My Lords, I am grateful to the Minister for that response. I declare an interest as my company provides specialist insurances to the cleaning industry. We all appreciate that there are problems relating to hospital cleanliness. Does the Minister support the conclusions of the recent Patient Environment Action Team survey, which shows a better performance from contracted-out cleaning services?
My Lords, the comparison of in-house services and outsourced services has been discussed by noble Lords on a number of occasions. I have not seen any hard evidence to suggest that a decision to outsource services has a direct impact on the quality of cleaning. Ultimately, it depends on the nature of the contract in relation to outsourced services or the nature of management in relation to in-house services. The key factor is leadership. When NHS trusts give a clear indication that cleanliness is a high priority, good services follow from it.
My Lords, there is much to be learnt from other countries, as other countries have much to learn from us. MRSA is much less prevalent in Holland compared with this country. Therefore, some of the measures that the Dutch are able to take are not practical for this country. But the latest figures show that we are starting to see a reduction in MRSA infections. We have set a tough target to reduce infections by 50 per cent by 2008 and we are determined to keep up the pressure on the NHS to do just that.
My Lords, has the Minister visited the Florence Nightingale Museum across the river in St Thomas's Hospital, where he can purchase a book entitled Notes on Nursing written by the great lady? The implementation of those recommendations saved many thousands of lives in the 19th century. When will he make it obligatory reading for everyone who works in the health service?
My Lords, I have not had the pleasure of visiting the museum, although I have visited St Thomas's Hospital many times. The noble Baroness makes a good point. I am sure that if we were to go on to discuss the issue, one thing that would come through is nurse leadership. It is abundantly clear that where modern matrons and ward sisters make it their business to ensure that their wards are clean and that the cleaners—whether employed directly or by contract companies—are part of the team, cleanliness follows. I very much endorse the sentiments behind her question.
My Lords, although every effort to keep a hospital clean is greatly to be recommended and commended, does my noble friend agree that there is very little evidence that the organisms mentioned, and Clostridium difficile, have any relationship to dirt in hospitals and that cleaning hospitals is not the issue when dealing with, for example, MRSA?
My Lords, my noble friend is right to suggest that there is no direct causal relationship between general cleanliness and the incidence of MRSA or C. difficile. However, a hospital that in general takes cleanliness seriously is, I think, much more likely to take the issues of MRSA and C. difficile seriously. Patients expect hospitals to be clean. The clear evidence is that there has been tremendous improvement in cleanliness standards. Of course, there is more to be done, but we should acknowledge the efforts made by the NHS in the past few years.
My Lords, the essential difference between the Dutch approach and the UK approach—there are similarities—is that in this country, many people carry MRSA, whereas in Holland far fewer do. It is much more practical for Dutch hospitals to take preventive measures than it is for hospitals in this country, in terms of the number of people who can be isolated and the facilities that they have. However, with the development of more isolation facilities, we see huge improvements in the way in which NHS hospitals deal with these matters. On MRSA, the hand-washing regimes and the collaboration between bed managers and infection controls teams means that we are beginning to see a downturn in the number of serious infections. We shall redouble our efforts to gain further improvements in the next few years.
My Lords, it is time to hear from the Cross Benches.
My Lords, I am a food producer and before I even think about producing any cheese, I ensure that I am clean, that my premises are clean and that my equipment is clean—by clean, I mean spotlessly clean. The food industry has done wonders in reducing the amount of food poisoning over the past few years by improving cleanliness standards. Could not the National Health Service learn something from the environmental health inspectors—and others in the food industry—who are doing so well?
My Lords, I am sure that that is an excellent suggestion, but we must not forget that in the past few years, the NHS has improved appreciably the standards of cleanliness and the resources that have been put into cleaning. Of course, we cannot be complacent, but the independent service self-assessment has shown that, in general, standards of cleanliness are improving and have improved. I expect and hope that they will continue to improve.