I beg to move,
That this House, whilst applauding the endeavours of dedicated NHS staff to do the best for their patients, is deeply concerned at the Government's continued failure to tackle effectively the continuing rise in the incidence of hospital-acquired infection;
notes with alarm the recent report by the Office of National Statistics that 955 people died with methicillin resistant staphylococcus aureus (MRSA) as a contributing factor in 2003 alone, an increase of 155 on the year before and more than double the level in 1997;
further notes that this seriously understates the gravity of the problem, given the failure to designate hospital-acquired infections on death certificates;
is particularly worried by the sharp rise in the number of MRSA infections in children and babies as confirmed in a Patients Association study;
further notes the continuing detrimental effect of the Government's obsession with targets which hinders the closure of beds or wards on clinical grounds when recommended by infection control teams;
believes that matrons should have responsibility in hospitals for the hygiene, cleanliness and care of patients and the power to enforce measures including bed or ward closures;
regrets the continuing failure of the Government to take measures recommended by the Public Accounts Committee and the failure to support a 'search and destroy' strategy as recommended by the Chief Medical Officer in his report 'Winning Ways';
and calls on the Government urgently to take concerted action to reduce drastically the level of hospital-acquired infections and restore the public's confidence in the safety of hospitals.
The terms of the motion will not be unfamiliar to many hon. Members here today, who will recognise the problem of hospital-acquired infections from constituency cases. The Opposition have raised this problem in their debating time on numerous occasions, and we shall make it a central plank of our campaigning up to the general election. It is right that we do so, and I make no apology for returning to the issue again, for the simple truth is that the problem is getting worse, not better.
Despite all the Government's initiatives, semi-initiatives, gimmicks, awareness campaigns and bluster, they have completely failed to get a grip on the situation, and the relentless advance and spread of hospital-acquired infections on their watch, leading to many thousands of avoidable deaths, is one of the great scandals of the past eight years.
We have had from this Government, and particularly from the Secretary of State for Health, prevarication, obfuscation, deflection and pure mystification, culminating last week in the Office for National Statistics reporting that 955 people died from specified methicillin-resistant staphylococcus aureus, or MRSA, in 2003 alone—an increase of 155, or 20 per cent., over the previous year, and well over double the rate that Labour started with in 1997. That, however, is just the tip of the iceberg, as it deals only with those deaths that are attributed directly to MRSA on the death certificate, let alone all the other hospital-acquired infections and the tens of thousands of patients who have contracted infections in hospital and survived.
When the hon. Gentleman was doing his research, did he notice a parliamentary question that I tabled—funnily enough, to the Minister who is to reply to him today, when she was a Treasury Minister dealing with statistics—relating to the fact that death certificate reporting was misleading? A person would die of septicaemia or pneumonia and that would go on the death certificate, but it would not show MRSA. If I catch the Speaker's eye, I want to show that the reporting figures that the hon. Gentleman is referring to are false, because this Minister remedied the problem. I also want to refer to the failure of successive Ministers, Labour and Tory, to address that and related problems.
I am grateful to the hon. Gentleman for those comments. In my research I spotted not only his question but the fact that he was one of only two Labour Members, including members of the Government, who ever raised the subject of MRSA in debate during the five years between 1992 and 1997 under the previous Government. It was such a scandal, apparently—all the fault of the Conservatives, who started all this—that not a single Minister initiated a debate on the subject in five years. Only one future Secretary of State for Health, Mr. Blunkett, tabled a written question on MRSA during the five years of the last Conservative Government. It was such a scandal that there was not a single debate and not a single oral question about it; just one written question.
The hon. Gentleman made a valid point about the problems of getting at the real facts and figures, caused by what is specified on death certificates. We know that doctors are increasingly reluctant to register deaths as MRSA-related because they fear that it might lead to legal action by patients' families.
I believe that we should be even-handed. If the hon. Gentleman is going to campaign on the issue of MRSA, good luck to him, but is it not reasonable to ask why the motion makes no mention of the last Government's decision in 1983 to introduce competitive tendering, which drove down cleanliness standards in hospitals across the country as well as the wages of decent, hard-working cleaners? Does he accept that that has a key bearing on the problems we are discussing?
I am afraid that the hon. Gentleman's intervention was typical of the deflection tactics usually employed by Ministers—but they do not usually have to go back more than 20 years to pin the problem on the Conservative party. There is hardly any record of infections of this kind in those days. I shall return to that subject later.
A conservative but realistic estimate by the National Audit Office puts the number of deaths from MRSA at more than 5,000 per annum. More than 40,000 people may have died of MRSA under the present Government; certainly more die of it each year than die in traffic accidents. Hospital-acquired infections are affecting more than 100,000 people each year in hospitals in England and Wales, the number being divided proportionally.
It is a particularly British crisis. The number of incidences of MRSA infection in the United Kingdom, at 44 per cent. of staphylococcus aureus blood isolates resistant to methicillin, compares with just 1 per cent. in Denmark and The Netherlands and 19 per cent. in Germany.Much as the Secretary of State always likes to shift the blame away from the Government, we do not think that the accusing finger should be pointed at hard-working, dedicated NHS staff.
The hon. Gentleman's figures related to hospital-acquired infections. Has he figures for the incidence of MRSA in the British population compared with that in the populations of the countries that he cited? Is that not the relevant factor, and is that not why the incidence is so much higher in the British hospital population?
That is another bit of deflection. Now we are blaming people before they go into hospital. All those figures are covered in all the reports, and whatever measure the hon. Lady chooses, and however subjective we may be, I am afraid we do not come out of it well.
Given what was said by Dr. Starkey, let me remind my hon. Friend that the report that first mentioned 5,000 deaths a year from MRSA in this country was the National Audit Office report, which specifically excluded a series of categories. Under this Government, those who die at home are not counted, along with youngsters and those on immunosuppressant drugs. The hon. Lady should take no comfort from the 5,000 figure, as the true figure is probably much higher.
That is why I said that my estimate—not my estimate, in fact, but a widely accepted estimate—was conservative. It also relies in part on the way in which hospitals account for hospital-acquired infections. Many hospitals will not necessarily treat infections as hospital-acquired if they manifest themselves a certain amount of time after the patient has left the hospital. Hospitals such as my own—the Worthing and Southlands Hospitals NHS Trust, in Sussex—do play by the rules and account for all infections in hospital and, within a certain time, after leaving hospital. Indeed, they do rather well, but other hospitals, because of the management pressures imposed by the Government's targets, do not.
The hon. Gentleman mentions the dedicated service of hospital staff. Will he therefore consider the Royal College of Nursing's observation that alcohol wipes are the best way to deal with the problem, and that ward closures would exacerbate it by spreading disease further?
I am grateful to the hon. Gentleman for giving way, and I can assure him that when I took part in Monday's NHS cleanliness awareness day, the matrons at the Worcester royal hospital told me that they do indeed have the power to close down wards when they fear infection.
The hon. Gentleman is concerned about how the infection figures are compiled. Does he agree that although the compilation of such statistics is an issue, the more fundamental problem is how people like us use them? We have a duty to use them carefully and properly in considering these matters, so will he denounce the comments of his colleague Mr. Lansley, who said:
"I don't believe the NHS statistics. Occasionally I bend them when they are helpful"?
The problem is that nobody knows what to believe and what not to believe. The hon. Gentleman is lucky if he found a matron who says that matrons have the power to close wards, because according to the experience of most of us, they do not, and they are too often overruled by management.
The plethora of half-baked knee-jerk reactions that the Department of Health often foists on NHS staff has served to increase the pressure on them yet further. As my hon. Friend the Member for South Cambridgeshire pointed out in an earlier debate,
"Doctors and nurses across the country tell me that they know how to deliver infection-free environments and that they have experience of doing that. They know that they can do it if they are given the support and the freedom to deliver the requirements of patient safety without being contradicted by Government targets and bureaucracy. That is what is urgently required now".—[Hansard, 8 September 2004; Vol. 424, c. 792.]
But they have been bombarded with no fewer than 23 initiatives in the past four years. In February 2000, departmental guidance was issued. In May 2000, the Department adopted and published "Standards of environmental cleanliness". In July 2000 there was the Government's NHS plan, which included a campaign to clean up hospitals. In December 2003, "Winning Ways Together" was published. There has been no lack of paperwork on these subjects, so why, after all those publications and initiatives, is the situation continuing to deteriorate?
The situation culminated in last week's ONS statistics and the designating of this Monday as "think clean" day. It would be laughable if it were not so serious. Every day should automatically be a think clean day. It is symptomatic of this Government's tick-box mentality that they think that, simply by having a think clean day, they can in some way sort out the problem.
Is the hon. Gentleman aware that Dr. Peter Maguire, a consultant anaesthetist at Craigavon Area hospital in Northern Ireland, has called within the past couple of weeks for automatic screening of NHS staff? Does the hon. Gentleman agree that that should be done as a matter of urgency to instil confidence in the patients who are being treated by these very staff?
My hon. Friend mentions pieces of paper. Does it surprise him to hear that when I recently visited a friend in hospital—in a mixed ward, incidentally—there was a piece of paper on the wall at the entrance to the ward stating, "All visitors and staff to wash their hands with the gel on the trolley on entering and leaving the ward"? There was no gel, and there was no trolley, so how on earth can a piece of paper be said to contribute to hygiene on the ward?
My hon. Friend is lucky to have seen a piece of paper giving advice. So often, during my many visits to hospitals, I have had to remind staff that I wanted to wash my hands or use the gel before visiting patients, and staff sometimes tell me that the stuff is not available.
The news has been even more worrying recently. The Minister's reply to my parliamentary question revealed that, between 1997 and 2003, the number of reports of MRSA in children up to the age of 14 trebled. More worryingly still, a study by the Patients Association released this week revealed that hundreds of babies, many just a few days old, have been infected with MRSA in hospitals around Britain. As Professor Hugh Pennington of Aberdeen university, a microbiologist and expert in hospital-acquired infections, is reported as saying:
"If babies are getting MRSA, that is of concern, because it shows there is something seriously wrong with the infection control procedures."
Hospitals in the survey included the Portsmouth Hospitals NHS trust, which admitted to having 38 babies aged under four weeks with MRSA. Eastbourne district general hospital in Sussex admitted that it had to close its baby unit for a whole week last year because five babies were carrying MRSA. Those figures alone suggest that the parliamentary answer by the Minister for Public Health, to which I referred, seriously understated the extent of the problem. In the other place, Lord Hanningfield asked a parliamentary question about the incidence of MRSA among children under five. The answer, provided by Lord Warner, estimated 71 cases in 2003, but that must be seriously awry simply on the basis of the figures that I have just provided.
Last Friday evening, I visited the neo-natal unit—the Trevor Mann baby unit—of the Royal Sussex county hospital in Brighton. It is a dedicated unit with a very professional staff doing a fantastic job under considerable pressure. The work is very demanding of staff, who have to look after babies born as early as 24 weeks after conception. If MRSA strikes there as viciously as it has in other hospitals, we really will face a serious problem that will affect some of the most vulnerable people in our hospitals.
We understand that, in order to deal with the problem, the Government have commissioned a study—yet another study—that will cost £140,000. How long will it take to report, and what are the Government doing now about improving screening for new babies? What are they doing about people and equipment coming into contact with new babies in these very high-tech and sensitive wards? We read that thousands of babies are also being struck down by the respiratory syncytial virus, RSV, which can be picked up on dirty wards in the same way as MRSA.
We can also see this week that patients are abandoning NHS hospitals and seeking treatment abroad, because they fear catching MRSA. Hans Finck, managing director of a German medical net company that organises treatment for foreign patients, said that thousands of Britons are travelling to Germany for operations. Before, he said,
"the main thing people used to mention was waiting lists in Britain, but now many mention MRSA."
The hon. Gentleman talks about being scared, but will he apologise to NHS patients and staff at Heanor Memorial hospital in my constituency for the Tory billboard poster on cleaner hospitals, which was placed nearby for a day? The recent Peat report showed that the hospital had good cleanliness throughout, a good matron, and good infection control procedures. The Tories were either ignorant of the controversy over press misreporting or they deliberately went ahead with scaremongering, which really upset local staff at the hospital. Will he apologise?
On the Peat report, I put it to the hon. Lady that of the 20 worst general acute NHS trusts for MRSA in England—they administer 34 hospitals—18 were rated, under the Peat guidelines, as acceptable for cleanliness; 13 were rated good for cleanliness; and three were rated excellent for cleanliness. Those included some of the hospitals with the worst MRSA rates, so she should reflect further on the definitions of her own Government and try to understand how those hospitals are being assessed. The Government are misleading the patients and the staff. If she thinks that it is a service to patients to conceal information, she is sorely mistaken. We are in favour of revealing any information for the benefit of patients, so that they can make informed choices and decisions. It is outrageous that patients who pay their taxes should not be entitled to receive that information. We will make that change after
My hon. Friend is making a powerful case. Will he consider the complaint of a constituent of mine, Mr. Bovill, which I have submitted to my hon. Friend Mr. Lansley? Mr. Bovill's experience in the Royal Berkshire, a highly rated three-star hospital, was very different from what he expected of a hospital that had passed the Government's tests. Could that demonstrate that, as my hon. Friend suggests, the Government do not always measure what matters to the patients? Mr. Bovill reports a very dirty hospital, and the explanation was that it was between cleanings and monitorings. Will my hon. Friend ensure that we allow hospitals the wherewithal to be clean at all times?
I applaud the tenacity of Mr. Bovill, who is doing the sort of job that might previously have been done by community health councils. They used to take up the fears and concerns of local patients about cleanliness in hospitals, but they can no longer do so. The poodles that replaced CHCs do not have the powers to do that job, and so in many cases it is up to individuals such as Mr. Bovill. The same problem has arisen with a hospital in a trust near my home in Sussex.
The truth is that the Government are losing the fight against the superbug. They are losing because they are substituting the quantity of their initiatives for the quality and effectiveness of what they should be doing, as recommended in previous independent studies by their medical advisers and by us. The Government have got the system wrong, and until they change it matters will not start to improve fundamentally.
I accept from my own subjective experience that the culture of cleanliness and disease control is very different now, even in the most dedicated hospitals, from that which existed 20 or 25 years ago when I worked in theatre. I knew what was expected of me and of other staff in the hospital.
The hon. Gentleman mentioned experience abroad. What assessment has he made of the contribution that might be made by bacteriophage therapies to reduce MRSA infection?
I have not made a detailed assessment of that, but we should learn from the experiences of successful hospitals on the continent. Indeed, we should have learned from them some years ago, but that has not happened.
I have the permission of my constituent, Mrs. White, to use her case. She came to my surgery in a very distressed state because her husband had died of a suspected hospital-acquired disease in the Royal United hospital in Bath. She told me that it did not look as if the hospital had been cleaned for weeks, and there were used syringes lying around. The local trust is in severe financial difficulties. Is it not time that the Government got to grips with those problems?
I sympathise with my hon. Friend's constituent, Mrs. White, but I am afraid that hers is not an isolated case. We must do more to restore the confidence of patients in our hospitals. We will do the patients, the staff and the whole system a disservice if we do not restore that confidence.
I have some specific questions for the Minister. Why will the Government not conduct a search and destroy approach to tackling MRSA and other hospital-acquired infections, as recommended by their chief medical officer in "Winning Ways" in December 2003? Such an approach has been dramatically successful in Holland and Denmark and could work in the UK. In the Netherlands, they screen patients and isolate those infected, as Mrs. Robinson mentioned earlier. Who exactly has the final say over infection control in hospitals? How can the Minister justify a situation, revealed by the National Audit Office report in July 2004, in which 12 per cent. of infection control teams reported that a recommendation to close a ward or hospital to admissions for the purposes of outbreak control was ignored? When will the Government give proper control of infection outbreaks to matrons or other appropriate health professionals, rather than to management ones to carry out the Government's obsession with targets? Where exactly does the buck stop in hospitals? Who is really in charge? Does the Minister not understand—as again the NAO suggested—that because of the pressure to meet Labour's targets, hospitals have poor infection control?
"The increased throughput of patients to meet performance targets has resulted in considerable pressure towards higher bed occupancy, which is not always consistent with good infection controls and bed-management practices."
That is a quote from the NAO.
The obsessive intrusion by central Government—the creation of targets that lead to clinical distortions—lies at the heart of the problem. I visited my local hospital and had a meeting with the chairman and chief executive. While that meeting was going on, there were 110 patients with a diarrhoea and vomiting bug. I was not told. The culture of fear that now obtains in many parts of the NHS is such that transparency has ceased because of the way that the Government seek to control, with targets and interference, the real function of the NHS.
I want to make progress, but I shall return to the hon. Gentleman in a moment because this will not be a long debate and many hon. Members will seek to contribute in interventions.
If hygiene is to improve, it is vital that hospitals are given real freedoms—to introduce initiatives, improve facilities and balance competing priorities, such as waiting lists and safe bed occupancy levels, without risking the wrath of Whitehall. As Dr. Alison Holmes, the director of infection, prevention and control at Hammersmith hospital has acknowledged,
"the juggling act of quick turnarounds and bed hogging required to perform more procedures on more patients with shorter stays in hospital is fuelling the spread of infectious disease."
The hon. Gentleman seems to be guilty of trying to make a general case from anecdotal evidence. Does he agree with the comment in a newspaper with which, I am sure, he will be very familiar—the Wiltshire Gazette and Herald—where the writer said that it is easy to cut and paste to give the impression that an institution is generally bad and filthy when it is not? The writer was Dr. Murrison, who is sitting two places from him on the Front Bench.
I shall make some progress.
Ministers have failed to take their own advice, which we endorsed. In their response to the 2000 NAO report that warned about bed occupancy rates, Ministers promised that, by 2003–04, bed occupancy rates could be reduced to 82 per cent. In fact, three quarters of trusts have been operating at higher rates than that—averaging 89 per cent. and 91 per cent. for orthopaedic and vascular surgery respectively. More than 90 per cent. of trusts with the worst rates of MRSA operate above the 82 per cent. target set by the Department and deemed safe by the Health Protection Agency. The Opposition have warned for the past five years and beyond about the consequences of not taking that seriously.
Professor Barry Cookson of the Health Protection Agency, when speaking to health professionals, talked openly about the need to reduce the pressure on the NHS and cut bed occupancy rates to 85 per cent., but before he could give one-to-one interviews with the media, he was mysteriously spirited away for a quiet chat with officials, only to re-emerge having toned down his claims—more dumbing down by the Government, who are not allowing the professionals to speak out. Is the Minister serious about tackling bed occupancy rates? Does she acknowledge that the issue is part of the problem—or is it all talk again?
The NAO report also found that the isolation facilities in some NHS trusts had been significantly reduced and that many infection control teams believed that facilities for isolating patients were unsatisfactory. In 2001, the Department of Health assured the Public Accounts Committee that the need for more isolation facilities was being addressed. So what has been achieved since then? What has actually changed four years on?
Is my hon. Friend aware that the NAO report also flagged up the fact that antibiotics are becoming increasingly powerless at dealing with the superbug? Surely that fact makes the Government's complacency even more unforgivable.
I agree with my hon. Friend. Even more worrying than that was a report in today's press that in the next few years, even the most powerful drugs available to combat the most potent strains will no longer be effective. We would thus face a gap in our weapons armoury to deal with the most powerful strains, which rings the alarm bells. We cannot afford to be complacent.
Let me ask the Minister several questions. What improvements to screening have taken place? How many hospitals currently screen vulnerable patients, such as elderly people and those in neo-natal units. Is there a link between the extent of screening and the significant differences in MRSA rates among hospitals? Do most hospitals now screen staff when there is an outbreak on a ward? What procedures are in place to make visitors more aware of precautions that they must take? Are there proposals to limit visiting times more extensively?
Not at the moment.
What action are the Government taking to promote the better training of staff? Does the Minister agree with the Royal College of Nursing that further action is needed to make infection control a mandatory part of training for all NHS workers? Is she worried about the situation described by Professor Richard Wise from the Birmingham City Trust, who said that the number of infection control nurses was "worryingly low", at one nurse to every 347 beds, and that there should be one nurse to every 200 beds? What progress have the Government made in meeting their target of one infection control nurse to every 250 beds?
Why will the Government still not publish infection rates for MRSA and other infections per clinical department as we have undertaken to do, given that hospital trusts have had a mandatory duty to report such infections since April 2001? Why should patients not have the right to know the truth? After all, the Secretary of State's opening pledge of his campaign for action in "Towards cleaner hospitals and lower rates of infection" was
"Being open with the public".
So much for that.
The Government's policy thus far has often been to deflect criticism on to anyone but them. The problem is apparently all down to the contracting out of cleaning staff that was started by the wicked Tories. Alas, Mr. Hinchliffe has left the Chamber. Ministers surreptitiously trot out the assertion that the blame should be put on contracted-out cleaners, or allow Unison to do the dirty work for them as a pay back for the £7 million of donations that it has given the Labour party since the last election. However, the chief medical officer is on record as saying that there is no link between contracted-out cleaning and MRSA rates. On the "Today" programme on
"There's no proven causal link between contracting out and MRSA".
Let us stop that debate now.
Indeed, 11 of the top 20 acute NHS trusts for cleanliness are cleaned by private contractors, while 11 of the bottom 20 are cleaned by in-house teams. Yet again, the picture is confused because the Government's patient environment action team—PEAT—scoring system gives a different impression of the situation, as I said earlier. In any case, surely it would be easier for a hospital to sack a duff cleaning firm that is failing to do its job properly than to sack in-house staff. We intend to give matrons and infection control teams a far greater say about such matters in the future and more powers to deal with the problem.
We agree that more needs to be done on cleaning. We agree that cleaning needs to be a more fundamental and central part of health spending on hospitals. However, it is entirely disingenuous to try to pin responsibility for the problem on a political decision going back to the 1980s. It is an attempt to deflect the blame from where it should lie.
The Government use the deflection tactic of saying that the problem is all down to the Conservatives' actions in the 1980s and 1990s, but if hospital-acquired infections were such a burning issue then, why did the then Labour Opposition not raise the matter a single time? There was not one Opposition day debate on hospital-acquired infections between 1992 and 1997. Mr. Blunkett tabled one written parliamentary question on the matter during his time as shadow Secretary of State for Health—on
Will the hon. Gentleman outline what steps the Conservative Government took between 1992 and 1997 to introduce surveillance measures for hospital-acquired infections? One reason why questions were not asked in the House is that the hon. Gentleman's Government were not providing the evidence.
It would be strange if a measure of an Opposition's effectiveness were how forward the Government were in making information available. If that were the case, we would not be raising this issue time and again. The Government have frequently sought to deflect attention away from the problem, have engaged in subterfuge and have not released the information that we have requested, so the hon. Gentleman makes a weak point. Is he saying that a Conservative Minister had to raise the issue before he would dare to ask questions? What utter nonsense. It is a national scandal that one in 11 hospital patients has a hospital-acquired infection at any time. The Labour Government have let our patients and our NHS down badly. They have confused quantity with quality by introducing a plethora of initiatives and gimmicks. They have deflected the blame so that it lies with anyone but themselves, but it has all been too late.
We will replace that catalogue of prevarication with an urgent timetable for action. Conservatives will put clinicians back in charge of determining whether or not hospital wards are safe. They will not be subject to the arbitrary targets imposed by a Government obsessed with numbers and throughput rather than quality and the safety of patients. Matron will be put back in charge of our hospital wards. There will be proper nursing matrons—not the Government's management matrons—who know whether or not a bed is clean and recognise the virtues of a good whiff of bleach in the air. There will be no doubt about who is in charge of wards under the next Conservative Government. Matrons will not soft-soap us on cleanliness. I recently spoke to a hospital infections director, who tried to convince me that dusting under a bed was not a good idea, because it encouraged any infections to become airborne and therefore more dangerous to the patient. Unbelievable—and she was on a six-figure salary.
Conservatives will not accept the Government's limp target for halving MRSA bloodstream infections by 2008, as the situation is too grave. Indeed, it is grave enough for the Secretary of State to make an appearance in the Chamber. We will institute the sort of ruthless search-and-destroy strategy that brought about drastic improvements in Holland. We will not compromise patient safety with unrealistic targets on bed occupancy levels, as that is a false economy. Hospital-acquired infections cost the NHS £1 billion, result in prolonged stays by patients who have caught infections and have a human cost for the people affected by them. The Conservatives will speed up the diagnosis of MRSA through the faster application of new methods, and will expand screening where appropriate. We will publish infection rates for all hospitals, because we believe that patients have the right to know. The National Institute for Clinical Excellence will be tasked to prepare evidence-based infection control standards, and we will fund hospitals to recruit more infection-control nurses and to install new technology to fight the superbug.
There is nothing in the motion that Members on all sides of the case cannot support if they genuinely believe in improving the safety of our patients and genuinely believe that hospital-acquired infections are a serious problem. There is nothing inevitable about the superbug crisis. It is time that the Government applied some of their own pledges from their latest rather vacuous pledge card to assess how they have dealt with this problem. "Your family better off"—not when it comes to the risk of MRSA. "Your child achieving more"—not with more children contracting MRSA in our hospitals.
"Your children with the best start"— at the risk of catching MRSA; I do not think so.
"Your family treated better and faster" and "Your community safer"—I do not think so. It is surely is a case of backward, not forward under this Government.
Last month, the chief medical officer, talking about MRSA, admitted:
"We've been perhaps a little bit too gentle on health infection in the past and it's now really no more Mr. Nice Guy."
It is time for Mr. Nasty on the Treasury Bench and his Government to move aside and make way for a party committed to taking this problem seriously, committed to the safety of our patients and our staff, and committed to the safety of our NHS. I commend the motion to the House.
I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
'welcomes the Government's commitment to tackle hospital acquired infections with a robust programme for improving standards in infection control;
congratulates the Government on its action plan for reducing infection rates, "Towards cleaner hospitals and lower rates of infection", and the introduction of the new target to halve the rate of MRSA in the first instance, and the appointment of local directors of infection prevention and control to cut cross infection locally;
supports the Chief Medical Officer's action plan "Winning Ways";
recognises that MRSA is a longstanding problem that became endemic in the National Health Service between 1993 and 1997 and believes that this Government is to be congratulated on introducing a system of mandatory surveillance for MRSA to establish its full extent;
notes that the Government is working with experts from home and abroad to identify the actions and best practice which will make a difference, including a matron's charter, a national hand hygiene campaign, improved standards and better inspection of hospital cleanliness;
and therefore congratulates the Government on its comprehensive programme of investment and reform that has equipped the NHS to deliver improvements in patient safety, and to reduce hospital acquired infections.'
I would like to get to some facts about why infections occur, about the solutions and what we are doing about them, about targets, about support for the NHS and about the whole issue of cleanliness, but I must start by asking why the Opposition have chosen so systematically to attack the NHS and to politicise the issue so consistently.
Last week, when the Office for National Statistics announced the new figures about MRSA on death certificates, it took the Leader of the Opposition only a couple of hours to hold a party political press conference attacking the NHS. In that press conference he had the opportunity to tell the country that while he was in the Cabinet, between 1993 and 1997, the percentage of Staphylococcus aureus isolates that were methicillin resistant, that is MRSA, increased from 5 per cent. to 30 per cent., and it has only now settled at just over 40 per cent. He also had the opportunity on that occasion of saying what he thought about the comment from Geraldine Cunningham of the Royal College of Nursing—whose comments have already been referred to—criticising the Leader of the Opposition's soundbite, saying:
"It sounds great, but how do you translate it? It is much more complex than just closing a ward. Actually, there are always patients in wards. If you moved them you would spread the infection."
We are using figures produced by the Government's chief scientist. [Interruption.] We will come back to the retrospective bit in a minute. I am very happy to go over some of the past with the hon. Gentleman, because I think that he will find that it is other than as he said.
The Leader of the Opposition also had the opportunity in the press conference to comment on the revealing statement by his colleague, the absent shadow Secretary of State for Health, Mr. Lansley, when last June he said:
"I don't believe the NHS statistics. Occasionally I bend them when they are helpful."
Perhaps the fact that he is not here means that he dare not show his face and respond. [Interruption.] I am happy to see Tim Loughton defending his hon. Friend.
It is dangerous for a Member of the male-dominated—exclusively, bar one—Opposition Benches to talk about multi-tasking when those of both genders on the Labour Benches are talented and have so many more women who are so good at multi-tasking. I shall respond to Mr. Burns who is waving at me in a moment, but first I want to deal with another matter.
Dr. Murrison is a member of the Opposition Front-Bench health team, and this is what he said about his local hospital in the Wiltshire Gazette and Herald:
"it is easy to cut and paste giving the impression that an institution is generally bad and filthy when it is not."
The hon. Member for West Chelmsford said:
"I certainly accept that that problem"— the growing problem of MRSA in our hospitals—
"cannot and will not be eradicated overnight".
However, that is what his party is calling for. He continued:
"efforts naturally have to be made to ensure that more is done to minimise and reduce the incidence of the problem, and I believe that cleanliness in our hospitals is a key factor in achieving that."—[Hansard, 8 September 2004; Vol. 424, c. 810.]
I shall return to cleanliness in a moment.
Will the Minister take this opportunity to condemn the "Horizon" programme, to which I think that she is referring, for cutting and pasting? I hope that we achieve a good overview of cleanliness in our NHS, which is what this debate is about, and I am sorry that she has chosen to quote selectively, which does her no credit.
The hon. Member for East Worthing and Shoreham could have commented on the issues or outlined his policy, but he attacked the NHS with a soundbite. Instead of soundbites, let us examine the real improvements. Reducing infections is a top priority for the NHS, because hospital-acquired infections, including MRSA, cause illness, pain, anxiety, longer stays in hospital and sometimes, regrettably, death. Since her appointment last October, our new chief nursing officer, Christine Beasley, has led a wide-ranging programme to improve both infection control and hospital cleanliness, which should reduce infection rates.
Let us move beyond the Opposition's soundbites to how such infections, which come from a wide variety of micro-organisms, are caused. By the way, the figure of 5,000 deaths mentioned by the hon. Member for East Worthing and Shoreham relates not to MRSA, but to hospital-acquired infections, which cover a wide range of infections, including bacteria from our own bodies. Unfortunately, not all hospital-acquired infections are preventable.
Many factors contribute to the problem, including the treatment of more susceptible patients, such as those with severe or chronic diseases, than ever before. At the same time, advances in treatment that improve patients' survival chances, such as chemotherapy, can leave them more vulnerable to infections. Other factors, such as increased antibiotic resistance, are also important. No single, simple solution exists to that complex and multi-faceted problem, but the risk of contracting those infections can in part be reduced by simple and effective infection control measures.
Health care-acquired infections are a problem in not only the UK, but internationally. In the United States, Australasia and most European countries, including the UK, the number of patients who experience a hospital-acquired infection ranges between 4 and 10 per cent., which is a remarkably consistent set of statistics. Hospital-acquired infections are not a new phenomenon. Although medical practices change and different micro-organisms are involved, estimates that about 9 per cent. of in-patients in England acquire an infection have not changed since at least 1980.
The attack with which the hon. Member for East Worthing and Shoreham concluded his gross distortion of the facts in opening the debate actually showed that nothing has changed since 1980. Health care-acquired infections have remained consistently at the same sort of rate across the piece.
I am saying that the rate of infection is the same, and has consistently remained about the same, over the past 25 years. As my hon. Friend Andrew Mackinlay rightly said, we were the first Government to introduce mandatory surveillance for MRSA bloodstream infections. That was initiated in 2001 and has since been extended to other infections. More data should be available later this year. The Conservatives were so unconcerned about this when they were in power that they did not even begin to count the number of infections. The hon. Member for East Worthing and Shoreham attempted to pin it on the then Labour Opposition, but we must have done something right, as we have been in government since 1997. He ignored the work done by my right hon. Friend Mr. Blunkett and my hon. Friend the Member for Thurrock in raising this issue in the past. When Conservative Members were in government they did not raise the matter at all—they did not worry about it and did nothing to counter it.
Does the Minister believe that the Opposition are raising the issue because of statistics published by the Government or because of the experience of constituents, who report to us time and again that they and their loved ones have been infected, sometimes fatally? She seems to be in denial about the fact that there is a problem. Let her go on denying it—it may enable her to score debating points in this Chamber, but it will not wash with the public out there.
The reason why the Opposition keep raising this matter has nothing to do with the issuing of statistics, nor with its having been raised with them by members of the public—many issues are raised with us—and everything to do with denigrating the NHS and providing a setting in which they can undermine public confidence in it in order to remove £2 billion—[Interruption.]
Perhaps I could share my experience of visiting my local hospital last Friday night and early Saturday morning. It is a 466-bed hospital, but only 12 beds were vacant in the entire place, and the bed managers told me that that was a particularly good situation. Seven of those beds happened to be in gynaecology. In order for the A and E department to meet the targets imposed on it by the Government, patients are shipped around from one bed to another, taking infection with them, until they eventually get to the right place. That is one of the causes of the problem, and it is the direct responsibility of the Government and their targets.
The reason why we are tackling these issues is that we were left with an NHS starved of investment—[Interruption.] That is a well-known fact, frankly. We inherited an NHS where many people were waiting more than 18 months; now, we have got waiting times down so that nobody waits more than nine months, and most people wait four or five months—
To make progress, I should like to move on to consider the information that we have. It shows a slight but not dramatic increase in MRSA in the past three years. However, we are not alone in experiencing such an increase—the same problem has occurred in Austria, Belgium, Germany and Ireland since 1999. We estimate that MRSA affects approximately 0.3 per cent. of patients or three in every 1,000. Of course, that is three too many in every 1,000 and we need to reduce that figure. However, the Opposition should be careful, in their delight in attacking the NHS, not to exaggerate a serious problem to the extent of unduly alarming patients and making them afraid to go into hospital to seek the treatment that they need.
Is not my hon. Friend the Minister worried about Conservative Members' level of scientific understanding? They cannot understand the difference between hospital-acquired infections as a group and MRSA. That led to their suggesting that the figure that you—[Hon. Members: "You?"] Pardon me, Madam Deputy Speaker. They suggested that the figure that my hon. Friend gave for the prevalence of MRSA in hospital patients was different from that that Tim Loughton cited for the total number of hospital-acquired infections. Obviously, the figures are different because they apply to different things. How can one have confidence in Conservative Members' arguments when they demonstrate that they have not the faintest understanding of what they are talking about?
As usual, my hon. Friend makes her point eloquently. We should be worried—I am sure that the country is concerned—about the prospect of such an Opposition ever becoming a Government.
We know that the infections can be prevented, we are acting on that important safety issue and we are committed to being completely open with the public about it.
My hon. Friend mentions openness. Conservative Members have cited what people in the NHS said, but does she remember that, in the old days, when the Tories were in control, they gagged people and prevented them from revealing problems? Whistleblowers were disciplined for speaking out. Is not it a good thing that they can say what they think under this Government?
Indeed. My hon. Friend brings me to an important part of what I wish to say in response to the hon. Member for East Worthing and Shoreham. He made several comments about the National Audit Office survey and the results of the infection control team survey.
The NAO survey was conducted in July 2003. It asked teams to report on a period that stretched back to 2000. Even over three years, the figures showed that almost nine out of 10 teams reported that they encountered none of the problems of having their recommendations rejected or discouraged by chief executives. I shall consider the rest of the findings shortly because I have some interesting facts, which I am sure that the hon. Gentleman will not like to hear.
In addition, a similar proportion of trusts reported that they had closed parts of hospitals to deal with outbreaks. None of the detailed returns from the 12 per cent. that reported that they had raised the issue but not closed wards mentioned MRSA. Not a single one mentioned it. Most outbreaks were of diarrhoea and vomiting and other similar, admittedly serious, infectious conditions. They were not MRSA. The Opposition's entire case is predicated on one report and finding. It is absolutely wrong.
I confirm to hon. Members the facts of my hon. Friend's case. When an outbreak of vomiting and diarrhoea recently occurred in Huddersfield royal infirmary, it was simple for people to report to the chief executive, who acted swiftly and kept me informed. Wards were closed when appropriate, and patients were treated quickly when necessary and sent home to avoid further infecting vulnerable patients. In other words, the tools needed to do the job were in place. Is not it important to continue that approach and ignore Opposition giggling?
My hon. Friend is so right. Of course, the Opposition complain if any operation is cancelled for whatever reason. They are trying, as usual, to have their cake and eat it.
Our plans to reduce infection rates were set out in "Winning Ways", which was published in December 2003, before any of the work that we have done, and that is now being used, albeit it did not mention MRSA in a single case. "Towards cleaner hospitals and lower rates of infection" was published last July. We are actively implementing those programmes and building on the work already under way.
The proposals to combat hospital-acquired infections are very necessary, but when I consulted a local doctor in an acute trust, he told me that the most effective way to combat MRSA in future would be with more nurses, more doctors, and better and newer hospitals with single-bed rooms. Investment is crucial to reducing infections. Does my hon. Friend agree, therefore, that proposals to take £2 billion out of the NHS could have devastating consequences for MRSA?
Absolutely. That would be devastating for many of our achievements. We have put £570 million extra into cancer treatment, for example, and anyone who considers the £2 billion that would come out can see the scale of the damage that would be done. [Interruption.]
Although I am happy to go on taking interventions, I would like to make some progress first.
As part of updating and improving the NHS, we are creating the extra capacity needed to ensure better patient care. Some £135 billion for the NHS was announced by my right hon. Friend the Secretary of State last month. Compared with 1997, there are 77,500 more nurses and more than 19,000 more doctors working in the NHS. The hard work of NHS staff will help us to reduce health care-associated infections. A major new initiative has been the introduction of a target to halve MRSA bloodstream infections.
I am delighted to have the opportunity to talk about targets. This problem is challenging, but we know that having a target ensures that an issue is given priority in the NHS. We believe that the new target will raise the profile of infection control and ensure that effective action is taken. Opposition Members have disagreed with national targets, repeatedly arguing against them in the Chamber and elsewhere. Their manifesto contains a commitment to oppose targets. They believe that the magic of the market will in some way make everything better. That is clearly nonsense. We have achieved a lot through having targets. In the case of infections, no one on the Opposition Benches would even know what was happening if we were not publishing the figures. Nor would they know what progress we were making if we were not measuring ourselves against a target.
That has nothing to do with whether I give way.
Hand hygiene is an important part of inspection control. Last September we launched what we believe to be the first ever national hand hygiene campaign. The clean your hands campaign was based on a thorough, successful pilot study undertaken by the National Patient Safety Agency. That evidence-based campaign is tackling what has been an intractable problem for health care systems worldwide, and its impact on infection rates will be evaluated.
We are also taking a proactive approach to research in that area. We hosted a science summit in December and issued a call for proposals on health care-associated infections in February.
I am grateful for what the Government are doing on this serious issue. To be prosaic, I get complaints from constituents, whose concerns I share, that some hospital staff do not take off their uniforms when they leave the hospital; they can be seen in supermarkets and so on in their uniforms. Back in the 1950s, the rule that staff should not go off site or travel to work in their uniforms was strictly enforced. Is that part of the Government's strategy to address the issue?
It is up to local trusts to decide on their policy. Some operate the policy of providing and cleaning uniforms on site, while others allow staff to take uniforms home and clean them there.
I should like to make some more rapid progress, but I want to deal with a couple of important matters raised by the hon. Member for East Worthing and Shoreham. He raised the question of MRSA and neonatal units. The figures relating to the parliamentary question that he mentioned are about reported bacteraemias only. Some of the figures in the Patients Association survey, which I think he was quoting, are for colonised patients—carriers—and not those who are infectious. That is an important set of distinctions, and we stand by our numbers: in 2003, there were only 71 reported MRSA blood isolates in England in children aged under five years. We expect that the provisional figure for 2004 will be lower.
I would like to make some progress. I am conscious of time, and this is a shortened debate.
We have been actively supporting NHS staff in achieving the changes that we want. Our programme is one in which local action is crucial. The requirement in "Winning Ways" for each trust to designate a director of infection prevention and control is helping to change the culture so that infection control is everyone's business. The directors report directly to the chief executive and the board. The hon. Member for East Worthing and Shoreham asked who was responsible for this matter; of course, at the end of the day it will be the chief executive and the board. That is only right and proper; I cannot see how the hon. Gentleman can possibly disagree. In coming months, the directors will be producing publicly available annual reports on their local situation.
Now that the Minister is moving beyond the knockabout politics that seemed to preoccupy her in most of the opening of her speech, will she specifically address the issues identified in "Winning Ways" with regard to the experiences of other countries? The document makes it clear that several policies have been adopted by other countries. I am sure that she is aware of them. Which of those recommendations has she taken on board in her policy for reducing the incidence of MRSA?
We have looked at a number of things. I am sure that the detail involved would require me to write to the hon. Gentleman, and I am very happy to do that. I can say that the suggestion that we should operate a destroy strategy, which has been canvassed today, would not be one of those options. We have looked at the policy and the rates of infection in the Netherlands. Indeed, a Dutch expert came recently to a national conference to talk with our experts. That expert said that such an approach would be inappropriate here. The search and destroy strategy is appropriate for the Netherlands because the country has a much lower rate of MRSA in the population as a whole. It has nothing to do with anything else; the approach is practically feasible in the Netherlands in a way that it is not here.
I must make some progress, or I will have the Whips on my back. I hope that hon. Members will be patient.
Cleanliness is improving, as is demonstrated by the PEAT—patient environment action team—visits. Notification of such visits will in future be made no earlier than the afternoon before the visit, and PEATs will not nominate areas for inspection until the inspection day. The results from PEAT inspections are very encouraging, but it is important that the public know that the inspectors are genuinely looking at hospitals as they are, not doing so after a notice period in which the place can be cleaned up.
I mentioned the launch of the matron's charter last October by Chris Beasley, our chief nursing officer. It is a clear document that sets out clear high standards and a new management system that will be evaluated in several sites to provide a means whereby matrons can control directly the use of cleaning resources at their disposal.
Hallelujah! I thank my hon. Friend for giving way. She will be aware that Lewisham hospital has been at the forefront of the initiatives on infection control, and that it has reduced its infection rates by almost 30 per cent since 2001. My hon. Friend Joan Ruddock and I visited the hospital a couple of months ago, not only to see what steps it was taking but to see a ward that had been closed specifically to deal with infection. In a 450-bed unit, the decision to close that ward would have been a very difficult one to take. In support of what my hon. Friend Dr. Starkey said earlier on the nature of MRSA, I must point out that the hospital is also undertaking screening of people presenting at the accident and emergency department. Of the 5 per cent. or so who come from nursing homes—all of which are privately owned in Lewisham—more than 40 per cent. have MRSA on admission.
This is obviously an issue for the NHS. It is also a problem because elderly people are especially vulnerable to infection, as are the very young; the figures on the rates of infection reflect that. My hon. Friend makes a useful point.
It has been suggested that our success in treating patients more quickly has impacted on our ability to control infection rates. The NHS runs at high bed-occupancy rates because it is treating more patients and cutting waiting lists. Increasing activity means that we have to work even harder to reduce the risk of infection, and that is just what the NHS is doing. There are examples of hospitals with high bed occupancy and low infection rates. Sheffield, for example, has an MRSA rate of 0.16 per 1,000 bed days, and an 88.7 per cent. bed occupancy rate. However, neither the Government nor the NHS is complacent about the attack on infection.
The Opposition need to understand that their silence on health policy is not good enough for the British people. Their policy on health is one soundbite: tackling MRSA is important, but it is not a health policy for a political party that wants to have custody of the NHS—
The hon. Gentleman says that it is awful, and he is quite right. It is awful. The Tories' policy is an absolute nightmare. What do they have to say about how they would improve results on cancer care or coronary heart disease, for example? What do they have to say about waiting lists and waiting times? What do they have to say, other than that they are going to take £2 billion from the NHS to subsidise the few who can already afford private health care? If they want to convince the British people that they can be trusted with the NHS, they will have to set out a health policy that will convince people they deserve that trust. The reason that will not happen is that their policy is to destroy the founding principle of the NHS by introducing charges for basic operations—
I will not.
The Tories' spin doctors have told them how unpopular that policy would be. Tory health policy is the policy that dare not speak its name—
Cash flowing out of the health service to subsidise operations for the few would result in under-investment, longer waiting times and, ultimately, the destruction of the NHS. That is the Tories' real agenda here. The crucial divide in health care is between the Labour party, which believes in an NHS that is free at the point of use, and the Conservative party, which would place a patient's ability to pay above their clinical need. I have set out the facts for the House, and I believe that they speak clearly for themselves. I trust that Members will oppose the Opposition motion when the time comes.
Hospital infections such as MRSA are not new—they were not conjured into existence in 1997. No matter how convenient that idea might be for the narrative of the Conservatives' general election campaign, it simply is not the case. The prevention, control and containment of superbugs has been a long-standing issue for the NHS and other health care organisations, both in this country and overseas. What is new is that, since the National Audit Office report of 2000, there has been a gradual and growing realisation of the scale of the challenge posed by superbugs, of the £1 billion cost of dealing with the consequences of infection that the report identified and of the annual toll of 5,000 preventable deaths.
First and foremost, the National Audit Office's message to the Government and the national health service in 2000 was, "Get a grip." Better management and clinical information were key to having an impact on the problem. To be fair, the Government instituted a system of mandatory reporting of MRSA bloodstream infection rates in 2001. Until that point, there was no clear measure of the scale of the problem. In 18 years in power, the Conservatives were content to rely on a voluntary reporting system that under-reported the problem—dramatically in parts of the country, but significantly across the country. That allowed MRSA rates and those for other superbugs to get out of control.
I must say to those on the Opposition Front Bench that it is not a sufficient argument to say that the Conservatives in government were not to blame because Labour in opposition did not ask the questions. That is an inexcusable rationale for saying that the Conservatives are not to blame. Indeed, Conservative Government policy on MRSA fell into three parts: say nothing about MRSA, learn nothing about MRSA, do nothing about MRSA. Nothing new there then.
Mandatory reporting helps only if it is smart mandatory reporting—if it helps organisations and clinicians to learn and change the way they work—but the system introduced back in 2001 fails that test. Collecting hospital MRSA rates might help headline writers to scare patients, but it fails to give front-line staff and management the information they need to fight infection.
According to the most recent NAO survey of infection control teams, when asked about the practical impact of collection of hospital MRSA rates, 27 per cent. of teams said it had no obvious effect. That is hardly a ringing endorsement from the experts on the ground.
In 2000, the NAO recommended that specialty level surveillance of hospital-acquired infections should be introduced. In the follow-up report last July, it said that
"there is still a lack of robust information on the majority of infections at both the local and national level. As a result it is still not possible to say whether there has been any tangible measurable progress."
It went on to say that information available from trusts suggested that the improvement had been small. Why? The NAO argued:
"The lack of ownership of surveillance data by clinicians is likely to be one of the main reasons."
More worrying still was the NAO finding that one in five infection control teams were not carrying out any surveillance activity other than mandatory MRSA bloodstream surveillance. Failure to set in place mandatory specialty-specific surveillance of infections has hamstrung the efforts of front-line infection control staff and let patients down.
Patients should have access to reliable and comparable information on infection rates, not just in the NHS, but in the private sector. For patients, doctors and nurses, a critical element in the quality control feedback loop is missing as a result of what the Government have so far failed to do. Putting it in place should be a priority.
The motion refers to the 955 deaths attributed to MRSA in 2003. That figure is based on data from death certificates, but it is clear that that is just the tip of the iceberg. In fact, no one knows precisely how many people die as a consequence of MRSA. The only way to get a true picture of the extent to which MRSA contributes to deaths in hospitals requires, according to the national statistician, Len Cook, special epidemiological research. It is time that more research in that area was commissioned. I hope that the Minister gives us some idea of whether such research will be carried out to achieve a proper fix on the number of deaths from MRSA and other hospital-acquired infections.
In opening the debate, Tim Loughton rightly said that front-line staff should have the authority to close wards to control infections, but that should be done by front-line staff with expertise working in collaboration with ward staff—not only matrons, but infection control teams. I agree with Beverly Malone, general secretary of the Royal College of Nursing, who said recently:
"The truth is matrons need to work in collaboration with other health professionals and managers to ensure the system works best for patients."
There should be no question of political targets getting in the way of such critical clinical judgment calls.
The leader of the Conservative party recently called for the return of matron, but why did successive Conservative Health Ministers fail to bring back matron between 1979 and 1997? How was the authority of front-line nursing staff over cleaning, hygiene and housekeeping undermined in the first place? I believe that the pressure to hit waiting time targets has made matters worse. As the NAO report showed, waiting time targets conflict with the prevention and control of infection.
I do not believe that targets can ever capture the complexity of delivering high-quality health care in this country. Targets inevitably miss the point. Last November, Dr. Andrew Bamji, a senior doctor at Queen Mary's Sidcup Trust, said that pressure to meet A and E waiting targets was undermining measures to tackle hospital infections. While Dr. Bamji was on holiday, two patients were admitted to his rehabilitation unit without being screened for MRSA, despite the protests of senior nurses. One of the patients later turned out to be infected with MRSA. Because of the target, a unit that had maintained a more or less MRSA-free record for more than two years became infected.
In December last year Annette Jeanes, lead nurse in infection control at Lewisham hospital—mentioned by Jim Dowd—said of the four-hour wait target in A and E
"You have people waiting in A and E and you physically do not have the beds to put them in. When a bed becomes available, there is not time to wash the beds and allow them to dry."
Preventing, controlling and containing hospital infections should never come second to political targets.
The rise of the hospital superbugs may have been fuelled by the Government's obsession with targets, but it did not start with that. Day-to-day control of everything that goes on in a hospital ward was first shattered back in the 1980s when a Conservative Government ordered hospitals to contract out their cleaning. Price and price alone became king—quality of service certainly did not. That generated the fragmentation of responsibility on the ward from which we undoubtedly still suffer today.
In 2000, the Department of Health issued a circular setting out a programme of action for the NHS on management and control of hospital infection. There has been no national audit of compliance with that circular and Health Ministers have made it clear that the Government have no plans to undertake such an audit. When "Winning Ways" was published in December 2003, the chief medical officer gave one of the reasons why an audit had not yet been conducted. He said:
"Despite the extent of the guidance issued to the NHS, such data as are available show that the degree of improvement has been small."
Ensuring compliance with guidance should be a priority.
There is no single quick-fix solution to the problem of hospital infections, but it is clear that concerted efforts involving, for instance, screening, hand washing and isolation can reduce the spread of superbugs. Good ventilation systems in wards, theatres and isolation rooms are vital to the combating of infectious diseases. According to the NAO, however, only one in three infection control teams felt that their hospital had appropriate isolation facilities.
The Department's 2000 circular required trusts to undertake risk assessments to determine appropriate provision of isolation facilities in each trust, but according to the NAO's report last year more than 70 trusts still had not done so. Of those who had, just 25 had obtained the necessary isolation facilities. There is no timetable for action on the results of risk assessment and there appears to be no sense of urgency either at the top, in the Department, or on the ground in NHS trusts.
It is a scandal that Ministers do not know how many isolation rooms there are in the NHS. How can the Government's contingency planning to tackle the threat of flu and other pandemics be acceptable and ring true if we do not have such basic information? There should be an urgent audit of current provision and future plans for isolation rooms.
If infection control is to make a difference, everyone who works in health and care must take it seriously. It is not just a problem in hospitals—it is a problem in other care settings as well. The role of infection control nurses and doctors in leading the cultural change is crucial. It must be cause for concern that, four years after the NAO published its first report on hospital-acquired infections, its follow-up report concluded that the budgets of one in four infection control teams had been cut—not increased, but cut. How on earth can they be expected to do their job?
Cutting infection is not rocket science. It is about relearning some of the lessons that Florence Nightingale taught more than 100 years ago. Fighting infection is a task for everyone who works in the NHS. What is needed may not be search and destroy, but it is certainly a zero-tolerance approach to infections in our hospitals.
The Liberal Democrats will vote for the motion, because it sets out the case for urgent action to fight infection. We will not support the Government's amendment, because it is far too long-winded and self-congratulatory. We do not need congratulations tonight. We need definitive action to deal with the problems of superbugs in our hospitals and to ensure that people do not become sicker when they went into hospital to be cured.
I was dismayed to hear the contribution of Tim Loughton. He is oversimplifying what is a very complex issue and ignoring much of the associated science. The Conservatives talk about methicillin-resistant Staphylococcus aureus as if it were a single homogenous phenomenon, but it is not: 17 strains of MRSA have some resistance to penicillin treatment. Clones 15 and 16 have become much more dominant in recent years in the UK, which is why we have witnessed an increase in such cases in our hospitals. In fact, clone 16 accounts for about half of all cases of MRSA in the UK.
"These clones appear to be highly transmissible compared to other MRSA clones, allowing them to easily spread from patient to patient . . . They are still quite uncommon in most other countries".
That point is pertinent to today's debate and to the comments of Tory Front Benchers. They say that we should use some of the best practice in other countries, which has had an effect on MRSA, but in many cases we are not dealing with the same strains, so the techniques used in those countries might not be appropriate here. We are dealing with the most resistant and most transmissible strains, particularly MRSA 16.
The genome for the MRSA 16 strain has recently been cracked and the toughness of that clone has become apparent: for example, it is very resistant to high temperature. There has been talk today of the need to wash nurses' uniforms and so on, but if we are to tackle this problem we need to bear it in mind that this strain can survive high temperatures.
Tory Front Benchers have also ignored the fact that Staphylococcus aureus is very common. Many of us carry it and, indeed, some 30 per cent. of the UK population are probably carrying it on their skin or in their noses and throats, so a third of those of us who enter the Division Lobby tonight will be carrying it. Some people also carry the resistant strains 15 and 16. We are dealing with something that is very common among the general public, but which will not have much of an effect on them. However, clone 16, which is causing most of the problems in the UK, does affect those with weakened immune systems and those who gather with many others in a single place—such as hospitals—because of its highly transmissible nature.
It has been argued that the problem has suddenly arisen because of cleaning contracts. Although that is an important subject, I am not convinced that that is where the blame lies. We need to consider why Staphylococcus aureus has become so resistant, and much of the explanation lies in its very nature. It mutates constantly. What was happening—we need to go back to the 1960s and 70s—is that antibiotics were prescribed when they were not, strictly speaking, necessary. The weakest strains died off and now we are seeing the prevalence of the resistant strains. That is why it is vital that everyone who is prescribed an antibiotic even now takes the full course. People may feel better after a few days, but if they do not complete the course, the resistant clones may become more dominant.
How do we tackle the problem? We need to reflect on the prescribing of antibiotics. Many primary care trusts and hospitals are considering that aspect and it is also vital to ensure cleanliness in hospitals, as the virus is likely to be transmitted through hand-to-hand contact.
Does my hon. Friend accept that, although there is not enough evidence to demonstrate that the contracting out of cleaning services per se was directly associated with the increase in MRSA, there remains something to be said about the downward cost pressure, which reduced the amount of money being spent on cleaning—whether in-house or contracted out—and did partly contribute to falling standards within hospitals? Where the overall health budget was very constrained in the past, the additional cost pressures were even greater. Thankfully, under the present Government, it is no longer quite such a problem.
My hon. Friend makes some very fair points. I was trying to emphasise that dealing with the problem of MRSA is not simply a matter of cleaning. Cleaning is one factor and good hand washing is important. We need to reduce skin-to-skin contact, which can transmit the virus.
My local trust has pioneered some of the important work that needs to be done. It is another reason why I feel that the Tories portrayed the problem in a way that is most unfair on hospital staff, particularly those working in the Northern Lincolnshire and Goole Hospitals NHS Trust. It has been one of the pilots for the clean your hands initiative. I mentioned on
It is right to view much of our debate as beyond, or one might say above, party politics. It is important to debate the issues in those terms, but I must tell the Minister that the suggestion that the problem has not worsened since 1980 does no favours to her, to the House or to the quality of our debate, because that is clearly not the case, as the statistics reveal. I shall deal with them in some detail in a few moments.
I am exceptionally grateful to the hon. Gentleman—and I stress that last word. My understanding of what my hon. Friend the Minister said was that the total rate of hospital-acquired infections was not worse. Everybody accepts, however, that the proportion of those infections that are caused by MRSA has increased.
The hon. Lady makes an interesting point, and it perhaps reveals that if Ministers do not make themselves clear, it is likely to lead to a misunderstanding of what they mean. The Minister was clearly making a partisan point. I hoped to move on from that by making a speech that is largely non-partisan.
In that spirit, it is of course true to say that MRSA is more common now for a variety of reasons, not all of which are the result of public policy. The reasons include the ageing population, the survival of more sick people, and the likelihood of transmission in a more mobile population. But the fact that MRSA organisms are often associated with patients in hospital—because they are, implicitly, sick, usually weak and often old—means that we must face certain public policy imperatives. We need a holistic approach to the problem. I am tempted to add phrases such as "sustainable", "involving stakeholders" and "joined-up thinking", as well as other new Labour-speak, but I shall move on.
The holistic approach needed begins with an acceptance of some of the facts and figures. For that purpose, we should be clear about the National Audit Office report. As my right hon. Friend David Davis said, the report says that at least 5,000 patients a year die from MRSA; that such infections cost the NHS as much as £1 billion a year; and that at any one time at least 9 per cent. of patients have an infection acquired during their hospital stay. The effect of those infections varies, from relatively minor to death.
Is my hon. Friend aware that the NAO said in its latest report, published in 2004, that had the Government implemented the recommendations in its previous report in 2000, up to 750 lives a year could have been saved? Some of his constituents use the same hospital in Boston as many of mine—Pilgrim hospital—and the issue causes them immense worry and concern, but it is not an attack on the hard-working staff of the NHS in our area to say so.
I am delighted to take my hon. Friend's advice on the latest statistics. He is renowned in Lincolnshire as a champion of the interests of the people of Boston and the surrounding area in respect of health and many other issues, and he is right to say that the NHS staff there and elsewhere do a first-class job. I am sorry to say that one of the smears that has emerged from this debate from Labour Members is the suggestion that Conservatives do not believe in the NHS. Let us put that to bed immediately. My two sons were born in Pilgrim hospital in Boston on the NHS, and I have never had private health treatment in my life. Neither have many other Conservative Members. We believe in the NHS no less than Labour Members. We want an NHS that is effective, that spends money properly and that deals with problems in the best way possible. That is true for MRSA as it is true for many other aspects of health provision.
Let us be straightforward about other facts that the Government challenged—they may be in denial—including the statistics showing that the problem has increased. Reports of bloodstream infections caused by MRSA have increased from 7,384 in 2002–03 to 7,647 in 2003–04 on the latest figures. That is a 3.6 per cent. increase, and we have no reason to believe that the rate of increase has fallen recently.
In the first three years of mandatory surveillance, the number of infections—both methicillin-sensitive and methicillin-resistant—increased, and the number of bloodstream infections caused by the methicillin-sensitive strains increased by 9.2 per cent. in 2002–03. The proportion of blood isolates resistant to methicillin is 44 per cent. in the United Kingdom. It is only 1 per cent. in Denmark; 1 per cent. in the Netherlands; 11 per cent. in Austria; and 23 per cent. in Spain. Only Greece matches the UK figure.
This is an increasing problem. That fact needs to be recognised, and I hope that the Government will accept that—in raising it from the Opposition Benches in the very bold and comprehensive way that my hon. Friend Tim Loughton did in his splendid opening remarks—we are not just illustrating a profound concern among Conservative Members but reflecting a profound concern among those people whom we represent. It is not good enough to say that we are scaremongering. My constituents raise the issue with me—I will not say every day, but certainly with alarming regularity. This is a real problem felt by the British people, and it deserves proper scrutiny by the House and an adequate response from the Government.
The Minister said that dealing with hospital cleanliness and MRSA was not a sufficient health policy. Perhaps she is right; this issue obliges us to look at some of the fundamentals about health, and in looking at them in preparing for the debate, I was alarmed at what I found. For example, it is sometimes claimed that the UK enjoys a similar quality of health care to that of other developed countries, but although indices such as life expectancy are similar, they are affected by many factors other than health care.
A recent study that measured the contribution of the national health care system to health outcomes placed the UK 18th out of the 19 developed countries studied. Similarly, a lot is of made of the Government's achievements in waiting times. It is true that the longest waiting times have fallen, but average waiting times have been little affected by Government policy. On one measure—the average waiting time of people on the list—average waiting times have only just started to fall significantly. On another—the waiting times of patients actually treated in any year—waiting times have actually increased.
Similarly, the Minister accused us of having no policy on mortality from major diseases, such as cancer and heart disease. It is true that deaths from cancer and heart disease have fallen steadily since 1999, but the Office for National Statistics has shown that the falling trend began in 1980 and has been sustained by improvements in lifestyle, particularly the reduction in smoking, improved diet and so on, rather than the extra funding of the past five years.
In summary, the OECD judged the Government's policy on health and concluded that the extra spending had made little difference to the mortality trend. It said:
"In the health sector there are few indicators showing unambiguous improvements in outcomes over and above trend improvements that were already apparent before the surge in spending."
So although the Minister said that we have no interest in those matters, that we have no policy on waiting lists or waiting times, that we are not interested in oncology and that we take no broader view of health, she should now acknowledge that not only is that not so, but when a broader view is taken, the Government's record is rather less rosy than she might suppose or want to suggest.
Well, the hon. Lady says that from a sedentary position, but she has accused us—as Hansard will show—of not having policies on anything other than clean hospitals. We are interested in such matters and we have policies on them. I mentioned those issues, which are relevant to the motion, because she did.
My remarks simply highlighted the fact that the Conservatives have no policies on those various matters. The hon. Gentleman made points about cancer and coronary heart disease, but he gave no indication of what their policies on such matters would be.
The hon. Lady attempts to divert me from the main message that I want to deliver, which is that she needs to take the motion, the subject and the concern of Opposition Members and the British people a little more seriously.
One of my constituents, a woman in her 30s, went into a local hospital for a hysterectomy. Unfortunately, she acquired MRSA, but it was not diagnosed until after she had left hospital. She died eight weeks later. That is the reality of the situation that her family and friends must face, and it explains why the debate must not be taken lightly. We need to step beyond some of the party political knockabout, which I am sorry to say preoccupied the Minister for too much of her speech.
What can be done? We need preventative measures, including a culture change in the attitudes of all those involved in training and managing staff. We need better risk analysis and clean hospitals. When the disease occurs, we need proper responses to it, which means rapid identification, effective isolation, and the most appropriate drugs treatment in terms of both quantities and regime. We also need proper research and science.
An uncourageous attitude to the problem will not make a difference, and not making a difference will cost more lives like that of my constituent. I am not prepared to pay that price and do not think that any hon. Member should be—the Conservative Front Bench certainly is not. I wonder whether the Minister is prepared to pay that price.
I am pleased that I have been called to speak, because I have been somewhat frustrated and angry. For several I, like several hon. Members, have drawn attention to the problem of hospital-acquired infections and MRSA, but we have not been listened to appropriately by either Conservative or Labour Ministers. However, for the record, I wish to draw a distinction between Ministers in the early years of the Labour Government and the present Health team. This problem was not addressed at a sufficiently early stage by successive Ministers.
Reference has been made to the causes of MRSA, of which there are many. There can be no doubt that the success of the national health service in having a greater throughput of patients is a contributing factor. One can also cite the slack regime of many medical staff, especially doctors, who should know better. They obviously do not like wearing white coats at present, and although I do not want to emphasise that point, it is indicative of the problem. Further factors are the minimal cleaning of ambulances, because they are used extensively, and the lack of destruction of bed linen and instruments, because of the serious cost implications of doing so.
The Conservative motion invites us to compare the Labour Government's stewardship of the matter with the previous situation. I hope that I am saying this objectively, but I do not think that that can be done. Part of the problem was that no statistics were available under the Conservative Government, which was also the case in the early years of the Labour Government. I draw a distinction between previous Health Ministers and the current ministerial team, because the latter have addressed that problem, albeit late. They have given themselves a presentational problem, because now that we have more accurate reporting, people are saying, "All this is out of hand."
The problem was always there, but it was deliberately suppressed, not so much by Ministers, whether Labour or Tory, but by the people who run the NHS. There was a conspiracy of silence, which still exists, partly because hospitals and individual practitioners in the health service were worried about litigation. Given the competitive nonsense of star-rated hospitals, naturally people are worried about admitting the extent of infection. There are resource implications. If wards or facilities are closed, that has an impact on waiting lists and so on.
I am afraid that I will not. The hon. Gentleman will share my frustration that the speeches of the Tory and Labour Front-Bench spokesmen lasted until eight minutes past six. This is supposed to be a debate, which means that we should all have a go, so if he will forgive me, I will not give way to him.
Fair comparisons cannot be made between the situation now and in the past. There has been too much partisan politics this afternoon. In The Independent on
"John Horam, Health Minister said in a Commons reply that the total numbers of cases of . . . MRSA . . . was not 'collected centrally', and the ministry had no idea of the number of cases in which the bug 'contributed to or caused death'."
That was part of the problem, but officials running the NHS were also to blame. Ultimately, of course, Ministers must take the blame. As recently as February 2000, Sir Alan Langlands, former chief executive of the NHS and part of the magic circle that runs the country, whether under a Labour or a Tory Government, was asked whether hospitals would be given targets for curbing infections. He said:
"I don't think I want to pin myself to a target at the moment, simply because we need to have a proper surveillance system that gives us baseline numbers against which we can set targets."
Sir Alan did not recognise the extent of the problem. Like many others, he did not want to admit the scale of the issue. He adopted a laid-back approach.
Tim Loughton said that I had raised the subject on a number of occasions in the House, and I am grateful to him for acknowledging that. However, he also blamed Labour for not pressing harder on the issue when in opposition. I was a member of that Opposition. I was not a Front Bencher—I never will be, thank God—but I was one of a number of Members who raised the issue. I double-checked my figures, and at least five peers raised it in the other place before 1997, including my colleague Lord Fitt of Belfast, whose moving speech I commend to hon. Members. I believe that Baroness Cumberlege replied to him, and she was working from the same brief that Mr. Horam used in his reply to my Adjournment debate. The thrust of their argument was that we were exaggerating the scale of the problem. We were Back Benchers, so they did not have to take any notice of us. They kept their heads down and spoke from their brief in the belief that there was nothing to worry about.
My hon. Friend Paul Flynn also secured a debate on the issue, as did my hon. Friend Mr. Sheerman. In fact, about 15 Back Benchers raised the issue in the closing stages of the last Tory Government, but it was ignored. We therefore depended very much on voluntary reporting. The Whip has raised his finger, but I wish to make one more point.
In his reply to my Adjournment debate, the hon. Member for Orpington said:
"Mostly, the type of infection will be trivial, but for patients who are in hospital, it can sometimes be serious, as the hon. Gentleman has noted . . . The infections are no worse than those caused by the ordinary bacterium."—[Hansard, 19 March 1997; Vol. 292, c. 859.]
He counselled me that it was important to get the matter in perspective and said that I was
"ill advised to introduce party politics" into such matters. I am guilty of many sins, but I did not do that then, and I have not done it today. Both sides are to blame to some extent, and we should urgently address the problem by homing in on poor managers in the NHS, particularly senior ones who have suppressed the truth.
The Minister is guilty of many sins, but when she was a Treasury Minister she was the first person to see to it that there were no longer fibs on death certificates. She ensured that the cause of death was properly recorded. Previously, pneumonia and septicaemia might be put down as the cause of death, when the truth was that the death was MRSA-related. My hon. Friend remedied that. However, now that there is accurate reporting, she faces a problem. She is being chastised by the Opposition.
In today's Britain, our lives are in greater danger when we are in hospital than when we are driving a car. What an extraordinary position to be in. MRSA and other hospital-acquired infections are ripping people's lives apart. Children have lost parents, parents have lost children and families have been torn apart.
It is not just that our lives are in danger; it is that our long-term health and well-being are also in danger. I know of cases of people losing limbs after catching MRSA in our hospitals; children who have been left partially handicapped after catching MRSA in our hospitals; and people who have been left housebound for months because of hospital-acquired infections. It is nothing short of a national disgrace, and, as my hon. Friend Mr. Hayes put it, it is a profound concern.
It is an absurd protestation from the Minister, in what I am sure will be her last speech in the House, that the problem has not changed in 25 years. Let me give her a direct example of why she is wrong. Pressure from the Government is making things worse. In my constituency, Epsom hospital is under great pressure. The neighbouring accident and emergency department at Crawley has been closed. The hospital is swamped with work and has a huge overflow of patients as a result of that closure. But the Government are demanding that it meet the four-hour waiting time target in accident and emergency, even with the extra patients. They are not just demanding; they are threatening managers if they fail to meet that target.
No, I have only five minutes.
Direct and unpleasant pressure is being put on the management team. Operations are being cancelled and elderly patients are being moved into a store room that has been converted at the neighbouring hospital, which was once a ward. As a member of staff who came to see me recently, too scared initially to give her name, said:
"Infection control guidelines have gone out of the window."
Epsom is not an isolated case. Throughout the NHS, doctors, nurses and hospital managers are coming under the most intense pressure to meet the requirements of Ministers. Some have even resorted to falsifying the figures, and infection control goes out of the window. Is it any wonder that the MRSA problem is getting worse and worse?
Is it not astonishing and alarming that 100,000 people a year catch a hospital-acquired infection? Surely Ministers have learnt from the experience of their own constituents how bad the problem is. The problem is one of rising disease, rising infection and appalling hygiene standards in many of our hospitals.
My right hon. Friend Mr. Redwood referred to one of his constituents who also wrote to me about the state of the toilets in that hospital. He said:
"I decided to try the other toilet; this doubles as a store room and at the time of my visit ¾ of the floor space was taken up with wheelchairs and large cardboard boxes . . . Bear in mind that all these boxes had come off the back of a lorry . . . Having used the lavatory, in order to get to the . . . wash basin it was necessary to move 2 or 3 wheelchairs thereby possibly contaminating the wheelchair."
That description is from a hospital that gets a green light on hygiene from the Government—another meaningless statistic from the Government that bears no relation whatever to the real experience of patients. All of this is happening today in hospitals around the country as we debate in this place.
The Government seek to pass the blame on to the last Conservative Government. They want the country to believe that the problem is down to contracting out cleaning services, but their own studies show that there is no correlation between contracting out and hospital-acquired infections. I have not noticed Ministers rushing to bring cleaning contracts back in-house. If a cleaning company is not doing its job properly, perhaps it is time to change the cleaning company.
Is it not about time that we addressed the problem in the real way that is necessary? Is it not about time that we had nurses properly in charge of their wards—a new generation of matrons with the power to withhold money from cleaning companies and if necessary to close a ward to ensure that it can be properly cleaned?
The Government have palpably failed to tackle the problem of MRSA, and their clumsy attempts to micro-manage the NHS from Whitehall are just making matters worse. In Britain today people are scared to go to hospital. What a damning indictment of eight years of Labour rule. What a disgrace in a country such as ours. It is time to do something about it, and after
In common with many Conservative Members, Chris Grayling has told us that he believes in the national health service, but his speech was designed to denigrate the NHS and the people who work in it. He did not have one word of praise for the hard work of NHS employees or one whisper about the improvements to the NHS or the attempts to improve the problems that he highlighted.
No one—certainly no Labour Member—doubts the seriousness of MRSA or tries to minimise its importance. However, it is one thing to emote, to frighten people and to pass anecdotes in this House, and it is another to tackle the issue. The hon. Gentleman did not mention that the NHS treats 1 million people every 36 hours. Given the scale of the NHS, certain challenges must be faced, but he did not say one serious word about how to face them.
We are all politicians, and we all do a bit of point scoring, with which I have no problem. However, it was stomach-churningly unpleasant to listen to scientific illiteracy on a massive scale from Conservative Members, whose comments did not include a word of science. They failed to understand that we must examine the evidence and the science, and base our policies on that examination, in order to deal with MRSA.
Tim Loughton seemed to think that MRSA and hospital-acquired infections are synonymous, and he did not seem to understand the distinction. When my hon. Friend Dr. Starkey pointed out that the proportion of MRSA in the general population might be an important factor, the hon. Gentleman did not understand. My hon. Friend Shona McIsaac understood that point and grasped some of the science, which is more than I can say of any Conservative Member.
In a brilliantly succinct point, my hon. Friend the Member for Milton Keynes, South-West explained the significance of the higher proportion of MRSA in the general population in a way in which children watching "Blue Peter" could have understood. The higher proportion of MRSA in the general population is important because MRSA is passed from person to person, and the important strains in our population are passed in that way. That explanation went a mile over the hon. Gentleman's head and he did not have the slightest clue what she was talking about. Conservative Members did not seem to understand that that factor is important and that we must base our policies on the science.
At least Mr. Burstow recognised that MRSA was not invented in 1997. He described the Tory policy as, "Say nothing, do nothing and learn nothing", and for once I agree with him—that description of Tory policy is so nice and simple that I will almost certainly steal it at some point in the future. The hon. Gentleman discussed single rooms and isolation facilities, but he ignored the fact that the latest NHS building projects include about 50 per cent. single rooms.
Hon. Members must ask themselves this question: which party is more likely to build an NHS that can tackle the problem? Is it the party that spent £33 billion on the NHS in 1997 and said that that was more than enough, or is it the party that has already doubled that expenditure?
Question accordingly agreed to.
Madam Deputy Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House welcomes the Government's commitment to tackle hospital-acquired infections with a robust programme for improving standards in infection control; congratulates the Government on its action plan for reducing infection rates, "Towards cleaner hospitals and lower rates of infection", and the introduction of the new target to halve the rate of MRSA in the first instance, and the appointment of local directors of infection prevention and control to cut cross-infection locally; supports the Chief Medical Officer's action plan "Winning Ways"; recognises that MRSA is a longstanding problem that became endemic in the National Health Service between 1993 and 1997 and believes that this Government is to be congratulated on introducing a system of mandatory surveillance for MRSA to establish its full extent; notes that the Government is working with experts from home and abroad to identify the actions and best practice which will make a difference, including a matron's charter, a national hand hygiene campaign, improved standards and better inspection of hospital cleanliness; and therefore congratulates the Government on its comprehensive programme of investment and reform that has equipped the NHS to deliver improvements in patient safety, and to reduce hospital acquired infections.