Clause 13 - Prevention and control of health care associated infections
Health Bill
10:00 am
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.