I beg to move,
That this House
supports NHS staff in their efforts to minimise healthcare associated infections;
notes with distress the failings disclosed in the report by the Healthcare Commission into the outbreaks of clostridium difficile at Maidstone and Tunbridge Wells NHS Trust;
deplores the failure by the Department of Health to secure new leadership at the Maidstone and Tunbridge Wells NHS Trust at an earlier stage;
regrets the repeated failure of the Government to ensure compliance with proven methods of containing infections, including screening prior to admission, adequate isolation facilities and optimum bed occupancy rates;
and calls on the Government to support NHS bodies in implementing zero tolerance strategies for healthcare-associated infections.
Time and again, we have brought Ministers to the Chamber to try to get action to combat infections in hospitals. Time and again, they stand at the Dispatch Box and say that that is a priority. Time and again, the independent evidence shows their subsequent failure to do what is proven to be needed. The Healthcare Commission's report on the outbreaks at Maidstone and Tunbridge Wells NHS Trust is only the latest, although possibly the worst, example of such reports.
When we brought the Secretary of State to the House to comment on the report, he said that that was an exception, but in 2005, the latest year for which we have figures, 3,807 deaths were reported to be associated with clostridium difficile, and 1,629 with MRSA. In 2006 some 20 NHS Trusts had C. diff rates higher than those reported at the Maidstone and Tunbridge Wells NHS Trust, although I hope that very few of those trusts are responsible for the kind of failings that were disclosed at Maidstone.
The purpose of the debate is once again to demand that the Government implement the comprehensive strategies against hospital-acquired infections that they have been advised to pursue for years. In particular, we hold the Secretary of State to account for his failure to act in relation to the failings at Maidstone and Tunbridge Wells. In our motion I have focused on three main topics—screening, isolation facilities and bed occupancy rates. I acknowledge that there is much else that will form part of a comprehensive strategy, including an antibiotic regime, high cleaning standards, improved hand hygiene, surveillance and new technologies for antimicrobial techniques and surfaces. I set out much of that in our previous debate in January, but I draw attention to the three matters that I mentioned, over which the Government could exercise influence through investment and policy.
"Some countries have been particularly successful in controlling MRSA.. Notable is the experience of the Netherlands. The Dutch strategy has been based on a policy of 'search and destroy'. This involves screening patients for MRSA and isolating those found to be positive. . .The Dutch have been able to set aside sufficient numbers of single rooms in modern hospitals and maintain a high healthcare worker to patient ratio. As a result, this approach has been remarkably successful."
So for nearly four years—I am sure hon. Members sometimes get tired of hearing us go on about it—based on that evidence, we have been calling for a search and destroy strategy.
If the Government had listened to the chief medical officer in the first place, and latterly to us, we would be halfway through the process of removing endemic infections, particularly MRSA, in our hospitals, and we would be halfway to achieving some of the MRSA rates experienced in the Netherlands and Denmark, and, as the European antimicrobial resistance surveillance survey published Europe-wide this week suggests, we would have made greater progress in the same direction as France has done. Thus far, however, we have not matched its performance.
Does my hon. Friend recall the case that I raised at Health questions a few days ago? A decorated RAF war hero in my constituency nearly died after contracting C. difficile in Southampton general hospital following a routine operation. Does my hon. Friend think that the reason for the inaction is that the people who suffer so much—and in many cases lose their lives—are of a certain age? If such things happened to people of middle age or younger, perhaps the Government would feel it necessary to take firmer action and act more decisively. Is not a form of ageism at work in respect of the problem?
I recall my hon. Friend's question, and I fear that he may be right, although I wish he were not. It is clear from the report on Maidstone and Tunbridge Wells NHS Trust that some of the same infection control issues were manifested in the lack of response to issues of privacy and dignity. That, of course, impacts disproportionately on the very elderly. Although C. difficile is not confined to the very elderly, they are particularly at risk. I share my hon. Friend's concern.
A search-and-destroy strategy would clearly take several years to achieve its aims, just as would a zero-tolerance approach in respect of C. difficile; we face increasing risks from new strains and from community-acquired infections. I do not discount the simple fact that even with such a strategy, there is a continual fight against the reintroduction of infection. However, an aggressive strategy of that kind is even more necessary now, as those more virulent strains become evident.
I want to pick up the point about elderly people who contract MRSA and other infections. Some of the most common sites for such infections are leg ulcers, which are very frequent among older people, whether they are admitted to hospital, in residential care or seen by practice nurses in the community. Does my hon. Friend agree that, as leg ulcers are so open and likely to acquire such infections, we should not only tend to their healing, but concentrate more on the issue of leg ulcers among the elderly, so that we can see whether they have acquired those diseases?
I am grateful to my hon. Friend. She and other Members may recall the work being pioneered by Ellie Lindsay, a former nurse of the year, in East Anglia. She has set up leg ulcer clubs and sought hard to persuade primary care trusts to operate precisely the focus that my hon. Friend mentioned. Unfortunately, Ellie Lindsay has had less success than she would have wished for. However, she is fighting to achieve what my hon. Friend mentioned.
The measures that the hon. Gentleman is outlining are fairly obvious, and they are critical. However, is not the real problem antibiotic resistance? Unless we tackle that at root by promoting more research, we will be stuck with the problem for a long time. Can the hon. Gentleman tell us what research was instituted by the Conservative Government to persuade the pharmaceutical industry and Government laboratories to crack that major pharmaceutical problem?
The hon. Gentleman may say that the measures are obvious, and they may be obvious to him, but they were not as obvious as they should have been in the Maidstone and Tunbridge Wells NHS Trust. From memory, I think that only about 7 per cent. of the appropriate C. difficile patients received access to Vancomycin. We have to make sure that the available antibiotics regimes are being used. In the majority of cases that it reviewed, the Healthcare Commission found that broader-spectrum antibiotics were being used when narrower-spectrum ones were available. Of course there is a need for research and the constant addition of techniques to deal with the problems.
Does the hon. Gentleman agree that, especially when we talk about ulcers, there is more to consider than broad-range antibiotics? There are other, effective ways of dealing with leg ulcers in particular. I am thinking of the surgical maggots available from ZooBiotic. They not only clean the wound, but combat the MRSA. The overuse of broad-spectrum antibiotics in dealing with infection in leg ulcers sometimes exacerbates the problem.
I am grateful to the hon. Lady. I recall her Adjournment debate on that subject earlier this year, which clearly caught the interest of the House. Where C. difficile is concerned, staff in the NHS need to be extraordinarily well aware of the risks that they run with broad-spectrum antibiotics, particularly when they are combined with proton pump inhibitors, because the combination of those two things can leave patients very vulnerable to the consequences of C. difficile infection and its proliferation. The hon. Lady refers to one way of combating that, but another would be the use of probiotics, which has been pioneered in Nottingham.
Dr. Iddon talked about things being obvious. Some of the things on which we should focus have been obvious for a long time—the point is that those things have not been done. Let us take the screening of patients for admission. Ministers have repeatedly told the House that they are in favour of screening at-risk patients, but it was not until September this year that they came to the House to say that they supported the universal screening of admissions. I welcome the fact that they have now done that, albeit that it is nearly three and a half years since we called for it to happen.
This is not the first time that the Department of Health has advised that. Last November a best practice code was published, which said:
"The logical conclusion of risk factor assessments and the results of modelling studies is that the most appropriate approach to the reduction in MRSA carriage in the population, and resultant MRSA infection, is the universal screening of all admissions to hospital".
Now, a year later, Ministers tell us that they are going to put in place the resources to support screening; we said during the general election that that should be done and that the necessary technology should be supported.
The hon. Member for Bolton, South-East mentioned research; we said that there should be research and support for new technologies to deliver rapid screening, so that when one is in a ward and asks staff about the process of managing patients, one does not find that it will be two days before they are in a position to be able to access results and know whether patients are infected.
In the past few weeks, I have had responses to freedom of information requests that I made of hospital trusts, and the results are deeply disappointing. Only 2 per cent. of trusts said that they screen all patients for MRSA, only 32 per cent. of trusts can provide any data on the number of patients screened, and not one trust collects data on whether patients are isolated following a positive MRSA screening result. None offered data on whether, if a patient was screened and found to be positive, they would as a matter of course be put in a single room or isolated. I am afraid that that rather accords with the findings of the Health Protection Agency, which were published by the Department just a couple of weeks ago, although not with a press release. The HPA said that nearly one third of trusts did not screen all patients, only 60 per cent. screened all previously MRSA-positive patients, and only 55 per cent. screened all patients from nursing homes, despite that being a high-risk factor. It is all very well to say that there should be screening of admissions, including emergency admissions, but that has been said before and it has not been done. We want to see results.
On the isolation of patients, Pat Troop, chief executive of the Health Protection Agency, said:
"The most effective way of controlling the spread of both Staph. Aureas and MRSA is through early detection and appropriate isolation and treatment."
In 2004, the National Audit Office noted that many trusts had undertaken a risk assessment but only a quarter had obtained the required isolation facilities. The study published by the Department last month said:
"Three quarters of Trusts indicated that they had problems implementing isolation policies due to inadequacies in the number and fitness for purpose of isolation rooms."
"Health Authorities should plan bed numbers in order to achieve a bed occupancy rate of no more than 82 per cent. in 2003-04."
What happened after that? The bed occupancy rate went up. It is still at 84.5 per cent., and in many parts of hospitals, it is way above that.
Cheltenham's private Nuffield hospital might agree with the hon. Gentleman, because it told me that it credited its virtually zero rate of infection to two policies: aiming for a 70 per cent. bed occupancy rate, and not outsourcing its cleaners. Does he now bitterly regret that his party, when it was last in government, pursued the exact opposite policies, which led to more than 90 per cent. bed occupancy rates and the outsourcing of cleaning staff?
Does the Secretary of State think that that was good? He might like to tell Martin Horwood that there were serious inadequacies of cleaning at Maidstone and Tunbridge Wells, but that the cleaning contract was not outsourced. In reply to questions, the Secretary of State and Ministers consistently say that there is no evidence to support the proposition that outsourced cleaning is necessarily any better or worse than in-house cleaning.
No, I am not going to give way; I am moving on.
Let me make it quite clear that bed occupancy rates are too high. In the past year, the Government have reduced the number of acute and general beds in the national health service by the largest proportion since 1982. We saw a reduction of 6,000 acute and general beds, which has taken us down to a figure of 127,000 such beds, when the NHS plan said that there would be a 2,000-bed increase to take us up to a figure of 135,000. There is a very big gap. Last year, The Independent said that the Department had conducted a review suggesting that reducing bed occupancy to a maximum of 85 per cent. would save 1,000 cases of MRSA a year. Apparently, according to speculation in the press, there are further factors that the Government know about, but which they have chosen not to publish. When the Secretary of State replies, perhaps he will tell us about some of those factors that the Department has found in its research.
Let me make something clear about these three factors. They are interrelated, and they require the Government to support investment in isolation facilities, as well as the policy change on screening. Screening requires more isolation facilities. It is no good having screening for admissions if there are insufficient isolation facilities available to back it up. Isolation requires more single rooms, and therefore more beds. It is no good the Government going down the road that they propose, if they are cutting beds at the same time, and if nurses do not have time to clean beds before patients are admitted. Those three things go together, and the Government do not appear to understand the necessity for a comprehensive strategy.
I shall just take a moment to talk specifically about Maidstone and Tunbridge Wells NHS Trust. I find it astonishing that the Government's amendment does not mention the outbreak of C. difficile at Maidstone, or the report. It really should. The House will recall the appalling failings in the standard of care provided. They were probably, or definitely, the main cause of death of approximately 90 patients, and they may have contributed to the deaths of approximately 270 patients in the period up to September last year. The failings were many.
Of course, some of the reporting concentrated on the failings of the nursing care, and they were severe, but we must be aware of the nurses' point of view. Given the intense pressures, very limited access to additional staffing—staffing numbers were going down—and bed occupancy rates of 90 per cent. or more, they find it hard to take the fact that they are held responsible for the poor professional standards when the management were putting them under intolerable pressure. The report discloses serious failings at every level: on antibiotic prescribing, which we were talking about; on lack of training; on the failure to establish an isolation ward for four months; and on simply admitting the scale of the problem. The public in west Kent were simply not told about the nature of what was going on.
Does my hon. Friend agree that it is terribly important that hospitals own up to the size of problems? I am dealing with a case in the Royal United hospital in Bath—I am looking forward to visiting the hospital on Friday to talk further about it—which is denying that there were any cases of MRSA at all during September. However, I know that my constituent, Mr. Don Stevenson of 8 Hatton way, Corsham, went down with MRSA on
That is extremely important. The code of practice, which we debated in the House a year ago, and which Ministers said would solve those problems, specifies in terms that there must be openness and information to the public about infection rates. It is quite astonishing that in a press release the management of the Maidstone and Tunbridge Wells NHS Trust tried to claim that infections had been brought in from the community. Only a small proportion of infections were acquired that way, so it was an outrageous claim.
Astonishingly, senior managers—the director of nursing and the chief executive—at one point denied to the Healthcare Commission that it was the trust's policy not to cohort patients for nursing. Contrary to the guidelines, that was exactly what was being done, but they did not seem to realise that, so management failings were extraordinary.
In the light of its findings earlier this year, the Healthcare Commission knew that there were significant failings in the management of the trust—but it was not until the publication of the report that the chairman and the chief executive resigned. More recently, non-executive directors and the former director of nursing have resigned. No one who saw the commission's report when it was presented to the Department of Health in May could have come to any conclusion other than that the failings in the trust's management and leadership were so great that they needed to be replaced.
The Secretary of State says that he was not asked to replace the management by the Healthcare Commission, so he did not do so. He hides behind the commission. He has instituted an independent leadership review, even though it will not serve any purpose, because the leadership has failed and its members are disappearing. One of them took a large severance payment, which the Secretary of State claims that he can stop—I doubt that he can—and the leadership is not in place in Maidstone and Tunbridge Wells to follow up the report and demonstrate to the public's satisfaction that there is new leadership in place. It will take far too long for that leadership to be put in place, but it should have been put in place in May, when the findings were first presented to the Department.
Does my hon. Friend share my concern that the new chief executive appointed to turn the trust has a part-time appointment, and is responsible, too, for the Ashford and St. Peter's Hospitals NHS Trust? Is that the level of commitment that he would expect to turn around the problems in our trust?
My hon. Friend makes an important point. If the Secretary of State had taken the action clearly indicated in the report and used his powers under section 66 to remove or suspend the board and put new leadership in place, my hon. Friend and his constituents would know that that leadership would be permanent and would take the necessary action. However, the Secretary of State did not do that. He hides behind the Healthcare Commission, but that is not its responsibility. It should investigate problems and report on them. It is the responsibility of the strategic health authority in the first instance, the NHS chief executive in the second instance, and Ministers in the third instance to exercise the power of performance management and, if necessary, to intervene. They have the powers under NHS legislation, but they did not use it.
The Minister of State, Mr. Bradshaw is always telling me that a consequence of our policy would be a lack of accountability to Parliament. Ninety patients died— [ Interruption. ] Indeed, since September 2006, there have been further deaths associated with C. difficile at the Maidstone and Tunbridge Wells NHS Trust this year. Who has come to the House to be held accountable for that? If Ministers are genuinely accountable, they should have used the powers that they claim are so important and done something about the problem. If they are not prepared to use them in those circumstances, in what circumstances would they use them?
Part of the report entitled "Developments since the investigation was announced" describes "musical chairs" among senior executives. There were further outbreaks of C. difficile in January in the Kent and Sussex hospital; in April at Maidstone and Tunbridge Wells; and in May and June there were 45 new cases of C. difficile at Maidstone, and nine deaths. I am not arguing that the failings disclosed up to September 2006 have continued to anything like the same extent, but it is perfectly clear from the report that things that should have been done have not been done. The policies were not shown on the departmental intranet. Earlier this year, the Healthcare Commission said that it was still observing patients with diarrhoea on open wards, and it saw patients with MRSA being barrier-nursed on such wards.
What was done to ensure that the new management at the Maidstone and Tunbridge Wells NHS Trust was in place at the right time? The Secretary of State did not take the action that he should have taken. He should be accountable to the House for that simple fact.
Is not the Government's response to C. difficile complacent? When the subject was considered in January, the Government failed to mention C. difficile in their amendment to an Opposition motion. Are not they simply responding to the Healthcare Commission rather than the pleading of people such as my constituent Graziella Kontkowski and the C. difficile support group?
I recall the occasion that my hon. Friend mentions, and also his Adjournment debate on the subject. The Government said nothing about C. difficile and, when we challenged them about what they would do, it was obvious that they had targeted MRSA and that C. difficile rates had risen because of lack of action on, for example, hand washing. They said that they did not believe that it was right to have a national target; a central target was wrong. They claimed that the targets had to be local because there was such local variation in C. difficile. Ten months later, the Secretary of State came to the House to say that central targets were essential. The Government have no comprehensive strategy and cannot even manage, in the space of a year, to maintain a consistent policy. The Conservative party has a strategy and a policy, which we would be prepared to pursue.
The amendment states that
"healthcare-associated infections (HCAIs) are a worldwide problem".
Indeed, they are. However, a Europe-wide survey shows that places such as Denmark and the Netherlands have succeeded with MRSA where we have failed. Even the French and the Slovenians have moved substantially in the right direction, whereas, according to the European Antimicrobial Resistance Surveillance Survey, we are moving in the wrong direction.
The Government had a policy of "bare below the elbows". That is good, but their document states that
"it seems unlikely that uniforms are a significant source of cross-infection."
They have a deep clean policy, but a press release that the Department published in September claimed that trusts were, in any case, conducting a deep clean on a ward-by-ward basis. Although the Prime Minister announced the policy, we found that no follow-up or evaluation was intended, and that it is only now that the Department is trying to put in place some structure for deep cleaning.
Yet in 2000 the NHS plan pledged
"a nation-wide clean-up campaign throughout the NHS starting immediately".
Mr. Milburn said in 2001:
"This extra money will help get the basics right. It will drive forward the biggest clean-up campaign there has ever been in NHS hospitals."
No stone is being left unturned in the battle against the superbug. We are improving cleaning standards, rolling out cleanyourhands and making sure infection control is a fully staffed priority for every NHS trust".
He said that approximately two months before the outbreak at Maidstone and Tunbridge Wells began, in circumstances in which nursing staff were not capable of delivering that priority.
We are told that there are to be 3,000 extra matrons. What is the evidence base for that decision? How long was it in gestation? Where is the consultation document for the Royal College of Nursing to consider its appropriateness? Why a matron for every two wards—why not a matron for every three or four wards? Where did that policy originate? Is it a case of what The Lancet described as
"Politicians...pandering to populism about hospital cleanliness" and not listening to the evidence?
The Government claim that they want targets, but 45 per cent. of trusts said that they had difficulty reconciling the targets for accident and emergency attendance with those for hospital-acquired infection. The amendment is too little, too late. The Government say that targets are essential, yet they get in the way of NHS staff doing what they need to do. We need a strategic approach, the resources to help NHS staff achieve the goal and time for change. 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:
"recognises that healthcare-associated infections (HCAIs) are a worldwide problem;
acknowledges that the recent Comprehensive Spending Review settlement for the NHS includes £270 million to tackle HCAI;
welcomes the initiatives the NHS is taking to manage infection control, including a new "bare below the elbows" dress code, new clinical guidance to increase the use of isolation for infected patients published in September, every hospital to undertake a deep clean as part of a wider drive for a culture of cleanliness, matrons and clinical directors to report directly to trust boards on infection control and cleanliness, annual infection control inspections of all acute trusts using teams of specialist inspectors, and MRSA screening for all elective admissions next year;
further welcomes the introduction of legislation for a new health and adult social care regulator with tough powers to inspect, investigate and intervene in hospitals that do not meet rigorous standards for cleanliness and a new legal requirement on chief executives to report all MRSA bacteraemias and clostridium difficile infections to the Health Protection Agency;
believes that centrally determined targets for tackling HCAIs are the most effective way of ensuring infection levels are reduced in every hospital;
notes that as a consequence MRSA bloodstream infection numbers are falling;
and welcomes the Better Care for All PSA Delivery Agreement, which sets two new targets for the period 2010-11 to keep MRSA bloodstream infections below half the numbers of 2003-04, and to deliver a 30 per cent. reduction in clostridium difficile infections from the numbers in 2007-08."
This is an important debate. Patients have a right to clean and safe treatment wherever they are treated in the NHS. Safety in health care, an essential element of every medical procedure, must be our priority. We have put in place a wide-ranging series of measures to tackle infections and improve cleanliness.
Health care-associated infections are acquired as a consequence of treatment for a medical condition. The problem is not new, nor is it unique to the UK. HCAIs affect every health service in the world, and prevalence in the UK is similar to that in other developed countries. For example, the rate of HCAIs is 9 per cent. in England, while rates vary between 6 and 10 per cent. in France and between 5 and 10 per cent. in the United States. Mr. Lansley mentioned Holland, which has enjoyed good success in tackling MRSA, but its rate of health care-associated infections is 7 per cent., which is very close to the rate in the UK.
The two major health care-associated infections in the UK are MRSA and clostridium difficile. MRSA is a bacterial infection that is resistant to commonly used antibiotics. It can infect surgical wounds and ulcers and, more seriously, can cause bloodstream infections. Clostridium difficile is a bacterium that naturally lives in the gut. Again, it particularly affects the elderly. When antibiotics kill off normal, healthy bacteria, the consequences can be severe, so antibiotic prescribing policies are even more important in controlling the disease.
The Secretary of State has rightly described the two main hospital acquired infections, but there have been recent newspapers reports about pseudomonas and the suggestion of a 41 per cent. increase over the past four years. Although levels are still low, reporting is currently not mandatory. Is the Secretary of State concerned about that increase and does he think that there needs to be a change to mandatory reporting?
Pseudomonas is a growing concern. We need to consider closely whether there needs to be mandatory reporting. Pseudomonas particularly affects people with burns and those who are very ill with specific diseases. It is a growing problem that we need to ensure receives adequate attention.
The risk of getting MRSA or C. difficile is low. Last year, there were just under 56,000 C. difficile infections and 7,000 MRSA bloodstream infections in our hospitals. That is still too many, but it has to be seen in the context of a health service that deals with 1 million people every 36 hours. The Government have introduced a range of measures to improve cleanliness and tackle infections. In 2001, we became the first country in the world to introduce mandatory surveillance of MRSA. We built on that in 2004, with the introduction of C. difficile surveillance for those aged 65 and over, the most vulnerable group of patients. In 2005, we enhanced the surveillance system for MRSA and earlier this year we extended C. difficile surveillance to every patient over two years of age.
My right hon. Friend may not be aware, but a company in my constituency called Carrington's has developed a fabric that kills MRSA. That could be a major battle winner against MRSA, so will he investigate whether it can be introduced further, into trusts other than those where it has already been trialled?
That may well be one of the 21 different new techniques and technologies that are being examined and trialled in some hospitals, to see whether the claims that the manufacturers make are borne out in practice.
We have the most comprehensive surveillance system in the world for health care-associated infections. The European Union is using our approach to C. difficile monitoring as its model, as it develops a pan-European approach to monitoring C. difficile. We have introduced a wide range of guidance and best practice procedures to support managers and clinicians to best meet the challenges of HCAIs. That includes the publication in 2003 of "Winning Ways", which provides a clear direction for the NHS on action to reduce the high levels of MRSA and C. difficile. In 2005, we launched the saving lives programme, a key initiative that all trusts have signed up to, in order to implement best practice to reduce infection rates. The programme was relaunched earlier this year to include best practice on antimicrobial prescribing and C. difficile high impact interventions. The clean your hands campaign, run by the National Patient Safety Agency, is now in its third year. All acute trusts are signed up to the campaign and the National Patient Safety Agency is now piloting an extension of the programme to other health and social care settings.
We have set up improvement teams in the Department of Health that are providing tailored support on MRSA and C. difficile. This summer, we doubled the number of these teams and, by the end of this month, they will have worked with 146 trusts. The work of the improvement teams has had a real impact on MRSA bloodstream infections in the trusts that they have helped.
We continue to set challenging targets to ensure that this issue remains a priority. Trusts are already working towards the nationwide target to halve the number of MRSA bloodstream infections by April 2008, and the latest data show that good progress is being made. Trusts will also be required to reduce the number of C. difficile infections by 30 per cent. as part of our new better care for all public service agreement.
Alongside this drive to reduce the rate of infections, there is a concerted effort to improve the cleanliness of our hospitals. High standards of cleanliness and hygiene are not just an important part of the drive to lower infections but a core part of what patients are entitled to expect from the NHS, day in and day out. In 2000, we introduced patient environment action teams, which assess annually every in-patient health care facility in England. The inspection covers hospital cleanliness, the quality of the environment, food and the issues of privacy and dignity. Thanks to the hard work of NHS staff, and to the priority that we have placed on this issue, hospital cleanliness has improved year on year since annual inspections first began more than seven years ago.
In that context, does my right hon. Friend recognise the important work that has been carried out at the New Cross hospital in my constituency, which has moved from below average to the top of the league table? He presented an award to the hospital for that work this week. Will he congratulate the staff on the tremendous work that they have done in very difficult circumstances?
Is the Secretary of State aware that the Royal College of Nursing has published 10 minimum standards for infection control, one of which is the adequate provision of changing facilities for staff in every hospital? Does he endorse that minimum standard and, if so, what is he doing to ensure that the Kent and Sussex hospital, which lacks those basic changing facilities, can have them?
That is an important aspect of this issue. This is not something that we believe that we should drive centrally, however, although there are other issues over which we should have central control. It is up to the local trusts, including the trust of which the Kent and Sussex hospital is a part, to ensure that there are proper changing facilities. I shall say more about that trust later, because I know that the hon. Gentleman has taken a keen interest in these matters on behalf of his constituents, who were so appallingly affected by the Maidstone and Tunbridge Wells report.
"this House supports NHS staff in their efforts to minimise healthcare-associated infections".
The Government's amendment to the motion, however, proposes that we leave out that recognition of support for NHS staff. Why is that?
I do not need to put it in amendments; I tell NHS staff week in and week out what a fabulous job they are doing. I know that the hon. Gentleman has been paying close attention to my words, and he will already have heard me say what a tremendous job the staff are doing.
It is thanks to NHS staff that we have seen cleanliness improving year on year since the annual inspections began seven years ago. At that time, about one third of hospitals were rated as poor. Now, only a handful fall into the lowest categories of poor or unacceptable. We raised the bar for PEAT scores in 2007, and I am pleased that the NHS has risen to the challenge. Even with this higher standard, figures published today by the National Patient Safety Agency show that in 2007, 98 per cent. of hospitals were rated excellent, good or acceptable, up from 95 per cent. in 2006.
But will the right hon. Gentleman acknowledge that the PEAT scores only get us so far, as throughout the period of the C. difficile outbreak, the scores for the Maidstone and Tunbridge Wells NHS Ttrust were acceptable?
The important change is that the PEAT scores were based then on one visit and the hospital was usually aware that the visit was going to be made. From this year, however, there will be a year-round appraisal that will not be based on the position on one day in the year. Standards have to be maintained through the year, but I accept that this is not the only issue. I am setting out a whole series of measures that we are introducing to tackle the problem.
The House will be aware that we have also introduced a strong statutory regime to support our drive to tackle infections. The Health Act 2006 introduced a mandatory code of practice for the prevention and control of health care-associated infections. That came into force on
We will continue to support the NHS to bring down infection rates. There is no single solution. In the past few months, we have introduced further measures to build on improvements already made. In July, we made an additional £50 million available to directors of nursing and a further £270 million will be made available by 2010-11 to support the drive to tackle infections. We are introducing MRSA screening for all patients—starting with elective patients—supported by £130 million of comprehensive spending review investment. We have published new guidance on uniforms, so that all staff workwear leaves the arm bare below the elbow to assist with hand washing, which is crucial in countering such infections.
To improve cleanliness and ensure that patients have confidence that their hospitals are safe, we have announced a deep clean of all hospitals, supported by strategic health authority funding of £57 million. This morning, I placed in the Library details of this funding for each area of the country.
I want to ask about high bed occupancy rates. The West Hertfordshire primary care trust was languishing around the weak category and was rated only 17 above the trust that experienced the dreadful deaths, yet we have a 95 per cent. bed occupancy rate. Will the Secretary of State address the problem of those rates, which seem to be linked to these infections?
There is actually no correlation between high bed occupancy rates and levels of MRSA, as the hon. Lady well knows. The Sherwood Forest Hospitals NHS Foundation Trust, for example, has a bed occupancy rate of 92 per cent., but it has cut the number of MRSA cases by well above the national average. As to the suggestion that we should set a national target for bed occupancy rates, I had thought that the Opposition were supposed to be against national targets. We have a bed occupancy rate of about 84 per cent. and we think that high levels of bed occupancy are wrong, but the real issue is how best to manage the beds, rather than providing simple statistics on bed occupancy.
But there is a connection between high bed occupancy rates and the ability to perform a deep clean. Milton Keynes hospital, which has an equally high rate, lacks any form of decanter area that would enable it to carry out a deep clean. What specific measures will the Secretary of State offer hospitals such as the one at Milton Keynes to enable them to carry out their deep cleans?
We are providing the funding to strategic health authorities and it is then a matter for them to oversee the process. Every trust has assured me that it will have completed its deep clean by the end of March. Many hospitals with high bed occupancy rates already have deep cleans. They usually find the capacity to carry them out around December or Christmas time. If Milton Keynes hospital has any specific problems, it should come and talk to us about them. Better still, it should talk to its SHA.
The Secretary of State is struggling for a good news story in all of this, so may I offer him one? It is the relatively low rate of health care-acquired infections in community hospitals. Does he not think it ironic that the Government are embarking on the biggest community hospital closure programme in the history of the NHS?
It is ironic that the hon. Gentleman should ask that question when he knows that we have put £750 million aside to build new community hospitals. We are actually presiding over a renaissance in community hospitals. All trusts will submit deep-clean plans to their primary care trusts. Strategic health authorities will take an overview of progress across their area, with trusts aiming to complete their deep cleans by March 2008.
Will the Secretary of State respond to a recent piece in The Lancet which cast considerable doubt over the value of hospital deep cleans? I can see that there are all sorts of good reasons for doing that, but the question is whether it will have a significant effect on the management of C. difficile and MRSA.
The article in The Lancet would have been fine if that was all we were suggesting we should do. I have already mentioned a number of initiatives—deep clean is one—and I will mention a series of other measures. Of course, deep clean on its own will not solve the problem, but it is highly symbolic in that it gives patients the confidence that that is happening in their hospitals at least once a year.
In addition to the measures I have mentioned, we are increasing the number of matrons to 5,000—to be in post by next spring. The hon. Member for South Cambridgeshire asked where that idea came from: one particular place it came from is his colleague, Miss Widdecombe—whom I notice is present. When we discussed the Healthcare Commission report on Maidstone and Tunbridge Wells, she was powerfully vociferous, as only she can be, on the need for more matrons in our hospitals. Sometimes, populist measures are right—and the public are absolutely right about the decline of matrons in the past. The right hon. Lady's point is important, because the public do see matrons in a certain light. Ward sisters do a tremendous job as well, but they also welcome the creation of more matron places because they see that as important for the job that they do.
Much as we would welcome modern matrons and more of them, the badge does not define the job. It is important that modern matrons have a managerial role of supervision on wards and that they do not just wear a badge and spend their time doing the paperwork in the back office.
I am told that they do just as the hon. Lady recommends in her brand-new community hospital in Tiverton, the construction of which she will no doubt congratulate us on. I agree with her point. Matrons will be able to set standards for cleaning and, where necessary, withhold payments and terminate cleaning contracts. Along with clinical directors, they will also report direct to trust boards at least quarterly on infection control and cleanliness.
We published new clinical guidance on isolating patients with health care-associated infection in September 2007. It outlined the importance of placing infected patients in single rooms. The Health and Social Care Bill, introduced to the House last week, will establish the care quality commission, a new health and adult social care regulator with tough powers to inspect, investigate and intervene where hospitals are failing to meet safety and quality requirements, including hygiene standards. The latest data on health care-associated infections were published earlier this month; they show that the actions we have taken are having an effect. The Health Protection Agency data show a drop of 10 per cent. in the number of MRSA cases, continuing the downward trend of the last 24 months.
Commenting on the MRSA data, the HPA's infection expert Dr. Georgia Duckworth said that MRSA has
"started to come down and that's brilliant news—two to three years ago professionals would have told you we couldn't have done that".
She also said:
"This is a major achievement against the seemingly unstoppable rise in MRSA bloodstream infections throughout the 1990s".
I have seen documentary evidence of a trust that wrote to clinicians saying that their foundation trust status would be threatened if the current MRSA rate were to continue, since which time they have massively cut the number of tests and have therefore shown a seeming improvement in MRSA infection rates. Will the Secretary of State comment on that?
We would need to see evidence of that. If the hon. Gentleman has it, he should let us see it. I would be perfectly willing to investigate that important allegation.
As the HPA's infection expert said, a seemingly unstoppable rise in MRSA took place in the 1990s. The number of clostridium dificile cases in the 65 and over group has fallen to 13,660, which is a reduction of 7 per cent. compared with the same quarter last year and a 13 per cent. reduction on the previous quarter. Although I welcome this debate, it is important that we try not to play party politics with an issue as vital as patient safety. For that reason, I have declined to mention the rise of HCAIs under the previous Government. [Interruption.] Well, I did not dwell on it, and Conservative Members should not tempt me to do so, because an explosion in MRSA took place during the late 1980s and early 1990s.
The hon. Member for South Cambridgeshire makes reference to the outbreak that occurred at Maidstone and Tunbridge Wells NHS Trust. I agree completely with the points that he made about the failures of management and the disgraceful attempt by its chair to blame the public and then to blame the nursing staff alone. Some failures by the nursing staff did take place, but when one reads the report, as I know the hon. Gentleman has done, one learns of an abject failure in training and in prescribing antibiotics, and of a failure right through from the medical director to staff on the wards. That must come down to a failure in leadership.
The hon. Gentleman made a point about the trust's leadership and the powers available to me. He is right that I could have used a section 66 power. However, all that leadership has now gone. As soon as the Stoke Mandeville report was published last July, the chair and chief executive went, but it was not as simple as that in the case of the Maidstone and Tunbridge Wells NHS Trust. However, as he said, its chair, its chief executive, its five non-executive directors and its medical director have gone, and the trust has a new management team.
The trust has confirmed that the proper procedures were not followed with that payment. The strategic health authority was not consulted and neither was the Treasury, so there is no legal basis for the payment. The suspension of the payment for 28 days gave time for that to be investigated properly. As I said during Health questions last week, we have written to every trust and chief executive in the country to make it clear that the public frown upon public money being squandered for unwarranted payments above the statutory minimum.
The Secretary of State may not have been adequately briefed on the developments in the trust's personnel. I understand that the medical director continues to be in place, and that at least some of the non-executive directors have agreed to go at the end of their term of office, but are still in place.
The hon. Gentleman is right; it is the director of nursing, who had a principal role in this, who has left. Three of the non-executive directors went immediately in November, and the other two are coming close to the end of their duty and will go at the end of this month. All non-executive directors will have gone by then.
I shall not reiterate everything that I said in the House at the time of the Maidstone and Tunbridge Wells report. The trust's leadership has been completely changed. A new chair and chief executive have been appointed on an interim basis, and all the non-executive directors on the board have left or will be leaving very soon. I can tell the House that the overall situation on health care-associated infections has improved. C. difficile rates at Maidstone hospital have almost halved since 2006.
During a recent visit to the hospital, I announced £350,000 of additional funding to enable the trust to carry out a deep clean this winter as part of a comprehensive cleaning programme. Earlier this month, I gave the trust clearance formally to appoint the company that will build a new £228 million hospital in the trust area at Pembury. The new hospital will have 512 en suite bedrooms and be the first 100 per cent. single-room facility in England, enabling much better isolation of patients with infections.
The hon. Member for South Cambridgeshire referred in his contribution to the search and destroy programme in the Netherlands. The Dutch have always invested properly in health care, so they did not go through what we went through in the 1980s and 1990s. In the Netherlands, there is a much higher prevalence of single rooms for patients. All our new hospitals will be built with at least 50 per cent. single rooms and if we had the same rate of single occupancy as the Netherlands, we could adopt a search and destroy policy, too.
We are building the first 100 per cent. single-room facility in England, which will, as I said, enable much better isolation of patients.
Ten years in which we built 100 new hospitals across the country—the biggest hospital building programme in the history of the NHS— [ Interruption. ] The hon. Gentleman is rather touchy about these issues; he says we have closed hospitals. We have not closed hospitals—we have opened new hospitals. The hon. Gentleman may be sitting on the Opposition Front Bench, but he still cannot come to grips with the need for the NHS to move with the times and adapt to new medical circumstances.
The report on trauma, published this morning, showed yet again that we need to specialise and move away from the fixation on defending the district general hospital in all its former glory.
I cannot believe that the Secretary of State seriously claims that a report that shows deficiencies in trauma care is simply an argument for specialisation and regional centres. The Conservatives have always argued for major trauma centres, but in addition to the availability of services in local accident and emergency departments. What the Secretary of State describes as a response to the report would strip away much of the emergency care in local A and E departments, which could be essential in the treatment of major trauma.
Time and again, the hon. Gentleman and his party talk about a moratorium on reconfigurations. That was their policy. That is what they were saying in the summer. They got their statistics wrong. They got the hospitals wrong. They got the areas and the geography wrong. The one thing that was clear and consistent was—no change. They are fighting a political campaign based on the lowest common denominator: any change anywhere must be wrong. That is the view of Mike Penning, as we know very well. I do not say that the report on trauma is solely about that issue, but it makes the point that we need clinicians who are dealing with such cases day in, day out, not once every couple of weeks. All the medical evidence suggests that conclusion, which is why the entire medical profession supports the kind of reconfigurations that the Opposition oppose.
I am talking about trauma, stroke care, cardio-vascular care and cancer care, where there is a move towards more specialist centres to deal with those conditions, rather than trying to pretend that every district hospital can be all-singing and all-dancing—the Opposition view, which we completely oppose.
As I have explained, ours is not the only country grappling with such issues. The range of measures we have introduced is making a significant difference. Our recent announcements are designed to maintain momentum in supporting the NHS to provide safe, high quality care to every patient. As Lord Darzi's interim report pointed out:
"Safety should be the first priority of every NHS organisation."
There should be a collective accountability for preventing infections. We need to focus all minds on cleanliness, which must be integrated into the culture by every member of staff on every ward and in every location involved in health care provision. I pay tribute to those NHS staff who work so hard to ensure that that is the reality in hospitals up and down our country.
We would probably all agree that we should treat this subject with the utmost seriousness. The Secretary of State is right: there should not be party political point scoring over a matter that causes so many families distress and trauma.
It is important that we keep the issue in perspective. Every year, more people die from thrombosis in hospital than from hospital-acquired infections. Deaths from thrombosis are often avoidable if hospitals follow proper processes.
Absolutely. I pay tribute to the hon. Gentleman's work on the matter. The fact remains that more people die in hospital from thrombosis than from hospital-acquired infections. It is important that we keep a balance when we talk about the subject. None the less, some 300,000 cases of hospital-acquired infections occur every year, with some 5,000 deaths and an estimated cost to the NHS of about £1 billion, which could be spent on patient care and doing good things for patients. The NHS must take such infections very seriously.
I know that it is not the subject of the debate, but does the hon. Gentleman agree that we should consider making mandatory the reporting back to the hospital of the deaths of thrombosis patients? Hospitals do not receive that information, and might not be following the right procedures.
I am at risk of getting into trouble with Madam Deputy Speaker, but that is important. Thrombosis is a hidden problem that does not get the attention it deserves.
Health care-acquired infections are a problem not only in hospitals but in care homes and nursing homes. A recently received parliamentary answer showed a rise in deaths in private care homes, too. We must ensure that attention is given to those services as well as to acute hospitals. Some 3 per cent. of the healthy adult population carry C. difficile in their bodies. It is prevalent in the community and is not a problem merely for our acute hospitals.
The motion rightly draws attention to the Healthcare Commission report on Maidstone and Tunbridge Wells NHS Trust. The Secretary of State's statement on
The report also raised issues that are the Government's responsibility. The Secretary of State is right to say that we should not try to score party political points, but he would accept that it is the Opposition parties' job to hold the Government to account and to ask pertinent questions. I want to go through some of the issues that the Healthcare Commission raised that are ultimately the Government's responsibility.
The Secretary of State said that there is no direct link between bed occupancy rates and the incidence of hospital-acquired infections, but he cannot deny the clear evidence that such infections are more prevalent in hospitals with high occupancy rates. Page 6 of the Healthcare Commission report states:
"The trust's bed occupancy rates were consistently over 90 per cent. in the medical wards at both Maidstone Hospital and Kent and Sussex Hospital. Higher bed occupancy led to less time for thorough cleaning of beds and the areas around them between one patient's moving and another occupying the same bed."
That is pretty clear, and the Government need to take careful note of what the Healthcare Commission says. Later, the report states:
"The report of the National Audit Office in 2004 found that preventing infections continued to be adversely affected by other NHS trust-wide policies and priorities. The increased throughput of patients to meet performance targets resulted in considerable pressure towards higher bed occupancy, which was not always consistent with good infection control and bed management practices. Higher bed occupancy meant that there was less time for thorough cleaning of beds and bed spaces between admissions of individual patients and a higher probability of transmission of infection between patients. Seventy-one per cent. of trusts were still operating in bed occupancy levels higher than the 82 per cent. that the Department of Health reported it hoped to achieve by 2003-04."
That is how the Healthcare Commission reported these concerns, so what has happened? The recent Liberal Democrat analysis of official Government figures found that almost half of NHS trusts have occupancy rates above the recommended level, that a quarter have occupancy rates above 90 per cent, and that 22 hospitals have occupancy rates above 95 per cent. Hospitals are frequently completely full, and the Secretary of State must recognise that the risk is that corners will be cut, as the commission suggested.
I am extremely grateful to the hon. Gentleman for giving way. The chief executive of Hull royal infirmary, my local hospital, has spoken to me about the difficulty of combining high bed occupancy rates with a suitable and proper cleaning regime. Does he agree that, to find out the truth, the Secretary of State need only go to his local hospital?
The evidence is overwhelming. I am worried that, rather than moving in the right direction towards the level that the Department believes to be appropriate, the figures are going in the wrong direction. In 1996-97, overall bed occupancy was at 80.7 per cent, whereas it had reached 85.3 per cent. by 2006-07. That is the average, and the House must bear it in mind that many hospitals will be way above that level, as I have already said.
Mr. Lansley referred to the leaked report from the Department of Health. It said that hospitals with occupancy rates above 90 per cent. have MRSA rates 42 per cent. higher than average. Professor Barry Cookson of the Health Protection Agency said in 2004:
"We have got to get down to 85 per cent."
Moreover, Alison Holmes, a specialist in infectious disease at Imperial college, said:
"The issue about bed capacity and throughput really does undermine best infection control practice."
How has the Secretary of State responded to the Healthcare Commission report? He rightly condemns what happened in that trust, but there are questions for the Government as well. Does he accept the Healthcare Commission's position on occupancy rates, and will he review the extent to which overcrowding is associated with an increased risk—and by that I do not mean that every full hospital has a high rate—of hospital-acquired infections?
Bed occupancy rates and the management of beds are important, but we do not need top-down targets for them. Does the hon. Gentleman accept that the Healthcare Commission did not make that one of its national recommendations? The report devotes a whole section to such recommendations, but it does not say that the Government should have a national target for bed occupancy. The report makes five national recommendations, and the Government have implemented them all.
I accept that. None the less, we must take the report very seriously, and I have quoted directly from it. Although the Secretary of State talks, rightly, about avoiding top-down targets, but they have often led to over-full hospitals. The report mentions the pressure of targets. The Secretary of State shakes his head, but page 8 of it says:
"The trust struggled with a number of objectives which they regarded as imperative. These occupied senior managers' time and compromised control of infection, and hence the safety of patients."
Page 9 says:
"We are concerned that where trusts are struggling with a number of problems that consume senior managers' time, and are under severe pressure to meet targets relating to finance and access, concern for infection control may be undermined."
There is specific reference to A and E targets:
"One senior manager said that because of other pressures and 'over-heating' in the trust, the A&E target was delivered at the price of chaos elsewhere in the system."
The Secretary of State has to understand that Maidstone is not alone; those concerns apply across the NHS. Trusts often feel that they are bamboozled by targets. He has accepted in other contexts that an over-reliance on top-down targets sometimes has perverse effects. I am in a sense challenging him to concede that that is a factor in the problem, as the Healthcare Commission recognises. Does he accept what the commission says? If so, is he prepared to ensure that hospitals are given guidance stating that, although there are other priorities, this must be the top priority?
The third issue that the Healthcare Commission deals with is the pressure of finances, which is a Government responsibility and leads, among other things, to cuts in nursing staff. The report says:
"Both trusts had undergone difficult mergers, were preoccupied with finances, and had a demanding agenda of reconfiguration and private finance initiative... Additionally, the impact of financial pressures was to reduce further already low numbers of nurses and to put a cap on the use of nurses from agencies and nursing banks."
Does the Secretary of State accept that in the past two years intense financial pressures on trusts to balance their books have sometimes had perverse consequences? That appears to have been the case at the trusts in question.
The next issue the report raises is the MRSA target. What concerns me is that, by targeting only reductions in MRSA, the former Secretary of State imposed what I regard as a political target of halving the MRSA rate by 2008, without paying any attention to C. difficile, which was increasing very rapidly. Again, the Healthcare Commission raises concern about that issue. Page 7 of its report says:
"Before the outbreak it only monitored the MRSA rate, as there was a national performance target in relation to MRSA, though not as regards C. difficile."
So the trust's attention was focused on MRSA, not on the bigger problem of C. difficile.
The strategic health authority has a role as well, as the report says that, before August 2006,
"the SHA was not aware of the relevant performance of trusts with regard to rates of C. difficile infection."
That body is supposed to monitor the performance of trusts in its area.
Commenting on the role of the Health Protection Agency, the report says that meetings with directors of infection prevention and control in Kent "focused on MRSA" and that there
"was no local monitoring of C. difficile".
Again, the focus was on what the Government chose to target—I think for political reasons—rather than on the growing problem of C. difficile. Again, targets distorted clinical priorities. Does the Secretary of State accept that setting arbitrary targets for MRSA, at a time when other hospital-acquired infections were increasing, had perverse consequences and was dangerous and damaging?
The next issue is antibiotic prescribing. All the professionals I have talked to say that that is the central and most important issue when dealing with C. difficile. I was surprised that the motion makes no reference to antibiotic prescribing. [ Interruption. ] I know that the Conservative spokesman talked about it. The Government amendment also misses it out. The Healthcare Commission report says:
"Antibiotics need to be seen, like all medication, as potentially dangerous drugs".
In 2005, a study of 300 European hospitals showed that the highest levels of MRSA were associated with hospitals using a high level of antibiotics, particularly the broad-spectrum antibiotics that we have debated previously. The Health Protection Agency and Healthcare Commission report in 2006 said that 38 per cent. of trusts did not have restrictions in place to prevent inappropriate antibiotic use.
The Government have issued new guidance on antibiotic use, but is it being monitored? Have trusts implemented the new guidance, and is it being applied effectively? It is clearly important that the prescriptive rules are applied. When I visited Hereford county hospital last week, I was told that a new policy on antibiotics had been introduced earlier this year and had had a dramatic effect.
Beyond Maidstone, the Conservative spokesman referred to the importance of screening and he was right to question why it has taken so long to introduce it. The Government say that they will introduce it for non-emergency cases by next year and for emergency cases within the next three years. In Hereford, I was told that screening of emergency cases had been implemented earlier this year. If that hospital and a small percentage of others—the Conservative spokesman referred to a survey he had undertaken—can do it, why cannot all hospitals? Does it really need to take three years to implement screening for emergency cases across the country?
I will conclude by setting out what we see as the priorities. First, I urge the Government to undertake a thorough, robust review of the impact of overcrowding in our hospitals. Overcrowding does not necessarily mean that a certain scenario will happen, but all the evidence indicates that there is a link, which needs to be addressed. The trends are in the wrong direction.
Secondly, there needs to be zero tolerance of failures of infection control. We need to get the mindset right. If senior hospital managers have failed in their duties to control infection, that needs to be treated as gross misconduct—it is that serious—rather than their getting a pay-off and a comfortable early retirement. That principle needs to apply throughout the trust, from the most senior people to those working on the wards. There should be no pay-offs. I acknowledge that the Secretary of State indicated that himself.
The next point is that matrons must be in charge of the staff in the ward, even if those staff happen to be employed by an independent contractor. The matron needs to have the power to remove an individual from the ward if they are not meeting the required standard.
There has been discussion about the Dutch approach. I recognise that rates in the Netherlands are not much lower, but we ought to acknowledge its good practice and strict process to deal with outbreaks. The Secretary of State is right that that is possible only because of the space in Dutch hospitals, but that brings us back to the occupancy rate. There needs to be space for isolation, and to enable a hospital to have some slack in the system. He is right that historical underfunding in this country resulted in too much pressure on the system, but staff need to be sent home if they are infected.
There need to be changing facilities for staff. Again, the Secretary of State is right: it may not be appropriate to impose such measures from above, but surely the Department of Health needs to say that all hospitals should, as a matter of best practice, have changing facilities for staff, so that they do not have to travel home on a bus in their uniform. We need monitoring of death certificates to ensure that it is common practice to record hospital-acquired infections when they are a contributory factor to death. The Healthcare Commission report found, in the sample from Maidstone that it considered, that in 20 per cent. of cases where C. difficile was not mentioned on the death certificate, it was a contributory factor. In other words, if we simply looked at death certificates, we would understate the scale of the problem. In many cases—I have come across the issue as a constituency MP—people who have died in hospital had C. difficile but there was no reference to it on the death certificate. We need common good practice on the issue, so that we can accurately assess the scale of the problem. The rules on antibiotic prescribing should be rigorously applied, too.
Finally, it is important to give the patient the power and the right to raise concerns in hospital about failures in hygiene standards. There must be a mechanism through which the patient feels able to raise concerns in hospital without feeling that they will suffer in some way. I recognise that the Government have taken steps to address the issue of hospital-acquired infections, but the question is whether they are doing enough, and are doing the right things. Today, I have raised a series of issues that the Healthcare Commission highlighted, and that fall within the Government's responsibility. If the Government intend to criticise the trust—and it is right that they should—they must also acknowledge their role and what they can do to address the concerns that the commission raises. I think that we all agree that the issue has to be treated as a top priority, so that we can ensure that people are safe when they visit hospitals, care homes and nursing homes.
I prepared two speeches for this afternoon's debate. In one of them, I assumed that there had been a constructive contribution from the Opposition, which meant that we could have a serious debate about a problem that affects not just Britain but all of Europe, and a debate about how other countries are dealing with this serious issue. Sadly, the Opposition decided to play politics with people's lives. It is important to give them a bit of a history lesson on what they did on the issue when they were in power.
I worked in the national health service from the early '70s to the early '80s. Those of us of a certain age can remember going into an NHS hospital where there was that smell of cleanliness. When a person who worked in the hospital left the ward and went straight to the pub or social to meet friends, people could tell that they had been in the hospital all day from the clean smell that prevailed. Let me tell hon. Members what happened on my ward. A domestic came on duty at half-past 7 in the morning and went off duty at 2 o'clock. Another domestic came on duty at 4 o'clock and went off duty at 8 o'clock. Those individuals were part of the health care team. They were totally accountable to the ward sister or the charge nurse. In fact, they made a major contribution not just to the cleanliness but to the morale of the ward. For example, when they were going off on Saturday, they would take bookie lines into local bookmakers for patients. They made a significant contribution to patients' well-being and care.
Sadly, the Conservatives came to power in 1979. In 1982 they introduced compulsory competitive tendering. [Interruption.] Conservative Members are laughing.
I am grateful to the hon. Gentleman for giving way rather unwillingly. He blames contracting out of cleaning services and competitive tender. My local trust has in-house services, and look where that has got it.
The right hon. Lady makes a good point, which I shall deal with. In 1982, 170,520 ancillary staff were employed in the NHS in England. By 1996, the number was down to 66,760—8,000 jobs a year or more than 20 a day were lost in the cleaning and ancillary service. Let us remember the process. Compulsory competitive tendering was allegedly a test of efficiency. In reality, health service workers who had worked in the NHS for five, 10, 15 or 20 years were sacked and asked to bid for their jobs back. At the same time they were told that £2.40 or £2.30 an hour was far too much.
The Government claim, rightly, that there have been 250,000 extra staff in the NHS, of whom 107,000 have been administrators. How many have been cleaners? Does the hon. Gentleman understand that on wards at Maidstone at the time that the infections were occurring there was access to cleaning for two hours a day twice a day. That is all that was available.
That is outrageous. The hon. Gentleman is right. Let me explain the process. Whether the contracts were won by the private sector or in house, the cleaning hours fell by two thirds in most cases. The scenario that I painted at the start of one domestic coming on duty at 7.30 am and working till 2 and another working from 4 till 8 was replaced by an individual who worked in four, five or six wards, whether that was privatised or in house.
Reference has been made to laundry services. Exactly the same scenario prevailed there. Working as a nurse, I had 12 uniforms. At any given time, four were in use, four were on the way to the laundry, and four were in the laundry. Again, after privatisation, that was cut down. In practice that meant that the majority of nurses started washing their uniforms themselves, adding to the difficulties. In some hospitals the turnover of staff was more than 100 per cent. There was no training for staff coming on duty. There were numerous stories of new people turning up in the morning and working on a ward an hour later.
We must remember the politics of the time. The early 1980s was the start of the No Turning Back group, many of whom were advisers to private contractors. What did the Conservatives do? They said that there was no problem, yet in a debate in 1997, my hon. Friend Andrew Mackinlay highlighted a report prepared by the Conservatives in 1990. That confidential document stated:
"Infection control costs are always difficult to assess, but there is general agreement that the costs of ignoring strains of EMRSA are higher than those of controlling them, particularly when the costs of potential legal action are included. Litigation by an infected patient is a growing hazard of MRSA outbreaks in hospitals and it is therefore important to demonstrate that well-documented and effective control measures are implemented."
"Official figures...show that the peak of the problem occurred in 1986."—[ Hansard, 19 March 1997; Vol. 292, c. 859.]
Yes, we may be entitled to some criticism, but we all have problems and difficulties in relation to the issue. At least we have come to the Chamber and said that there is a problem, and we are facing up to it. That was not the case with the Conservative party.
May I first apologise for not having been here during most of the opening speeches? I had already told Mr. Speaker that I was coming from Market Harborough—splendid place—and was at the mercy of both trains and a passage across London in the rush hour.
I am grateful for the opportunity to speak in this debate, particularly as my trust forms such a central part of the motion. I digress for just a couple of seconds to answer the gibe made by Mr. Devine. He said that because I had private health insurance, I was some sort of terrible public liability. I point out to him that every time that I pay full whack for my prescriptions I take a burden from the NHS. Although I am an OAP, I still pay full whack—a bit more than the hon. Gentleman pays, and people benefit from it.
However, I digress; I shall pull myself back into order before you do, Madam Deputy Speaker. I turn to the main part of the motion. I make no apology for repeating what I said when I raised a question with the Under-Secretary of State for Health, Ann Keen, after the publication of the report into Maidstone and Tunbridge Wells NHS Trust. I have since had a meeting with her and I reiterated the point then.
The crux of the matter relates to authority and accountability in the wards themselves. No matter how good the chief executive or matron, they are not on the ward all the time. They cannot be. Ward sister, however, is on one ward for an entire shift and therefore authority and accountability need to be vested in her. It is clear that that system has broken down in large parts of the NHS and in particular in my own trust. I do not wish to go over again the problems that my trust has faced, because the crucial thing now is that we look forward and try to put right what has gone wrong. We should address ourselves to the future, rather than always harp on about the past.
Nevertheless, I have to say that, despite all the publicity around that report and all the local press and media coverage, I still got a letter from a constituent saying that she had recently visited a relative in hospital where a nurse had dropped a syringe on the floor, picked it up and gone to use it. The nurse was stopped—this is the crucial point—not by a ward sister but by an observant relative, who said, "Hey, you can't use that." The role of a ward sister should be almost wholly supervisory. She should be going round the ward saying, "Nurse, that drip is empty", "Nurse, that patient has been ringing the bell", or "No, nurse, you don't use that syringe—you've just dropped it on the floor." That is the ward sister's job, together with issuing appropriate instruction of the nurses as to why not to use the syringe that has just fallen on the floor—if such instruction should really be necessary.
However, the ward sister does not do such things anymore, and there are three reasons for that. First, her role has become confused and she spends far too much time commissioning blankets and bandages instead of supervising the nurses. Secondly, she spends rather too much time filling in forms. If this Government do not get to grips with form-filling, targets and box-ticking, a lot of time will be diverted from the sharp end of patient care. The ward sister also nurses, because when there are nursing shortages she has no choice but to do so; and while she is nursing, however admirable that may be, she is not supervising others. Thirdly, there is an air of what I might describe as excessive egalitarianism whereby she no longer likes to boss. When I went to see the Minister, she told me rather endearingly how she used to be bossed tremendously, even to the extent that she was not allowed to plump up a pillow because it released germs into the air. Indeed, she told me that she never plumps up her pillows at home having learned that lesson so thoroughly. What a difference between that level of supervision and what we have today. We need the ward sister bossing, however nicely and politely, and taking control of the ward.
Ward design has a major role to play, although I know that that cannot be put right by the middle of Tuesday afternoon. I have had one very positive experience of the NHS in recent years, when I took my mother into Royal London hospital under trauma procedures. The wards there were of the old Nightingale design, which meant that all the nurses could see all the patients all the time and all the patients could see all the nurses all the time. Nobody was ringing bells for people to appear round double corners, which is the layout of most modern wards. Given that the Government are boasting about how many hospitals they are building, perhaps before they build any more they might revisit the whole issue of ward design and how easy it is for nurses to be supervised in a situation where they can hardly ever be seen.
Does my right hon. Friend agree that fundamental nurse training in attitudes to hygiene needs to be considered in order to tackle the widespread problems around the country?
That must be right. We need to get right back to the sorts of situations that the Minister described to me, with meticulous attention paid to hygiene whether it relates to pillows or syringes, let alone telling a patient to "go in the bed", which, as she will be aware, is what happened at Maidstone.
I would like something terribly simple: an air of carbolic, as I described it to the Minister. I had some sympathy for the hon. Member for Livingston when he described the situation that used to prevail in hospitals, whereby one was immediately hit in the nostrils by the scents of disinfectant, carbolic, floor scrub and every other horror. Now, even hand-washing is a forgotten discipline. It would be helpful if very basic hygiene practices were restored.
As a slight digression, I also think that we need to look at the NHS as a whole and ask whether what we have is going to last us to the end of the 21st century or whether we need to carry out some serious restructuring. That does not mean the sort of piecemeal restructuring going on at the moment, which is afflicting my trust, where in order to have a trauma specialism at one hospital—I have nothing against such a specialism—people going in under accident and emergency procedures have to travel 17 miles on B roads before they may be attended to. Nor do we want, as also proposed under the reconfiguration, those using maternity services to have to travel down to Tunbridge Wells, so that anyone whose labour runs into difficulty at Maidstone will be taken there along 17 miles of B road. Tunbridge Wells is a splendid place, but no one wants to travel 17 miles by B road when they are in severe orthopaedic trauma, or in a complicated labour. Therefore, those sorts of reconfiguration are not the answer.
We need to consider the financing of the NHS, and whether those who can do so should be encouraged to take some of the costs on themselves. We need to face the fact that the state cannot do everything—it does not. What, after all, would the hon. Member for Livingston say to those who were told to go blind in one eye before the other could be dealt with? The state cannot do everything, and it is time that it stopped pretending that it can. By pretending, it is running a three-tier NHS. At the top are those who get their NHS treatment or who choose to go private; at the next stage are those who cannot get their NHS treatment and can go private but do not want to do so; and at the third stage are those who do not get their NHS treatment, and could not go private if they starved themselves for a month. If we do not look at the whole picture of the NHS, we betray the most vulnerable in the population.
I come to this debate as someone who has actually cleaned hospitals in a previous job. I have cleaned up after patients who have been suffering from the conditions in question, and it is tough to do so, particularly when dealing with something like clostridium difficile, and the sheer number of spores that are produced in the faeces of someone with diarrhoea as a result of C. difficile. They are produced in enormous numbers, and it is quite tough to clean all the surfaces involved to ensure that there is no transmission from the environment. I did that work many years ago, so the situation is not new. C. difficile has been with us for many decades, and it is only recently that there have been particular problems, which I shall come to later.
I want to start by talking about methicillin-resistant Staphylococcus aureus. I have listened to debates on this issue so many times in this House. I listened to what Mr. Lansley said, and I believe that he oversimplifies a complicated subject. He makes comparisons with other countries, such as the Netherlands, but when we are dealing with MRSA, we are dealing with something like 17 different strains. The strains prevalent in hospitals in places such as the Netherlands are different from those prevalent in this country.
Given the time pressure, I will not. In this country strains 15 and 16 are the most prevalent, and those strains are the most resistant of all—far more resistant than the ones prevalent in the Netherlands and Denmark. Those are the strains most prevalent in Japan, too, for example, and no one who has been to Japan and seen hospitals there would say that they had problems with their cleaning regimes and hygiene. As we are talking about such a serious issue, we have to keep in mind the science that underlies the subject.
The hon. Lady accused me of oversimplifying by trying to draw an analogy with the Netherlands, but in fact I was citing the chief medical officer, who, in December 2003, drew attention to the experience of the Netherlands and the use of a search-and-destroy strategy. If it is good enough for the chief medical officer, it ought to be good enough for the Government—but it was not.
The hon. Gentleman has missed the point that I am making. This issue is far more complicated than is often evident in short debates such as this, as we tend to make simplified speeches. Of course we should take note of what happened in the Netherlands, but if we simply transferred everything that was done in that country to the UK, it would not have the same effect, because we are dealing with different strains of MRSA.
Some 30 per cent. of us carry Staphylococcus aureus on our body: one third of the Members who will go into the Division Lobbies tonight carry it on their bodies. Some of us even carry resistant strains, but the majority of us are healthy individuals. Staphylococcus aureus acts opportunistically, and targets people with compromised immune systems who are vulnerable to it. Most of us will not be troubled by MRSA.
We have to consider why Staphylococcus aureus has become a problem in this country. It is largely to do with the inappropriate prescribing of antibiotics in past decades. People were often given antibiotics almost like sweeties: if someone had a snuffle or a cold, they would be given antibiotics. It was quite wrong to give people antibiotics in those circumstances, as they killed off many of the less damaging strains of Staphylococcus aureus, so that the resistant strains came to the fore and became increasingly prevalent. We must therefore look at prescribing regimes, and hold back from prescribing so many antibiotics. That is as true for C. difficile as it is MRSA.
The Northern Lincolnshire and Goole Hospitals NHS Foundation Trust is my local NHS trust. It is responsible for three hospitals, and it pioneered the cleanyourhands initiative. MRSA rates have continued to decline, and the trust's target is one case a month across all three hospitals. The trust has one of the lowest MRSA rates in the country, because it pioneered that initiative, but—and this is a gripe I have with the Government—it was told to reduce that rate by half. Given that it already has one of the lowest rates, the statistics become quirky. If we have two cases a month, one of which might be acquired in the community, not hospital, we will not reach our target. People will report the trust as a failing regime, but in fact the chances of acquiring MRSA in those hospitals is minimal.
I pay tribute to the phenomenal work undertaken by those hospitals to bring the rates down. For example, they assume that everyone who is admitted is MRSA-positive unless proven otherwise. Everyone has to undergo an alcohol body wash to decolonise the body of MRSA, and the hospitals will soon progress to nasal decolonisation as well. The cleaning in those hospitals is in house, and that is welcome. They are considering more innovative ways in which to deal with cleaning to reduce not so much MRSA but other infections.
Let me consider C. difficile. Again, I pay tribute to Diana, Princess of Wales hospital, Goole hospital and Scunthorpe district general hospital. They are working hard on C. difficile and putting in place cleaning regimes to tackle the environmental contamination that can occur from the multitude of resistant spores that C. difficile produces. Their work is phenomenal.
Miss Widdecombe is present, and I emphasise the fact that I do not believe, considering the science behind the subject, that we will ever completely eradicate C. difficile. There are 100 types—I think type 027 causes the problems that we are experiencing in the UK. It produces many toxins, which lead to fatalities. It is so resistant and produces so many spores that I am not sure whether we shall completely eradicate it. However, the work being done to reduce it is welcome. Again, we must stop prescribing so many strong broad-spectrum antibiotics, which destroy the good bacteria in the intestine, thus allowing the production of the toxins. That is a serious problem.
I pay tribute to the work in my area to reduce the rates of C. difficile and MRSA—I will not go into detail about pseudomonas or norovirus this afternoon. However, I should like the Government to consider the statistical quirks, which show that one case per month across three hospitals is fine, but two cases mean the red zone. We must reconsider that. It was disheartening for staff to be told that they were in the red zone because there were two cases, as opposed to one, across three hospitals.
I shall be brief, and stick to the present rather than looking back to the time of Florence Nightingale. I begin by praising all our nurses and doctors, not only in my constituency but throughout the country. They do a wonderful job and we should be proud of them.
I want to consider what affects my constituency and start with the case of a 40-year-old man, whom I visited at his home because he was too ill to come to my surgery. He had been admitted to Whipps Cross hospital, one of two hospitals that services my constituency, with a severe orthopaedic complaint. He was then transferred to the Royal orthopaedic hospital, so I make no accusation about where he contracted MRSA. However, he contracted it. Six months on, he has been unable to work, go out properly or function normally. It has wrecked his life. Those things are affecting our constituents today. Another case is that of a lady whose daughter took her to King George hospital. Tragically, she lost her life through C. difficile. I will not go into more detail because the family has asked for formal investigations into the matter.
I also want to cite the case of my daughter, who went into Barnet general hospital when she was pregnant earlier this year. My wife and I visited her. I used the alcohol scrub to wash my hands, but I noticed many visitors to the hospital not using it and not being asked to use it. That is not the fault of the nurses on duty, who are simply rushed off their feet and unable to do that. I blame the management and the powers that be, but I do so pragmatically—I am not looking today to have a political go at anybody. We need to try to resolve the problem, for the sake of all our constituents.
Mention was made earlier of the chief executive of Maidstone and Tunbridge Wells trust. The House might be interested to learn that her partner was the chief executive of our trust, Barking, Havering and Redbridge trust, who surprisingly resigned within seven days of her resigning, allegedly—the trust will not release the figures—receiving a substantial sum of money for going on and furthering his career elsewhere.
Well, I can only say that the allegations were about £300,000, and £1.1 million into a pension, although those are allegations. The figures have not been released and I have no way of verifying that. What happened was disgraceful, whatever settlement was received. However, families who have lost relatives have asked the police to investigate that chief executive, so I shall be careful in what I say, as I would not want to affect that.
When the head of the NHS recently appeared before the Select Committee on Health, I asked a question about that chief executive. The implication was that he had not quite gone voluntarily, and might have been helped on his way. That is in the minutes as a matter of record, as any hon. Member who reads them will clearly see. My point is that if the person in charge is not doing their job, there is a knock-on effect on everyone else and a price to pay, and that price is too high for our constituents. However—this will come as a shock to my side, who should please forgive me—I want to say thank you to the Secretary of State, who has agreed to look into the case of that chief executive. I believe that it might be too late to stop any payments, but I would be grateful if that could be looked into, and if the correspondence, for which I am also grateful, could be passed on.
I am not going to list the things that my hon. Friend Mr. Lansley mentioned earlier, but if we do not tackle the problem in a number of different ways, we will be letting down the people who put us in this place. We owe it to them and to ourselves—we could all be patients—to rectify the problem. Let us do it now. That will have to come from the top—from the Secretary of State.
I congratulate the Opposition on choosing the subject of this debate, which represents good use of an Opposition day. I do not want to disappoint them too much, but I will not vote for their motion, although I welcome the opportunity to take part in this debate, which I have found extremely interesting up until now.
It would be remiss of us to have a debate on what is seen by the general public as one of the biggest patient safety issues in the country and not put that debate in its proper context. We have had a chance today to raise some of the many issues associated with MRSA and C. difficile, but we should do so in a balanced way and look at the wider picture of problems with patient safety and of public concern about national health issues.
That was touched on by Norman Lamb, who opened his speech by saying that we needed to see the issue in context. The hospital-acquired infections of MRSA and C. difficile are a matter of great concern, but they are as nothing compared with the problem of hospital-acquired venous thromboembolism. Mr. Scott talked about the tragedy of his constituent going in for orthopaedic surgery and coming out with the dreadful infection of MRSA. However, believe it or not, his constituent was 25 times more likely to come out with a potentially fatal or debilitating venous thromboembolism, which could involve deep vein thrombosis, than he was to contract MRSA or C. difficile. According to the latest recorded figures, just over 2,000 NHS patients died after contracting MRSA. In the same period, as far as we know—I ask the House to listen carefully to this figure—25,000 patients a year died from hospital-acquired venous thromboembolism, yet we hear very little about it.
Mr. Stuart made the valid point that the difference between the two kinds of hospital-acquired conditions is that the figures for the deaths caused by the superbugs are collated accurately by the NHS, yet the number of deaths caused by hospital-acquired venous thromboembolism are not collated properly. So when we say that 25,000 people a year are dying unnecessarily from hospital-acquired venous thromboembolism, that is a great underestimate. That figure comes from the Health Committee's report in 2005, which, I am pleased to say, was accepted in full by the Government and the chief medical officer, but it is almost certainly a great underestimate of the exact figure. I refer the House to the seminal work of Dr. Ander Cohen of King's College hospital, one of the leading epidemiologists in the country. He suggests that the figure is at least double the one that I have just cited.
These are huge numbers, so when we have a debate on hospital-acquired diseases and patient safety issues, for goodness' sake let us look at them in context. The Government have rightly decided to spend £270 million a year on tackling hospital-acquired infections such as MRSA, C. difficile and some of the new conditions that have recently been identified, yet they are spending less than £30 million a year on the prevention of venous thromboembolism.
It has been made clear from the start of this debate that tackling those superbugs is not a simple business. In fairness to Mr. Lansley, he said that we needed to take a comprehensive approach. We need new research into medicines, a review of bed occupancy and more deep cleaning in our hospitals. Even if we had all those things, however, there would be no guarantee that they would have the desired effect. As far as deep vein thrombosis is concerned, however, all that we need to do is to introduce mandatory risk assessments in all patients in the NHS, which is relatively easy compared with treating the superbugs. We know that that could save at least 15,000 lives a year and avoid the tragedy associated with this unnecessary loss of life.
The chief medical officer, having been asked to report on this matter by the Government, recommended that we should produce mandatory risk assessments for all NHS hospitals, certainly in England. He made that announcement last April. Shortly afterwards, National Institute for Health and Clinical Excellence guidelines were issued which contained the same recommendation for the risk assessment of patients using a relatively simple questionnaire, to enable doctors to work out what thromboprophylaxis—preventive treatment—could be applied. This devastating loss of life could be prevented at very low cost and, in some cases, at no cost at all. Those recommendations came out seven months ago, and we welcome the steps that the Government have taken.
The all-party parliamentary group on thrombosis conducted a survey, starting in August, that was published this week. It surveyed 174 NHS hospitals and received a very good response. Eighty-one per cent. responded, and 99 per cent. of those hospitals said that they were aware of the chief medical officer's recommendations on dealing with this condition—I stress that this is hospital-acquired; this is not DVT in the community—and of the NICE guidelines, both of which recommended mandatory risk assessment. We do not want to decry—indeed, we want to encourage—such responses in future, but sadly, fewer than a third—only 32 per cent.—actually implemented risk assessments on all their patients, as recommended. We calculate that it is seven months since the recommendations and guidelines came out.
Once again, I ask the House to listen carefully. We have heard figures on deaths from MRSA and C. difficile, but they are as nothing compared with the number of deaths from hospital-acquired deep vein thrombosis. We calculate that since April to today, approximately 11,000 patients have died. The all-party group on thrombosis and the excellent charity Lifeblood believe that those deaths were unnecessary and were relatively easily preventable. If we did something now, we could offset the cost of those who suffer this dreadful illness but survive—usually after orthopaedic surgery and general medical treatment—and re-present themselves to the NHS. No correlation is made with their presence in hospital, but the cost of those patients re-presenting themselves back to the NHS is £640 million a year.
I welcome what the Government have done since the Health Committee report two years ago. They have moved quickly and comprehensively, but we cannot wait another 18 months for these mandatory risk assessments to come into our hospitals, which could mean thousands, if not tens of thousands, more patients—especially in England, but in the whole of the UK—dying from this condition.
It is a great pleasure to follow John Smith, who made a powerful and well argued point about an issue that I had not appreciated before. However, I would argue that it is not a question of having one or the other; we need to save lives in respect of both.
I shall speak mainly about C. difficile, as the hospital that most of my constituents have to attend has the worst rate of C. difficile in the country. I am pleased to see my hon. Friend Mr. Hollobone in his place, as I am talking about Kettering hospital. I know that my hon. Friend pays a great deal of attention to this matter.
The likelihood of someone getting C. difficile in Kettering hospital is three times the national average. I hope to make constructive points tonight, as I refer to a particular constituency case, but there must be some reason why Kettering hospital has such a high rate. One thing that we know about our primary care trust is that it is the worst funded in the country. The national capitation formula shows that, this year, our PCT is £38 million underfunded, as it has been for every one of the last four years—so we are talking about substantially more than £140 million. We know another important factor, which is that the hospital is very efficient, but that the capacity is never there. A bed is emptied and another patient goes in. We thus have underfunding, high capacity and the top rate for C. difficile. I do not want to make a party political point, but there does seem to be some correlation between the three. I do not believe that we could have the worst funded area, a highly efficient hospital and the highest rate of C. difficile without there being any sort of correlation.
I want to pay tribute to the staff of the NHS, particularly in my area. The doctors, nurses and ancillary staff are superb. They helped save my wife's life and I spent a lot of time in local hospitals seeing what happened. On the capacity problem, I recall my wife having a major cancer operation. She was lying in a hospital bed with drains; she had just come back from the theatre. The ward was full of course, and they cleaned it while she was there. They started to clean the bed and above it, and they sprinkled dust all over her, because they had no other opportunity to clean the ward. Lack of capacity is one of the problems we face. If there was more capacity in hospitals, and fewer targets, the situation would improve.
I know that the chief executive of Kettering hospital is working very hard to improve the situation there, and I understand that the latest figures show an improvement; I think we are now the fourth worst in the country, so we are going in the right direction.
I am listening carefully to what the hon. Gentleman says, and it is clearly a concern if there is a particularly high incidence of clostridium difficile in his local hospital. Has he asked the hospital about their prescribing regimes, because generally speaking C. difficile is brought on only by over-prescribing powerful broad-spectrum antibiotics?
I am grateful to the hon. Lady for her intervention, and I listened to what she said in her powerful speech, but may I move on to discuss a specific case study? A number of people have come to see me about C. difficile in my area, and one family has been willing to go public about what happened. It is to do with the case of Mr. Frederick Harrison who, sadly, died a few months ago in Kettering hospital. Let me read what Mrs. Harrison, his daughter-in-law, said:
"My father in law was admitted to KGH in March 2007 after a fall. He was kept in overnight as he had a slight temperature. They then said he could not be discharged until the Monday because no Doctor was available to sign the paperwork. That weekend the ward he was in was closed to visitors for a week because of an outbreak of diarrhoea.
My father in law was then transferred to the new isolation unit as he had contracted C-diff. He was there for 4 months in isolation, no children allowed to visit, and visitors and visiting time was limited. Although all the nurses were absolutely fantastic he was told to soil the bed, which he found very distressing.
We were advised he was clear of the infection and he was moved to the Isebrook Hospital for rehabilitation. He started to slowly recover, but again after a fall, we were told the C-diff was back and he was transferred back to KGH isolation unit.
He died on
On registering the death my husband was told that this was to keep the statistics down. This cannot be right. This is a horrible, degrading infection and we would not wish any other families to go through this. However we also could not have gone through a post mortem or inquest at the time, and did not contest the fact that it was omitted from the death certificate."
I think that many people would understand Mrs. Harrison's concern. She concluded by saying about Mr. Harrison:
"Yes he was 86 but before March he was reasonably healthy.
I am not a Doctor but after 7 months in isolation C-diff must have been a contributory cause of death."
I want to make the point that that highlights: there appears to be under-recording of deaths from C. difficile.
I wholeheartedly agree with the hon. Gentleman. In the last Parliament, I drew that to the attention of the then Member for Welwyn Hatfield when she was a Treasury Minister, because the Office for National Statistics has responsibility for the veracity of the death certificates, not the national health service. This problem will go on and on unless Ministers instruct that if doctors and hospitals do not complete death certificates accurately and candidly that will be treated as a serious disciplinary offence.
I welcome, and agree with, that intervention. I have taken the matter up and have received a letter from the Society of Registration Officers. It says that it is not down to its officers to decide what is on a death certificate, but that they have to put down what the doctor says. I can understand that when Opposition politicians are jumping up and down and complaining, people in hospitals where there is concern about C. difficile are under pressure not to record the facts properly.
I know that the Government are beginning to take this seriously, because I have been given a document, dated
"there is still a widespread belief that the figures underestimate the mortality associated with both MRSA and C. difficile. This is compounded by the idea that doctors are reluctant to put information about HCAIs on certificates, or indeed that they are discouraged from doing so."
My point is that we must have tougher standards, so that we properly record the number of C. difficile deaths. Unless we do that, we will never be able to tackle the problem.
The hon. Gentleman raises such an important point that I should answer it at this stage. There is a duty on doctors to record the cause of death accurately on death certificates. The chief medical officer wrote to all doctors to remind them of the importance of giving full and accurate information on death certificates. MRSA or C. difficile infection will be cited on a death certificate if the certifying doctor considers it to have been the underlying cause of death. Many patients who become infected with an HCAI have other serious and potentially fatal underlying medical conditions.
I assure the hon. Gentleman that I am aware of the case that he mentions and that the chief executive in Kettering has taken the point very seriously. I believe that we are addressing the hon. Gentleman's concerns.
My hon. Friend the Member for Kettering reminded me before the debate of our request last May for a Department of Health Minister to come to Kettering general hospital to examine the problems that it faces. We have not received a response to that invitation, so I would like to make it again today.
I agree with my right hon. Friend Miss Widdecombe: the overwhelming mood in west Kent is that we must move on and rebuild confidence in our local NHS having learned the lessons. If we are to do that, we must not ignore lessons that are still to be learned from the report. Discussion about the headline measures to tackle infection control has continued, but in the brief time available to me I want to mention four contributions that we must continue to take into account in the weeks and months ahead.
First, if any possible good could come out of the report, it is that it has concentrated Ministers' minds on the need for a new hospital to serve the people of west Kent. The two hospitals in my constituency, the Kent and Sussex and the Pembury, must be two of the most decrepit in the country. Pembury hospital is a converted workhouse. The buildings that are not part of the workhouse are wooden huts. It is impossible to imagine patients and staff of a hospital elsewhere in the country suffering from such conditions in the 21st century. I welcome my right hon. Friend's support, and I hope that the sad opportunity that this report has given us to press the case for a new hospital will ensure that it is delivered after decades of waiting.
Secondly, we need to go beyond the initial response on infection control and implement a zero-tolerance approach to hospital-acquired infections such as C. difficile. The national target of a 30 per cent. cut is fine as far as it goes, but we need to rebuild confidence to match the confidence that people on the continent and people using the private sector have in their hospitals. They fully expect to come out of hospital without having acquired an infection.
Greater urgency is required. The excellent matron of Kent and Sussex hospital, Linda Summerfield, took me on a tour of the wards recently. They were spotless and their cleanliness could not be faulted; nevertheless we saw physically inadequate facilities. In an intervention earlier, I mentioned the lack of changing facilities. The Royal College of Nursing is clear: every nurse should be able to travel to work in their own clothes and change on site into a uniform that is laundered on site and guaranteed to be free of infection. That is impossible at Kent and Sussex hospital, because the changing facilities have space for only a dozen people at a time, in a trust that employs many hundreds. There is an urgent need to address such facilities.
Curtains are another factor. It is imperative that hospitals have disposable curtains, rather than tatty old curtains that attract the spores that contribute to C. difficile. When I put that point to the trust's chief executive, he told me that there were plans to replace the curtains over time, but that is not good enough. The situation is urgent, so if it is clear that disposable curtains will make a difference they should be used throughout the entire trust immediately. I am concerned about the lack of progress on that issue.
We need to consider the adequacy of the management team that replaced the previous, inadequate team. We have a new, interim chief executive and I have no personal complaints about his authority or capability to manage the trust, but I am concerned about the fact that he is only part-time. He is also the chief executive of the Ashford and St. Peter's Hospitals NHS Trust in Surrey. The headline on the press release announcing his appointment was "Glenn Douglas to split time equally between two organisations".
A trust needing as much care and attention as ours requires a full-time chief executive. Of course, we require a skilled individual and I should be delighted if Mr. Douglas, with his skills, was appointed full-time as interim chief executive. He may be spending too little time at Maidstone and Tunbridge Wells although, to be fair, I do not think that is the case. However, we cannot engage in a smoke and mirrors exercise and pretend to people in Surrey that they have the full-time attention of their chief executive, given that hospital-acquired infections in his home trust increased by 88 per cent. over the past year. If there is one lesson we should learn from this whole episode it is that we cannot keep the public in the dark with nudges and winks about what is going on in the NHS. If the man is supposed to be running two trusts we need to know about it, and people in Maidstone and Tunbridge Wells need the same clear message as people in Surrey.
Finally, as we reflect on the grossly inadequate supervision given by the failed management of the trust over the past few years, we can see that there is a general problem of accountability. I would be hard-pushed to say to whom any of the NHS institutions in my area—the strategic health authority, the Maidstone and Tunbridge Wells NHS Trust or the West Kent PCT—are accountable. If I ask questions of the Health Secretary about local issues he will say it is a matter for the local trusts, but I have no direct means of holding them to account, other than, occasionally, to embarrass them publicly, which is a crude mechanism. I hope that we will reflect on the lessons and design in the appointment of new non-executive directors, not just in our own trusts, but more widely across the NHS, a more genuine means to hold NHS managers to account.
We should make it clear to non-executive chairmen that they have a duty to the public. That applies to George Jenkins, the interim chairman of Maidstone and Tunbridge Wells trust, and every non-executive chairman of NHS bodies throughout the country. Their role is not always and everywhere to defend management. In the absence of anyone else—although that absence is a fault of the system—their responsibility is to represent our constituents and take management to task when necessary. The Maidstone and Tunbridge Wells non-executive directors and chairman failed abjectly in that responsibility. I look to the new chairman of our trust, and the new non-executive directors to be appointed, to exercise that role.
There is a pattern of incompetence, but also a pattern of a lack of accountability. That does not extend just to the NHS. One positive message that we can take from the situation to ensure that such an event is never repeated is to re-inject more accountability to local people into the NHS and other bodies that need it, so that managers feel that they are being scrutinised at all times.
Of all the reports that hon. Members may have read recently, none is more damning or more distressing to read than the Healthcare Commission's report into the outbreaks of C. difficile at Maidstone and Tunbridge Wells NHS Trust. I have no doubt that the sense of betrayal among local people is immense. The success of the NHS is largely down to the confidence and trust that people have in the organisation and its staff. There is no doubt that the majority of NHS staff continue to work to achieve exactly that end. The rise in health care-acquired infections has seen the loss of that trust, a loss of confidence and an increasing sense that NHS staff are no longer in control of their own decision making.
We have heard some excellent speeches. I did not entirely follow the speech made by Mr. Devine, but I am concerned that his attempt to focus on the events of 20 years ago or more was simply an opportunity to deflect attention from the failures of the Government today.
As a former nurse, I thank my hon. Friend Mr. Scott for his tribute to nurses across the country. He gave a particularly evocative account of two of his constituents, one of whom sadly died. He also raised the issue of large payouts to senior managers, which continues to concern a number of hon. Members, particularly when those managers have presided over significant failures in trusts. He was generous, however, in his praise of the Secretary of State.
John Smith was also generous in his political stance and raised the important issue of venous thromboembolism. Mr. Bone mentioned his concern for his constituents, who are served by a hospital with the worse C. difficile rates in the country. As well as paying tribute to all NHS staff, he also mentioned the experiences of one of his constituents.
My right hon. Friend Miss Widdecombe talked about authority and accountability on the ward through the ward sister. I am sure that I speak for all hon. Members when I say that her anecdote about a nurse who went to use a syringe that had fallen on the floor was truly shocking. She also mentioned the confused role of senior nurses, nurses covering shortages and form-filling. She spoke with her usual and much-welcomed common sense.
Shona McIsaac spoke passionately about the prescription of broad- spectrum antibiotics. She paid tribute to her local trust, which I gather is a centre of excellence. She also mentioned the fact that figures can be extremely misleading.
My hon. Friend Greg Clark, like my right hon. Friend the Member for Maidstone and The Weald, was particularly touched by the recent events, which left 90 people dead, while 270 deaths had C. difficile cited as a contributory factor. My hon. Friend has campaigned long and hard for a new hospital and has been particularly concerned about the issues associated with built structures, nurses and their uniforms and the practices that are followed. No one knows better than him the urgency with which the matter needs to be dealt.
My hon. Friend Angela Browning mentioned leg ulcers. Labour Members mentioned research and the overuse of antibiotics. In particular, Mrs. Moon mentioned treatment with maggots. My hon. Friend Dr. Murrison talked about the need for the Government to face up to the situation and cited individual constituents' experiences.
My hon. Friend Mr. Lansley spoke from the Front Bench and focused in particular on screening, isolation and bed occupancy. He also referred to the Government's plans for a deep clean. In particular, he noted that the Department of Health had said that there was no central programme for that, nor any plans to monitor progress, and that it was a matter for local determination. In addition, the Department said that no dates had been set for commencement or completion of the deep clean, that there would be no new money for it nor any repeat programme. Finally, my hon. Friend noted that the Department had supplied no news on training—perhaps the Minister will be able to bring us up to date about exactly what training will be given to help NHS staff to achieve this so-called deep clean. It seems to me, and I am sure to many Opposition Members, to be no more than a gimmick.
A Healthcare Commission report was published in July in response to requests from the chief medical officer for ways to reduce infection rates. It stated:
"We found evidence that a significant number of trusts were also experiencing difficulties in reconciling the management of" health care-acquired infections
"and cleanliness with the fulfilment of targets".
It would be awfully welcome if the Secretary of State listened to this bit, as it is the one that I do not think that he entirely understands. He needs to grasp the difference between targets and outcomes. He does not support outcome-driven activity, but he does support process-driven targets. For exactly the reasons cited in the Healthcare Commission report to which I have referred, he needs to pay attention because, if he continues with his obsession with targets, we will not see any improvements.
The report found that 45 per cent. of trusts were experiencing difficulties with accident and emergency targets. In addition, 29 per cent. of trusts told the commission about difficulties with waiting times and lists for the treatment of in-patients, while 36 per cent. reported that they had experienced difficulties reconciling the management of health care-acquired infections and cleanliness with the fulfilment of financial targets. The Secretary of State continues to deny that evidence.
Moreover, the report found that 46 per cent. of trusts do not have a programme to check the cleaning of beds and the spaces around them. Only 48 per cent. of trusts report all health care-acquired infections, and 19 per cent. report none. Another 26 per cent. report less than half of such infections, and 62 per cent. do not audit readmission to hospital of people suffering from them. The report is truly damning about what is going on.
Until the Secretary of State starts to listen, and to accept the causes and consequences of health care-acquired infections, rates will continue to rise. Protesting about the progress that has been made while denying the figures and causes will not get anywhere. The right hon. Gentleman asked that this debate be non-party political, but he must accept the facts. The problems are to do with bed-occupancy rates, targets, competing priorities, antibiotic prescribing habits, the number of nurses on wards and the number of hand basins available per bed. They are also to do with our built structure, and with training, monitoring, audit and the need to change practices on the basis of that audit.
The Secretary of State maintains that infection rates here are similar to those in the rest of Europe, but I doubt that that is any comfort to the relatives of the 90 patients who died in west Kent. We must adopt a ward-to-board approach, but hospital boards must be able to make decisions on the basis of clinical need, not of Government targets. That means that some targets must be let slip sometimes, but a culture in which senior managers do not listen to what is happening at ward level because they fear not meeting Government targets and thus getting sacked will mean that what happened at the Maidstone and Tunbridge Wells NHS Trust will occur again.
I urge the Government to look again at the debate. I urge them to rise to the challenge that health care-acquired infections raise. I urge them to return to decisions made on clinical grounds by clinical staff in clinical settings. I urge hon. Members to support the motion.
We have had a lively debate and covered much very necessary ground. I will endeavour to cover the numerous queries raised, but I hope that hon. Members will understand if I write to them if I am unable to answer specific questions.
What is clear from today's debate is that we all agree that tackling health care-associated infections is, and will continue to be, a key challenge for the NHS. It is also clear that the issue is not confined to England; it is a worldwide challenge. In fact, infection rates are higher in the United States, where medicine is practised and funded very differently from the NHS. We must learn from the tragic mistakes that we have heard about and redouble our efforts, of course, to ensure that every patient gets the safe, high-quality care from the NHS that is their right.
Hon. Members' contributions have been very informative. My hon. Friend Mr. Devine has, of course, great experience in the NHS and put his heart into dealing with the heart of much of the matter. We must have properly qualified staff who are dedicated to being part of our team, whether they are ward cleaners—the domestic staff, as they were called—or work right up on the board, as good, positive leadership is required.
Of course, Miss Widdecombe made some very relevant points. In particular, I agree with what she said about the sister or charge nurse who is in charge of the ward. Ward designs were mentioned. Of course, we cannot have separate rooms and isolation and continue to have Florence Nightingale wards, which she mentioned.
On ward design, does my hon. Friend accept that the technology of hospital equipment is very important? Colson Castors has developed a microbiologically resistant castor specifically for hospital beds and trolleys. Will the Department consider that as part of the armoury of policies designed to curb such infections?
I thank my hon. Friend for that comment. It is the duty of us all to look at every innovation and change in technology and science to help with this important health care issue. Hon. Members on both sides of the House have mentioned research, and we could consider it in an all-party way, because of the victims and their relatives and given the seriousness of not doing so. I make a plea to look at all the experience together to try to bring about a safer health care environment for all our constituents. To do that, much of Lord Darzi's review of the NHS is addressing one of the main issues—quality and safety—and I look forward to the consultation, to which Members who have spoken today will contribute.
I accept the invitation to visit, made by Mr. Bone, and it is very important that I do so. I have visited many constituencies to date and seen the improvement. In particular, I was able to see the change that has been made at the Countess of Chester hospital, when my hon. Friend Christine Russell invited me to Chester—an area that I hold dear to my heart, because I started my NHS work as a clerk at Chester infirmary.
Greg Clark mentioned that money should be made available for changes in design and, very importantly, for patient safety. I remain concerned that money is being mentioned, because the money is available for such things to take place, and I am happy to investigate that further.
In relation to the uniform guidance—an issue that was raised by the Opposition Front-Bench spokesman—it is recognised good practice for staff to change at work before going home. There is no evidence of a risk of infection, but there is evidence of an effect on patient confidence, which is of course important.
We must remember that the latest figures from the Health Protection Agency show that we are heading in the right direction in tackling infection. I am looking forward to seeing how best we can demonstrate the effects in further reducing health care-associated infections. The further investment highlighted by the Secretary of State in his opening speech will cover further measures such as screening for MRSA for elective patients. It will also ensure that every acute trust has undergone a deep clean by
The private sector, in the main, undertakes elective surgery, which is very different from the work that our NHS does. The Health and Social Care Bill, introduced last week, will establish a new regulator. I urge hon. Members to vote to support the new tough powers that will allow that regulator to investigate and intervene on issues such as health care-associated infection.
The issues of targets and bed occupancy have been raised. Patients have a right to clean and safe treatment, regardless of where in the NHS they are treated. I am very clear that if trusts fail to deliver that, senior managers and trust boards will be held accountable. As has been said, that will go right down the line from the ward to the board. There are no excuses. The management of complex systems, such as health organisations, requires the balancing of many different priorities.
In a moment.
"targets are not to blame for the Trust's leaders taking their eye off the ball. Managers always have to deal with conflicting priorities and plenty of organisations do it successfully."
Nor do high levels of bed occupancy prevent trusts from reducing MRSA. Over the last 24 months, the extent to which trusts with high bed occupancy have reduced their MRSA levels is similar to that of low occupancy trusts. For example, Sherwood Forest Hospitals NHS Foundation Trust has reduced its MRSA rate significantly more than the national average, while maintaining high levels of bed occupancy. We are expecting a report from Professor Barry McCormick at the end of the year, which will update his previous report on bed occupancy.
My fellow Ministers and I were shocked by the situation described by the Healthcare Commission in its report into Maidstone and Tunbridge Wells NHS Trust. I have been on the record as saying that the report was
"as serious as it gets."—[ Hansard, Westminster Hall, 23 October 2007; Vol. 465, c. 49WH.]
On behalf of the Government and the national health service, I would like to take this opportunity to apologise again to all those who have been personally and directly affected, and to offer again our condolences to the families of those who died.
I have not got time to give way.
I hope that hon. Members will be able to take some encouragement from this debate. Health care-associated infections are a challenge, not just for hospitals in the UK, but worldwide. However, as the Secretary of State and I have explained, the NHS is demonstrating that it is up to the challenge. That is nowhere more the case than in Wolverhampton, where leadership was provided not only by the director of nursing, Cheryl Etches, but by the chief executive, David Loughton, who reversed the most serious MRSA and clostridium difficile infections. They received the Secretary of State's award and the Health Service Journal award on Monday. We can praise—
I saw the report on
Question accordingly agreed to.
Mr. Speaker forthwith declared the main Question, as amended, to be agreed to.
That this House recognises that healthcare-associated infections (HCAIs) are a worldwide problem; acknowledges that the recent Comprehensive Spending Review settlement for the NHS includes £270 million to tackle HCAI; welcomes the initiatives the NHS is taking to manage infection control, including a new "bare below the elbows" dress code, new clinical guidance to increase the use of isolation for infected patients published in September, every hospital to undertake a deep clean as part of a wider drive for a culture of cleanliness, matrons and clinical directors to report directly to trust boards on infection control and cleanliness, annual infection control inspections of all acute trusts using teams of specialist inspectors, and MRSA screening for all elective admissions next year; further welcomes the introduction of legislation for a new health and adult social care regulator with tough powers to inspect, investigate and intervene in hospitals that do not meet rigorous standards for cleanliness and a new legal requirement on chief executives to report all MRSA bacteraemias and clostridium difficile infections to the Health Protection Agency; believes that centrally determined targets for tackling HCAIs are the most effective way of ensuring infection levels are reduced in every hospital; notes that as a consequence MRSA bloodstream infection numbers are falling; and welcomes the Better Care for All PSA Delivery Agreement, which sets two new targets for the period 2010-11 to keep MRSA bloodstream infections below half the numbers of 2003-04, and to deliver a 30 per cent. reduction in clostridium difficile infections from the numbers in 2007-08.'.