Clause 13 - Prevention and control of health care associated infections
Andrew Murrison (Shadow Minister, Health; Westbury, Conservative)
I beg to move amendment No. 104, in page 8, line 7, leave out ‘may’ and insert ‘shall’.
After seven days we have finished what many would say is the most exciting part of the Bill—in terms of public controversy, it probably is. However, we now move to other parts that are equally important. Certainly the issue of the prevention of hospital-acquired infection exercises many of our constituents. I am sure that in the next few hours we will have a good and fruitful debate on this part of the Bill in general and the amendment in particular.
We have discussed the difference between “may” and “shall” at considerable length, and I can almost predict what the Minister will say in response to the amendment. However, it is worth restating, with the indulgence of the Committee, the importance of “shall” as opposed to “may” in common usage. In the past few years, the Government have produced a raft of announcements and initiatives that have as their aim the control of hospital-acquired infections. It is important to make the point early in the debate that MRSA is just one of those infections—there is a great deal of confusion in the public mind and, I am sorry to say, in the minds of parliamentarians as well. However, there has been little in the way of results.
It is odd that we should be having this debate today, because this very morning the Healthcare Commission released its findings, having been commissioned to produce a report on the position that we have reached on hospital-acquired infections. I looked it up this morning on the website; it was embargoed until one minute past midnight, but it is there now. It makes quite uncomfortable reading. As it is so timely I hope that hon. Members will indulge me in saying a little about it. It is germane to the changing of one little word which would dramatically alter the emphasis of what the Minister is aiming at.
We should probably view the clause as bright idea No. 24 in the panoply of announcements that the Government have made on the issue. We are a little cautious and are mindful that bits of paper, announcements and good intentions do not clean hospital wards. They do not tackle the doubling of MRSA rates since 1997 or take us much further forward. We are left, I suppose, with the code that the Government want to introduce. It is important for us to try to beef it up and to tease out from the Minister what she wants it to achieve—the specifics.
The 23 previous announcements have been a catalogue of good intentions, but we and, more importantly, those on the front line have been left none the clearer about what people are supposed to be doing and how each announcement would materially affect the bottom line: reducing the toll from hospital-acquired infections, which currently runs at 5,000 deaths a year. That is more than the number of people who, tragically, die on our roads every year. A link seems to be missing. I fear from the wording before us that the code will be No. 24 on the list. We shall go no further forward unless the Minister is specific about what she is going to do. The proposed new section will permit the Secretary of State to introduce a code with, presumably, lots of good stuff in it, but we need to know what content the Minister wants and what she wants to achieve. We are none the clearer. It could be a code with all sorts of funny things in it that the Committee or the House might not think would move matters along.
The Minister will have noticed from our extensive list of amendments that we are attempting to beef up the code provisions, and you will have noticed, Lady Winterton, that our 10-point plan for improving the cleanliness of hospitals and reducing hospital-acquired infections has been, to an extent, transported into them. The plan resulted from a widespread consultation with those whose day-to-day lives are spent dealing with the problem. It seemed to us helpful, and was widely appraised and accepted, so we thought it reasonable to include it in the code. Many of the amendments reflect our 10-point plan and I hope that the Minister will discuss each one in turn and tell us why it should not be in the Bill, giving it some teeth.
The word “shall” puts an onus on the Secretary of State. We tabled the amendment because it is all very well to say that the Secretary of State may issue a code—we may all do all sorts of things—but we want something actually to be done. The Committee would, in passing the amendment, tell the Minister in no uncertain terms that something will be done. It would not give permission for it to be done on a discretionary basis in the future, but would tell her, “There is a real problem here. Please get on and do something, and bring out the code”, and ordain that she act. The amendment would up the ante a bit.
I know that the word “shall” has a particular meaning in parliamentary draftsmanship, and the Minister will no doubt tell me that “may” is more appropriate because of the way in which these things are drafted, but we must also consider the matter in terms of common usage. People out there who consider our proceedings might be baffled about announcement No. 24 and why the Minister is saying only that she may bring forward a code rather than that she will do so. That is the crux of this simple amendment. I hope that the Minister will tell us why she cannot accept this small change. She showed that she is capable of listening and, to an extent, of backing down—she listened in the debate that we have just had to my right hon. Friend the Member for North-West Hampshire and the hon. Member for Barnsley, East and Mexborough, who has just left. That is good and how things should work in Committees. I hope that she will reflect on our amendments to clause 13 in that vein, starting with this one.
My case has, coincidentally, been strengthened today by the Healthcare Commission’s report. The commission clearly feels that there is an ongoing, big problem despite the previous 23 announcements. I shall briefly inform the Committee about the content of the report, as I doubt many hon. Members will have had the chance to read it yet. I am a slightly tedious individual who gets in at 7 o’clock in the morning and has nothing better to do, and this morning I looked at my computer and picked up on the report, so I happen to have read it.
The commission looked at 99 hospitals and banded them, according to how clean they were, in bands 1 to 4. Thirty-three hospitals did very well and were placed in band 1, which shows that there is nothing to stop hospitals from aspiring to the highest standard of cleanliness. Forty-four hospitals were placed in band 2, and 23 in bands 3 and 4, of which a large number were those concerned with mental health.
The Minister will probably point out that those hospitals are not surgical hospitals—which care for people who are acutely unwell and are a particular case in point. We need to be clear that the risk to people is proportionate to the nature of the intervention that they are undergoing or to their condition. Most of us would not pretend that mental health patients generally are quite as susceptible or vulnerable to the range of infections as others. That is accepted, but, equally, it is not reasonable to accept low standards of hospital cleanliness for patients in that vulnerable situation. I hope that the Minister will not fob off the report by saying, “Well, it is to do with mental health institutions.” I well remember being simply horrified during my training by the level of cleanliness in the psychiatric hospital in which I worked, south of Bristol. I hope that such standards do not prevail, but I suspect that they probably do in some places. The report certainly suggests that they do in some areas.
The report goes on to say that only a third of the hospitals are achieving high standards of cleanliness, which is quite right from the figures, but which is worrying. Given the furore in recent years, we would expect hospitals mostly to achieve a high standard of cleanliness. I expect that when the public gets hold of the report—it will probably be covered in tomorrow’s papers—people will be similarly horrified that most of the hospitals in this country are not coming up to what the Healthcare Commission regards as a high standard of cleanliness.
The head of operations at the commission, Simon Gillespie, said that
“the findings show that too many hospitals are failing to perform as well as they could. And some have particularly poor standards of cleanliness.”
He went on to say:
“If a hospital has dirty and poorly maintained facilities, patients will have little confidence that it can implement the more sophisticated precautions that are needed to prevent infection.”
I shall come later to some of those sophisticated ways to prevent infection. We know that it is not simply a matter of cleaning the floors, but if a ward looks dirty, patients will be worried.
We all have constituents who tell us that they are not happy with the cleanliness of wards. It is usually the relatives, friends or visitors of patients who are acutely ill who write or contact us to say that they are horrified by what goes on. They sit by the patient’s bedside, often for long periods, and are therefore able to observe what goes on. Indeed, they are often the best witnesses. In my experience, one will often sit by a hospital bedside for a long time, observing what goes on. One becomes a bit of an expert on the goings-on in a particular ward; one gets to know the individuals and, very often, the cleaners. It is a salutary experience and one becomes something of an expert witness.
The letters that I receive from such people have quite an impact on me. It is worrying when they come up with—admittedly anecdotal—reports about poor standards of cleanliness in hospitals. That usually results in my writing to the Secretary of State for Health to ask what is going on. She usually helpfully forwards my letter to the relevant trust chief executive.
The things described in the Healthcare Commission report really happen, so it is extremely timely. It just so happened that the report appeared only hours ago, and the commission could not have anticipated what stage our proceedings would have reached, but it seems to have done its job extremely well in that respect. When the Minister addresses this little amendment of mine—positively, I hope—perhaps she will also comment on the commission’s findings.
Steve Webb (Shadow Secretary of State for Health, Health; Northavon, Liberal Democrat)
I will try to deal briefly with the amendment. As the hon. Member for Westbury hinted, the Committee has been in “may” and “shall” territory before. I understand and sympathise with the spirit of the amendment, which makes it clear that if we are to have chunks of legislation about codes of practice, we want to be sure that they will be enforced. We would therefore much rather that the Bill said “shall”, so that we knew for certain that the Government would get on with delegating the task of producing the code of practice, than the Government simply having the power to delegate the task but not necessarily doing so. In a sense the debate is slightly artificial, because none of us doubts that the Government will act on legislation once they have passed it, but the amendment prompts us to ask why the Bill was drafted in such a way.
The hon. Member for Westbury mentioned the Healthcare Commission report, which is germane to this part of the Bill and to our discussion of codes of practice. When I was interviewed about the report at five past midnight, I was on with someone from MRSA Action UK, which is an action group representing people who, in many cases, have suffered bereavement as a result of MRSA and hospital-acquired infections. I do not speak for the members of that group, but having met them, as other hon. Members have, I am sure that people who have been victims of those various bugs would want not permissive legislation, but legislation that required tough action to be taken.
As we shall discuss on later amendments, it is not sufficient simply to say that there should be a code of practice. As the hon. Gentleman hinted, although I am not sure how far he would take the logic of his argument, codes of practice are fine and good and might be broadly beneficial, but there appears to be no teeth. I am perfectly happy with the amendment, but on its own—the way in which we conduct our proceedings inevitably means that it is not necessarily appropriate to group it with other amendments—it does not cut the mustard. It is not enough simply to say that there must be a code of practice, because there is little sanction or penalty in the Bill. We may insist in the amendment that there should be a code of practice, but nothing might happen if people breach it. We will come to the enforcement of penalties later.
In supporting the amendment, therefore, we are certainly not saying that it goes far enough. However, we want at least to ensure that a code of practice is introduced as a result of our deliberations.
Jane Kennedy (Minister of State, Department of Health; Liverpool, Wavertree, Labour)
First, Lady Winterton, may I say what a pleasure it is to serve under your chairmanship. I look forward to a good natured debate on an important subject—one in which the public rightly take a great interest. Although leeway was given to both speakers, I shall try to respond to their comments without straying too far from the amendment, which is narrow. We will probably debate some of the issues raised this morning in greater detail when we come to clause 14, which deals with the duties and responsibilities of the Healthcare Commission.
Secondly, I congratulate the Opposition Front-Bench spokesmen—the hon. Member for South Cambridgeshire (Mr. Lansley) and his two honourable and gallant Friends, the hon. Members for Westbury and for Reigate (Mr. Blunt). I have not seen it reported, but I assume that they have been confirmed in their positions. I am pleased to see them in their places, and I wish them well in their roles.
The hon. Member for Westbury raised some good points. I shall start by speaking about those with which I agree. He was right to say that patients in mental health institutions deserve precisely the same quality and standard of care as patients elsewhere in the health service—wherever that care is commissioned.
I welcome the Healthcare Commission report. Sir Liam Donaldson invited the commission to undertake that study. Today, we are debating the code, and at future sittings we will be considering the commission’s role. We want to develop that role so that we do not have to ask the commission to undertake specific studies; it will become an integral part of its work. We will give the commission powers to inspect the performance of health service organisations against the code.
It is worth knowing exactly what the Healthcare Commission said. The hon. Gentleman quoted from its report. We always quote selectively in order to prove our point, but on that point I begin to disagree with the hon. Gentleman. Simon Gillespie also said:
“We have found some excellent performance. It is a myth to say all our hospitals are dirty.”
The constant repetition of that myth is a disservice to the health service and to the public; it makes people anxious, but their anxiety is ill-founded.
The Healthcare Commission inspected a random sample of 28 independent hospitals, but the rest of the sample was not random; it inspected 10 of the best and 60 of the worst performers in the national health service. I was encouraged to hear that 45 of the 60 worst performers were found to have made substantial improvements. Hospitals will benefit from the detailed report that the commission will make after every inspection. The inspections will enable the institutions to understand where they are failing and to improve their performance, so that they deliver better, cleaner hospitals.
The hon. Gentleman rightly pointed out that some hospitals were performing very badly. However, I was puzzled by the BBC’s headline. I forget the exact words, but the spin on the story was remarkable. The commission’s report was balanced; it rightly turned the spotlight on those areas that were failing and showed where improvement was needed. That is the purpose of commission reports. They remind the health service of its responsibilities to its patients. I know that the institutions that have been inspected will take note and will work hard to improve.
Andrew Murrison (Shadow Minister, Health; Westbury, Conservative)
To be fair to the BBC—unusually so—it was saying that if hospitals such as Great Ormond Street are achieving so much, why on earth are the rest not doing so. If some are managing to do that, it is clearly not that difficult. What is happening with the rest?
Jane Kennedy (Minister of State, Department of Health; Liverpool, Wavertree, Labour)
The hon. Gentleman makes a fair point, but I believe that the BBC spin was misleading. A significant number of institutions were inspected in which some areas had suffered a failure in cleanliness. However, there was no overall failure in cleanliness. That was in the band 2 category. Those institutions, those hospitals, those places delivering health care will need to attend to such matters. However, to categorise two thirds as having failed was overstating the findings of the report. The hon. Gentleman may say that I would say that. However, I am working with the Healthcare Commission and the NHS; and I am legislating in order to bring about the improvements that he and I agree are needed.
The hon. Gentleman asked me about the Government’s strategy and the purpose of the code. The code is available; indeed, I had copies of the draft made available to the Committee.