butler never got the results of that scan as she collapsed the following day. The scan revealed she suffered a massive bleed in the brain and she died two days later.

It was alleged the HSE had delayed a CT scan which would have alerted medical staff to the existence of her condition. The family claimed their experts would argue, in October 2006, Ms Butler was suffering from a “sentinel” or “herald” bleed, which was a precursor to a large bleed.”

Information Source: The Irish Times 13/07/10

It’s Just Not Fair

It is a disgrace and a source of national shame that in 2010, in the country with the highest rate of cystic fibrosis (CF) in the world, we still do not have a purpose-built adult CF unit. An independent review of CF services in Ireland by Dr R.M. Pollock, published in 2005, found that most adults with CF were being treated in facilities that were dangerously inadequate. In reality, very little has changed since then for CF inpatients. The average life expectancy for a CF person in Ireland is a full 10 years lower than in Britain or the US, largely because of the failure to provide specially trained staff and sterile, en-suite hospital facilities. It’s just not fair that people with CF should be spending so much of their already short lives waiting for the most basic of services.

St Vincent’s Hospital, Dublin is the national adult referral centre for CF patients in Ireland. Last year, the HSE said that it didn’t have the money to go ahead with building a special 120 bed facility, with 30 en-suite rooms to cater for these patients. The public outcry that resulted, led our Minister for Health to declare that an alternative funding approach involving builders and banks, could deliver the facility as promised. This latest hold-up has come about as a result of a failure on the part of the Department to award a tender to construct the €40 million unit.

Orla Tinsley is a young woman with cystic fibrosis. For the past five years, she has campaigned vigorously for the provision of a dedicated CF unit. While receiving urgent medical treatment at St. Vincent’s hospital last week, she wrote the article below about her frustration that the designated site for the new facility remains empty…

“OPINION: The news that there has been further delay in the cystic fibrosis unit at St Vincent’s hospital in Dublin is disheartening, but hardly surprising, writes ORLA TINSLEY

Five years ago this month, my first article was published in this newspaper. I wrote about being an 18-year-old with cystic fibrosis treated in the national referral centre, St Vincent’s hospital. It was my first experience of sleeping in a room with senile and confused women who coughed, pooped and died in the room in which I slept.

I didn’t understand how the rules on cystic fibrosis care could change so much from a children’s hospital to an adult hospital. As a child I was not allowed to share a room with someone who had cystic fibrosis because of cross-infection.

In Vincent’s, sharing a room with another CF patient was a common occurrence until two years ago because there was no other space. I shared a room with a girl who also had CF and we became great friends over the summer months we were in there. We stood outside the hospital on the June bank holiday eating cool-pops and watching the mini- marathon go by. A month and a half later she was dead.

It was the first time I fully realised that CF is something you cannot control, although it takes a while to accept.

I ran the mini-marathon two weeks ago and finished in high spirits. When I sprinted past Vincent’s, I thought briefly of that day and was glad to be running. The next day I flew to Barcelona and lay on the beach, relaxing for five days. I had gotten over the previous rough summer of spontaneous lung bleeds that halted my life and made it impossible to plan anything. I had gotten over the collapsed lung last year and I started work, like any 23-year- old, which feels so great.

Then I got some shoulder pain: my lung had collapsed again. Had I trained too hard or done something wrong? My consultant said it was just one of those things that happens with cystic fibrosis.

Admitted to Vincent’s a week ago, I was put on 100 per cent oxygen to try and reinflate my lung and given painkillers. My medical team were incredible and I got a bed immediately.

For the first two days I shared a room with five other women on a ward where the staff did not specialise in cystic fibrosis. I was exhausted and filled with painkillers; I was not as aware as I needed to be. When I had to go for an X-ray, the nurse looking after me said I didn’t need oxygen to go along with my wheelchair. My oxygen saturations were good and it was a short trip.

I explained she was wrong, the oxygen was flushing the nitrogen oxide out and encouraging the lung to reinflate. We argued but I left without oxygen. I waited there without oxygen among patients who were coughing.

The ward sister apologised that I had been left without oxygen.

The distressing element of this scenario is that if I was in a unit with nurses specially trained in CF, this would not have happened.

I am just one person with cystic fibrosis and each person’s story is so individual. When I am not sick I work as hard as I can and I love my life. I know some day that that will end, things will get slower, I will spend more time lying in beds with various tubes.

I will be unable permanently to make that choice to get up myself and walk away from a screaming room-mate or a dying woman or drag all my medical equipment and tubing with me to sleep in the corridor, as I have done on previous occasions.

Not being able to access a single en-suite room when I needed one was not surprising, but it was frustrating. The lack of sincerity in the Government commitment to our dedicated CF unit is disheartening and degrading to the 1,300 people living with CF on this island.

There has also been no commitment to the number of beds that would be specifically ring-fenced for people with cystic fibrosis in the 100-bed unit that will treat many other illnesses.

We need 34 beds to deal with the daily intake of patients with cystic fibrosis. These beds cannot, as it has been suggested by those in charge, be given to other patients if people with cystic fibrosis are not there to take them.

We need cleanliness and exclusivity. We’re not asking for gold-plated oxygen tanks, we’re just asking those in power to help us stay alive in rooms that comply with international standards.

This litany of broken promises is embarrassing for Ireland. When I talk to patients or parents of young children abroad they are continuously shocked by the standard of care for CF patients here.

They have offered money to sort out our Irish mess.

I do not want to die in our Irish mess.

The eight single en-suite rooms at the national referral centre are not enough. We deserve single en-suite rooms when we present at hospital with a mild exacerbation or a painful, collapsed lung. It is the only way to get full quality treatment for most patients with multi-faceted cystic fibrosis.

People waiting on the transplant list deserve to be in single en-suite cubicles.

This time coming into hospital, I didn’t have to go through AE, but I will have to again. This time, no one used the room I slept in as a toilet or had MRSA or screamed throughout the night, forcing me to sleep in the corridor.

But it will happen again and is happening to other people with cystic fibrosis around Ireland who are exposed to life-threatening cross-infection as you read this.

The Pollack report was published in 2005. It  In reality, very little has changed since then for CF inpatients. When building eventually starts on the unit, it will take 14 months to complete.

We live in hope with a heavy dollop of cynicism, as always.

I walked by the site in the sunshine the other day during physiotherapy. It sits there, decanted and waiting, just like the rest of us.

If there’s such a thing as campaigners fatigue, I may be experiencing it. I have been writing the same thing for five years. It’s a depressing thought that I will be doing it for another five”.

I salute Orla Tinsley for writing this courageous article. It’s a damning indictment of our government’s appalling lack of commitment to CF patients who continue to be exposed to life-threatening cross-infection. The Irish political system is rotten to the core if it can allow this issue to continue. It’s just not fair!

Information Source: The Irish Times 25/06/10 and 26/o6/10 and The Cystic Fibrosis Association of Ireland.

The Buck Stops Here

For anyone who has ever been diagnosed with a missed miscarriage, I expect that this week’s news about miscarriage diagnosis may well have proved somewhat unsettling. This latest health scandal only emerged when a woman who was wrongly diagnosed with a miscarriage, decided to go public with her story to encourage women in similar situations to get a second opinion if they have any doubts.  About a dozen women have subsequently come forward with stories of having been wrongly told by maternity hospitals that they were carrying dead babies, only to give birth later to healthy infants. More than 150 people have contacted emergency helpline numbers since yesterday. Health Minister Mary Harney is continuing to refuse to comment on the issue, claiming that it is a matter for the HSE.

*”The HSE has been forced to instigate an investigation into all suspected miscarriage misdiagnosis cases over the last five years in an attempt to uncover the true scale of the growing terminated pregnancies scandal. The review will focus specifically on women who were recommended drug or surgical treatment (D&C) to remove what was in reality a perfectly healthy foetus. The nationwide examination will focus initially on complaints by the expectant mother at the time of the incident. It will also examine a growing list of new cases which have come to light this week, and further disputed cases which may or may not involve miscarriage misdiagnoses. The review will be confined to the past five years. ”

Many moons ago, I was diagnosed with a missed miscarriage at the end of the first trimester of my 2nd pregnancy, having contacted the maternity hospital for advice as I’d noticed ‘spotting.’ An ultrasound scan was carried out by my obstetrician at the hospital and I was told that the pregnancy had failed. Apparently, there was no heartbeat visible, just an empty embryonic sac with a diagnosis of a ‘missed miscarriage’ and a referral for a D&C the following day. At the time, a missed miscarriage was medically referred to as a ‘missed abortion’ and the subsequent D&C was referred to as an ‘evacuation of the retained products of conception (ERPC). Having arrived at the hospital as an expectant mother, I left in tears with those horrific terms reverberating around in my head. When I returned to the hospital the next day, no further scan was done to confirm the diagnosis prior to the D&C being carried out under general anaesthetic. Following this week’s awful revelations, I’m amazed that I never thought to question the diagnosis. I suppose times were different then.

Mary Harney should know better than to pass the buck to the HSE. After all, she is the Minister for Health and Children.

* Information Source: Irish Examiner

Back from Dead

This is a true story. Note the date the 999 call was made.

A pregnant woman who was clinically dead for 30 minutes has made a full recovery and is about to give birth thanks to the heroic efforts of a paramedic team.

Catherine Curran, said she owes her life and that of her unborn baby to a paramedic team from the Dublin Fire Brigade and the Health Service Executive (HSE), who were honoured for their efforts at the weekend.

The mother of three went without oxygen for 30 minutes and was given the last rites after suffering cardiac arrest due to Sudden Adult Death Syndrome (SADS) on September 9, 2009.

She was eight weeks’ pregnant when she fell out of bed and stopped breathing until an advanced paramedic team from the HSE was able to revive her heart using a defibrillator and adrenaline injection.

She survived the initial attack but her prognosis was bleak and she was left temporarily blind, paralysed and cognitively impaired due to brain damage she suffered during the ordeal.

But six months later, after extensive rehabilitation therapy, she has all but recovered.

She is now looking forward to the birth of her baby next month, whose development appears to be normal.

“My recovery is miraculous and everybody has said that,” Mrs Curran said last night.

“I was told that only 6pc of people survive SADS and only 3pc of those are left unscathed.”

“My obstetrician said: ‘This is unknown territory for me.’ They had never seen someone who was pregnant go through this before.”

Amazing

Ms Curran’s husband credits the swift action of the paramedic team for saving his wife and unborn child. “They did an absolutely amazing job. Every second is like hours for the potentially lethal damage to her and the baby,” he said.

He rang 999, which coincidentally corresponds to the date of the ordeal, and paramedic Joe Watson of the Tara Street brigade control room talked him through performing CPR over the phone, while a paramedic team rushed to their home.

They administered a defibrillator several times but Catherine continued to flatline until the combined effect of the defibrillator and injections revived her.

They then rushed her to Beaumont Hospital where she remained for two months after the ordeal.

The paramedic team, including Mr Watson and the five-man Dublin Fire Brigade unit and the HSE ambulance crew, were all given plaques for their efforts at a commendation ceremony on Saturday.

Dublin Fire Brigade Assistant Fire Chief Ritchie Hedderman said the brigade decided to honour the team after Mr Curran wrote him a letter expressing his gratitude.

“I was so impressed by the letter that I thought the fire brigade staff should be commended,” he said.

“It’s the first time we’ve had someone write back and say: ‘Well done, you saved my wife’s life’ and we thought we should reward them,” he said.

“It looked like a hopeless situation. But Mrs Curran is living proof that if you can get shock into someone soon enough, their chances of recovery are excellent.”

Information Source: Independent.ie – 30 March 2010.

An Unholy Mess

No, not my poor old head. I’ll tell you about that another day.

I’m talking about the latest controversy to rock the Irish health service. Yet another systems failure has emerged which directly impacts on patient care and safety. Am I surprised? Sadly, not one bit.

News emerged earlier this week that almost 58,000 x-rays taken over a 5-year period at Tallaght hospital in Dublin, were never reviewed by a consultant radiologist. Today, we hear that many thousands of GP referral letters lie unopened and unanswered somewhere within the bowels of the hospital.

Now everyone’s fighting over who’s to blame for these astounding revelations.

Consultant radiologists at Tallaght hospital say that over the past three to four years, they have written more than 40 letters to hospital management seeking extra staff to cope with the volume of work. They also say they warned management that there was a growing delay in reporting on X-rays but nothing was done.

The new CEO at  the hospital says that he only became aware of the problem when he was appointed in Decemberof last year.

The GPs in the area say that they’ve been aware for a long time of a major problem with regard to referral letters sent to Tallaght hospital.

Our Minister for Health is conveniently out of the country at a time when the health service is falling apart.

The Health Service Executive (HSE) is floundering around trying to restore public confidence in a health service that is on the verge of collapse from years of mismanagement and under resourcing.

There have been heated exchanges in the Dáil this morning over the lack of accountability for the mess.

The whole situation beggars belief. Patient care and safety have undoubtedly been compromised by this latest health scandal. The sad reality is that what’s emerged from Tallaght hospital this week, is only the tip of the iceberg.

Antibiotic Stewardship

Did you realise that at least 50 per cent of antibiotic use in Irish hospitals is inappropriate? One of the foremost concerns in modern medicine is antibiotic resistance. Antibiotics are the first line of defence against many infections but overusing or misusing them can cause more harm than good.

The HSE Health Protection Surveillance Centre (HPSC) has published an updated set of expert guidelines, to promote rational antibiotic prescribing in Irish hospitals. The recommendations range from the relevant structures and personnel that should be in place in all hospitals, to specific interventions that should be considered once essential structures are in place. The guidelines, if adhered to, will save money in the long run.

The Guidelines for Antimicrobial Stewardship in Hospitals in Ireland aim to cut antibiotic resistance and improve patient safety. They represent huge savings as the costs associated with people being infected with a resistant bug, can be enormous. Antibiotic stewardship, which implies quality prescribing, is distinguished from antibiotic control, which implies limiting use. The primary rationale for antibiotic stewardship is the prevention or reduction of antibiotic resistance.

The guidelines recommend the appointment of teams of clinical microbiologists, infectious disease consultants and antimicrobial pharmacists in every acute hospital across the country. Approximately 20 hospitals already have antibiotic pharmacists in place and these hospitals have seen the biggest reductions in antibiotic use. This scheme has the potential to make a real difference in the fight against hospital infections. I welcome it with open arms.