New Clause 1 — Infection control standards
Mr Paul Burstow (Shadow Secretary of State for Health, Health; Sutton and Cheam, Liberal Democrat)
I support the new clause; it is useful and would improve the Bill. It also enables us to explore a little further some of the issues discussed outside this place last week, in conversations on the GMTV sofa and following the publication of the NAO report.
In my intervention on Mr. Lansley, I referred to "Towards cleaner hospitals", because it struck me as symbolic of the true content of the document that neither of the two copies sent electronically to my office could be opened, so one could not see what was new about the Government's announcements. I fear that as we examine that document in greater detail we shall find that there is almost nothing—if anything—new and that it was merely a ragbag of recycled announcements brought together to provide some cover in a particularly embarrassing week, before the publication of the NAO report last Thursday and, subsequently, of the latest MRSA figures. The figures were brought forward so that they could be published on the same day as the NAO report, thereby conflating them with it and obscuring their importance. I am, therefore, sceptical about what the Government proposed on Monday.
My scepticism was reinforced by the fact that I understand that the hon. Member for South Cambridgeshire quite properly sought to secure an urgent question to enable the matter to be discussed, but that his request was declined for various reasons. Indeed, no written statement was made to the House. My understanding of the conventions—I may be wrong; if I am, I am sure I will be put right—is that new policy and substantive changes in Government policy must be announced first in the House, not on the sofa of GMTV. Therefore, one can only conclude charitably that the Secretary of State for Health has not announced a new policy to deal with the threat of hospital-acquired infections. The hon. Member for South Cambridgeshire gently discussed the reasoning and rationale behind the publication of the document on Monday, but its publication was very much about managing the fallout from a very negative report that examined the Government's progress since 2000, when the NAO first considered the issue in detail and made its comprehensive set of recommendations to the Government.
I want to explore one or two of the issues in the report that fit very nicely with the standard-setting responsibilities that the new clause would give the Health Protection Agency. It is right that a body with a deal of independence from Government has the responsibility of becoming almost the critical friend when it comes to such issues. Only a couple of weeks ago the Health Protection Agency set out the scientific basis for some of its concerns and what it saw as the links between bed occupancy rates and hospital-acquired infections—something that is reiterated and borne out in the NAO report.
"The Agency shall draw up and consult on a protocol with the Commission for Healthcare Audit and Inspection to collect and publish information concerning the performance of NHS organisations in controlling healthcare-acquired infections."
The Minister said that that was unnecessary because it would be covered in the star ratings. The criticism in the NAO report, which relates to the Government's attempted rebuttal of my amendment in Committee, seems to be that the star-rating system is much more focused on process than on outcomes. In other words, people can tick all the boxes, adhere to all the guidelines and have wonderful policies lining the shelves of the infection control team's office, but whether or not people still pick up infections and get sicker in hospital would not count in awarding the star ratings. Surely that must be the litmus test of whether the NHS is getting to grips with the problem of hospital-acquired infections, irrespective of whether those involved have ticked all the boxes and have all the manuals in place.
The report "Winning Ways", which was published last December, shows that, according to currently available data, the Government have achieved only a small improvement. I hope that the Minister will be able to explain that and say what will be done, in concrete terms, to change it. That small improvement was mentioned not only in "Winning Ways", the chief medical officer's report, but in the Commission for Health Improvement's findings. In its annual report, published in May 2003, the commission concluded that it
"had seen few examples of notable practice in infection control; good policies did not always exist and, even when they did, they were often not followed sufficiently well to make them effective."
The new clause proposes a mechanism to ensure that the standards are grounded in good practice across the NHS.
The NAO refers at paragraph 2.21 of its report to the fact that it undertook a survey in February to evaluate the implementation of a number of aspects of the Government's policies. It found that trusts expressed concern that, for example, the only people who could undertake the role of the new director of infection control in hospitals were the existing infection control doctors. There still seems to be a great deal of uncertainty and lack of clarity on the ground about the precise remit of infection control directors. I hope that the Minister will be able to shed some light on that.
One of the most worrying findings was contained in paragraph 2.25 of the report. Almost one in four NHS trusts—24 per cent.—said that they had cut their budgets for infection control since the NAO last looked at the issue in 2000. That is an extraordinary finding, and I hope that the Government were sufficiently disturbed by it to make their own inquiries through the strategic health authorities and so forth.
Another figure struck me when I read the NAO report, and its significance was reinforced by representations that I received last week from the Infection Control Nurses Association, which feels rather shut out from the Government's latest set of announcements about how to take forward the fight against infection. Paragraph 2.32 of the NAO report states:
"Twelve per cent. of infection control teams reported that their recommendation to close a ward or hospital to admissions for the purpose of outbreak control was refused or discouraged by their chief executive. Two per cent. of teams also reported that their strategic health authority had refused or discouraged their recommendation."
One of the points that the Infection Control Nurses Association strongly put to me was that it feels quite insulted by the idea that the best way to solve the crisis of infection within the NHS is to fly in experts from abroad when there are experts in our country who are not being adequately used, sufficiently consulted or given the authority on the ground to do the job. It is strange that, four years on, the NAO is yet again having to recommend in its report that it should be mandatory that infection control teams are consulted on the letting of a range of contracts from cleaning and laundry to catering. It is disturbing that, when it comes to their judgment being applied with regard to the risk of infection and outbreaks, those teams are being turned down, presumably because of concerns about hitting targets.
The hon. Member for South Cambridgeshire mentioned the NAO report's remarks on chief executives. It said:
"Almost 50 per cent. reported that waiting times for inpatient treatment had caused conflicts, one third that trolley waits in accident and emergency departments caused conflicts, and one in ten experienced difficulties in reconciling the management and control of hospital acquired infection with other targets."
The truth is that the Government's obsession with targets—the targets and tick boxes that they have so many of nationally—gets in the way of, and conflicts with, the objectives of trying to contain and prevent infection. That is not my view; it is the view of NHS managers and staff articulated through the NAO report. It is no wonder that on Monday the Government were keen to do all that they could to cast a shadow over that report so as to obscure its findings.
The report's findings on bed occupancy are also worth commenting on, and I hope that the Minister will address them. When the Government responded to the NAO report and the Public Accounts Committee on this matter in 2000–01, they basically said, "Don't worry; it will be sorted out because we will make a massive investment in the NHS so there will be more beds, more staff and bed occupancy rates will come down." However, we now know from paragraph 2.34 of the NAO report that the reverse has happened: bed occupancy rates have gone up. In answer to a parliamentary question that I asked, I learned that, according to the Department of Health's hospital activity statistics, whereas bed occupancy rates were 80.8 per cent. in 1996–97, they rose to 86.5 per cent. by 2002–03. That is a significant increase, well above that which the Health Protection Agency seems to think would be appropriate and certainly well above that which the NAO recommends in response to the representations that it has received.
On the Bill's Second Reading, I raised some questions about surveillance, which go to the heart of how to ensure that standards really are bedding down and having traction on the problem. I asked the Under-Secretary of State for Health, Dr. Ladyman, to outline the timetable for the roll-out of the surveillance of other types of hospital-acquired infection, because I understand that MRSA accounts for only 44 per cent. of such infections. Subsequent to that, the NAO report makes interesting reading, because paragraph 3.5 states:
"Instead of developing mandatory specialty specific surveillance of bloodstream, surgical site and urinary tract infections whose information would be fed back to clinicians to improve practice, the Department focussed on trust wide surveillance of MRSA bacteraemias and other specific organisms, together with plans for mandatory reporting of orthopaedic surgical site infection."
Although the hon. Member for South Cambridgeshire is right to say that it would be an engine for choice if people had information and a clearer idea of the worst hospitals for infection, surely the key is to provide clinicians with information in such a way that they may identify how mistakes are made so that practice can be changed. The current system does not do that. Indeed, the scariest statistic from the report is that 18 per cent. of infection control teams fail to carry out any surveillance activities other than the mandatory MRSA bacterium surveillance. No other activity is going on in many of our trusts to find out which parts of hospitals are experiencing the worst rates of infection so that real feedback may be given to clinicians to enable them to change practice and save lives.
I hope that the Minister will tell us how the Government, at long last, are ensuring that the succession of initiatives and announcements—recycled, re-announced and so on—are beginning to have a real effect on the NHS. Will she also tell us when the Infection Control Nurses Association will have the opportunity to meet Ministers to discuss its worries about Monday's announcement and the NAO's findings, and talk about how it may help the Government to crack the problem of infection?