Infection Prevention and Control — [Mr George Howarth in the Chair]

– in Westminster Hall at 9:30 am on 15 May 2018.

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Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 9:30, 15 May 2018

I beg to move,

That this House
has considered raising standards of infection prevention and control in the NHS.

This issue has been brought to my attention by a number of health organisations, and by lobby groups within the House as well. We are very aware that 5 May marked World Hand Hygiene Day and I am very glad to have secured this debate, to draw attention to the importance of infection prevention and control in the NHS and, in particular, the role of good hand hygiene in raising standards.

The first time the matter came to my attention was when my brother Keith had a serious motorbike accident some 12 years ago. Whenever we visited him in the Royal Victoria Hospital, we were told by the nurses to wash our hands: “Everything has to be very, very hygienic in here.” We washed our hands almost to the point of obsession because in that ward people were between life and death, and infection could have meant the end of a life.

This year, World Hand Hygiene Day focused on raising awareness about sepsis. We all know about sepsis through our constituents and the stories in the press as well. The World Health Organisation estimates that sepsis affects some 30 million patients worldwide every year. In response to a business question that I put to the Leader of the House, she suggested I seek a debate in Westminster Hall on the matter. As I am not very often here, I thought I would introduce a debate myself for a change—it would perhaps be an occasion. Here in the UK, there are 44,000 deaths from sepsis every year and it is a priority area for the Secretary of State. Effective hand hygiene plays a key role in reducing the risk of healthcare-associated infections such as E. coli, which are a major risk factor for developing sepsis.

I told Professor Didier Pittet, director of infection control at the World Health Organisation, that a debate on infection control was taking place in Parliament—I wished to inform him about what we were doing.

Photo of David Simpson David Simpson Shadow DUP Spokesperson (Environment, Food and Rural Affairs), Shadow DUP Spokesperson (Business, Energy and Industrial Strategy)

I congratulate my hon. Friend on obtaining the debate. Yes, he is not often here and it is good to see him speak. On infection control, when we go to hospitals it is amazing to see patients standing in their dressing gowns, outside the front doors, smoking—human rights and all the rest of it—some of them running about with a drip in. All that infection is brought back in. Does my hon. Friend agree that something surely needs to be done from that end as well?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

My hon. Friend is right. I hope that hospitals will take note of what is said in this debate and take action accordingly. It is all very well a visitor washing their hands almost to the point of obsession—every time they go out and come back in again—but hopefully that same level of hygiene control is being done by the hospital as well.

When I notified him of the debate, Professor Didier Pittet said:

“In the early 2000s, the NHS was the first ever health system to use a hand hygiene promotion strategy modeled on the World Health Organisation’s. This strategy went on to be active in 186 of the 194 UN member states. I call for the UK and the NHS in particular to reinvigorate hand hygiene promotion as the main strategy to reduce infections. The WHO hand hygiene promotion strategy saves between 5 and 8 million lives in the world every year, and will save hundreds of thousands in the UK.”

So, the importance of the debate is clear.

I spoke to the Minister before the debate and gave him a copy of my speech, to make him aware of what we are trying to do and the questions I want to ask him. I have absolutely no doubt that the shadow Minister and all of us here will be saying the same thing. We are looking for the same thing. There are some pilots in place and some recommendations coming from across the NHS, and we want to look towards those as well.

Photo of Gregory Campbell Gregory Campbell Shadow DUP Spokesperson (International Development), Shadow DUP Spokesperson (Cabinet Office)

My hon. Friend talks about similarities and about issues being the same. Does he agree that, on the various standards—all of which are improving all of the time across the United Kingdom—we should all strive for best practice, with the most successful practices being replicated right across the United Kingdom in all the devolved institutions?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

What my hon. Friend says is wise—we always hear very wise words from him, no matter what the debate. If we have best practice in Middlesex, Edinburgh, Cardiff, Newtonards, Bangor or Belfast—wherever it may be—let us replicate it everywhere else. My hon. Friend is absolutely right.

It is true that here in the UK we have made good progress in reducing the number of healthcare-associated infections over the past 10 to 15 years. The introduction of mandatory reporting of infections in the early 2000s has certainly helped to track the trends. When we look at some of the things we have done, there is good news. In 2003-04 the average quarterly count of MRSA bacteria was 1,925, but by 2008 it had reduced by 57% to 836—a significant reduction. Although that should be a cause for celebration, rates of healthcare-associated infections remain stubbornly high. Today’s debate is really about getting to the stubborn hard-core hygiene-related infections that do not seem to want to move.

The results of the most recent point-prevalence survey show that the number of patients contracting an infection in hospital is staggering. Every one of us knows how important the matter is. When my dad was in hospital for a time, he was always catching infections there. I am not saying that that was the fault of anyone, but I had thought that the possibility of infection would be greater at home—in hospital you expect it to be lower. Unfortunately, in the cases that I am aware of of people going into hospital with an illness, the rate of infection is high. People worry about that. My constituents worry about it, and I believe that everyone else’s do as well.

One in every 16 patients contract an infection in a UK hospital. That is only 6.4%, but it is 6.4% too many. There are 5,000 patient deaths every year from healthcare-associated infections. That is the thrust of the matter. If we are having deaths in hospital due to these infections we need to address the issue, and I look to the Minister for some thoughts on how we can do that. I am confident that he will come back with something that will help us in our debate.

The human cost of infection goes without saying. However, healthcare-associated infections also have a significant financial cost, which cannot be ignored. The health issues are one consideration, but the financial spin-off is also great. If we can address the infections early on, we can reduce the financial implications and also the deaths and infections. At a time when the health service is facing an unprecedented strain on services, reducing that financial burden is all the more pressing. It is estimated that hospital-acquired infections cost the NHS in excess of £l billion a year, which is 0.8% of the health service’s total budget. That is not an insignificant amount; £1 billion would change a lot of things for the health service and also, I believe, for people’s lives. That amount includes the immediate costs of treating patients in hospital, and also downstream costs due to bed-blocking—we all know the problems with bed-blocking. The costs are especially relevant, given the challenging winter that the NHS has just come through, with hospital capacity reaching 100% in some cases.

If I ask my constituents back home, where we unfortunately have a non-functioning Assembly, what the key issue is for them, they will say that it is health, and it will continue always to be health. If I may make a political statement, but not for any reason other than to illustrate the point: if Sinn Féin were to grasp what is important—and health is one of the things we can agree on—we could move forward together.

Photo of Jack Lopresti Jack Lopresti Conservative, Filton and Bradley Stoke

I congratulate the hon. Gentleman on securing this important debate. I spent some time in hospital a few years ago and it was a positive experience with a happy outcome—and I escaped infection. Does the hon. Gentleman agree that it is important to get right locally the fundamentals of fighting the global threat of anti-resistance to so-called superbugs?

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

The hon. Gentleman is absolutely right; we have got to get it right in our own hospitals and across the NHS and the whole United Kingdom of Great Britain and Northern Ireland, and then we can look further afield to other countries. He reminds me that last year I had occasion to be in hospital three times for various operations. I never had any infections. I had nothing but the best care. The surgeon’s knife went in the right direction and removed what had to removed. It was important to do that. The important thing is that we have hospitals and an NHS that are excellent. When the NHS works well, it is the best in the world, but sometimes we need to think about things.

The cost of infections to the NHS includes the immediate costs of treating patients in hospital, bed-blocking and so on. There are also issues with hospital capacity, which has reached 100% in some cases. The World Health Organisation estimates that 50% to 70% of hospital-acquired infections are transmitted by hands, so improving hand hygiene must play a central role in any strategy to reduce hospital infections. It would be remiss of me not to note the work carried out by the Secretary of State to improve patient safety in the NHS—let us give credit where credit is due. In November 2016, there was a commitment to halve gram-negative infections by 2020. The Secretary of State announced he would appoint a new national infection prevention lead, Dr Ruth May. Both are important steps in bringing down infection rates and show a commitment to do so.

Given that 50% to 70% of hospital infections are transmitted by hands, I was encouraged to see alongside those measures a commitment for the NHS to publish staff hand hygiene indicators for the first time. If hand hygiene is done—it should be, and perhaps there are indications of places where it has not been—then publishing hand hygiene indicators will allow benchmarking between hospitals and help drive up standards of hand hygiene. If we can have a system that can help drive hand hygiene, we should have it. Perhaps the Minister can respond to that point in his summing up.

The policy should not be implemented by weighing or counting cartridges used in hospital hand sanitiser dispensers. If it is done by the number of cartridges used, we might be under the impression that things are going the right way, but there has to be a wee bit more to it than that. Without factoring in patient bed numbers and staffing levels, the information is, I gently say, somewhat meaningless in showing hand hygiene compliance levels. The intention is right, but other factors need to be looked at.

The Secretary of State is a strong proponent of the use of reasonable technology in the NHS. Like me, he believes it has the power to radically change how we deliver care. Electronic monitoring technology can monitor hand hygiene to deliver real-time, accurate data to drive behavioural change. We want to see behavioural change where staff are not as active on hand hygiene as they should be.

Electronic monitoring is an innovative practice that is used internationally. Studies from a hospital in the US have shown that following the adoption of the technology, hand hygiene compliance improved by 30%. If we use that methodology, hopefully we can replicate what has happened in the US and reduce infections. That 30% increase corresponded with a 29% decrease in the number of MRSA infections, saving that one hospital more than $400,000. Here in the UK, electronic monitoring is being piloted at a number of hospital trusts in what the Care Quality Commission describes as “outstanding” and “innovative” practice. It goes back to what my hon. Friend David Simpson said in his intervention: where we see good things happening, we should be doing those things across the whole United Kingdom. My hon. Friend Mr Campbell also referred to that.

If the results from the US are replicated here in the UK—they can be—the national adoption of electronic monitoring technology could see 30,000 fewer infections, saving the NHS more than £93 million. More importantly, it would mean less infection, fewer people staying in hospital and fewer deaths. Dr Ruth May, the national infection prevention lead, said that,

“the collection, publication and intelligent use of data…will ensure organisations improve infection control and help…poor performers get the support they need”.

Those are very wise words. While I welcome the announcement of the hand hygiene indicator policy, it appears that progress on its implementation has stalled. I suppose that is the point I am coming to and the reason for this debate. The Department of Health and Social Care has missed its own deadline to publish the data by the end of 2017. Data is so important in drawing up a strategy, policy and vision of how we can address the issue.

We have been collecting mandatory data on the number of healthcare-associated infections, such as MRSA and C. difficile, since 2004. When hand hygiene is so critical to reducing the number of healthcare-associated infections, it is difficult to see why it has taken more than 14 years to publish data on staff hand hygiene—data that we are yet to see. I find that incredible. I spoke to the Minister last night, so he knew I would raise this issue. The key issue for me is how we use the data we have to make a policy and a strategy from which we can all benefit. To mark World Hand Hygiene Day, the World Health Organisation is calling on Health Ministries worldwide to make hand hygiene a marker of care quality. If we do that right, we will be going in the right direction.

Will the Minister consider making hand hygiene a national marker of care quality? Will he, on behalf of the Secretary of State, outline who is responsible for the implementation of the policy? Will he set out a clear timeline for the collection and publication of this data, which is critical to driving up hand hygiene standards in hospitals? Someone walking through the door of any hospital will always first notice the smell. They will probably notice the warmth of the hospital, because it is there to care for patients and those who are ill. They will also see nurses running about with their gloves on. Hand hygiene is important for them, but we need to drive it a wee bit harder from the ministerial point of view and the local hospital point of view, to ensure that it happens.

Publishing data on hand hygiene compliance is a simple first step in improving hand hygiene, which is essential to raising standards of infection prevention and control in the NHS. It will save lives and money, and we cannot afford further delay. The UK and the NHS have been at the forefront of worldwide infection prevention and control strategies since the early 2000s. While a good deal of progress has been made since then—we welcome that progress, some of which has been significant—there is much work to be done to realise the Secretary of State’s ambition: that the NHS will be the safest health service in the world. We should strive to be the best. In many cases, we are the best, but we can certainly do better. The role of good hand hygiene in reducing hospital-acquired infections and improving patient safety cannot be overstated. We must also acknowledge that the current method of direct observation in monitoring hand hygiene in hospitals is no longer fit for purpose, and that technology can and should play a role in changing behaviours.

I look to the Minister for his response. I thank all Members for taking the time to come to Westminster Hall on a Tuesday morning to make a contribution. We look forward to those contributions.

Photo of George Howarth George Howarth Labour, Knowsley

I do not propose setting a time limit on speeches. It might be helpful by way of guidance to suggest that if everyone speaks for no more than 10 minutes, it should be possible to accommodate everyone who has indicated that they want to speak.

Photo of Andrea Jenkyns Andrea Jenkyns Conservative, Morley and Outwood 9:48, 15 May 2018

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate my hon. Friend Jim Shannon on securing a debate on a matter that is of great personal importance to me, as I lost my own father to MRSA that he caught in hospital.

In 2011 my dad, Clifford, went into hospital for a routine operation to drain fluid from his lungs. What should have been a 20-minute procedure turned out to be two and a half hours as trainee doctors practised on him. The whole event was a real catalogue of errors regarding cleanliness in the hospital. To begin with, the cleaners kept their mop buckets in the room where the procedure was done—it was not a sterile environment. Also, located in the adjacent rooms were patients infected with MRSA. So, the staff did the procedure next to rooms where people had MRSA. Also, a number of doctors and nurses came into my dad’s room and did not wash their hands. I saw some of the same nurses later, having cigarettes outside in their uniform. My hon. Friend David Simpson mentioned patients doing the same. One nurse came into my father’s room to administer some antibiotic cream that was to be placed in my father’s nose, and she used her bare hands and did not wash them afterwards.

The scale of the problem is vast. The World Health Organisation estimates that 50% to 70% of hospital-acquired infections are transmitted by hands, and that more than half are preventable through good hand hygiene. Yet, in the UK, a patient admitted into hospital has a 6.4% chance of contracting a hospital infection. In total, more than 300,000 patients are affected by hospital infections in the UK every year. There are 5,000 patients who, like my father, die from a hospital infection every year. That is 5,000 too many. For me personally, it meant that my wonderful dad, my hero, never got to meet my husband; my dad never got to walk me down the aisle at our wedding last year; and my beautiful baby son Clifford, who is named after my dad, never got to meet his amazing granddad. That is just my own personal story. There is an inadequacy in existing practice.

The Government have done a lot to move forward on hospital-acquired infections, and I know that the Secretary of State and the chief medical officer really do care about the issue, as I have had several meetings with them over the past three years and my all-party group on patient safety has worked closely with them. Dr Whitford has also worked closely with me on this. The chief medical officer has done a great deal globally to lead the way in highlighting antimicrobial resistance.

However, it is important that this debate draws attention to the fact that the current system of hand hygiene monitoring in hospitals needs updating, and is inaccurate and outdated. There are better monitoring systems out there. The old system allows poor hand hygiene practice to spread, and can put patients’ lives at risk. The system currently in place is known as “direct observation”, and there are three fundamental flaws within it. First, many of the nurses currently performing direct observation audits on colleagues are not trained to perform such tasks. That means that audits are often incomplete, inconsistent and ineffective.

Secondly, direct observation artificially inflates reported compliance, owing to something called the Hawthorne effect. Naturally, staff wash their hands more frequently when they know they are being monitored. In 2015 I ran a hand cleanliness awareness campaign here in Parliament and 40 colleagues, cross-party, signed up to it. The Deb Group collaborated with me on my Handz campaign and I was astounded at the research that the group showed me. It has conducted peer-reviewed research that shows that the true levels of hand hygiene compliance are in fact between 18% and 40%, rather than the 90% to 100% typically recorded in UK hospitals. That means that direct observation as a means of monitoring artificially inflates reported compliance by as much as 50%. We cannot begin to address the problems of poor hand hygiene when our hand hygiene audits report figures of 90% to 100% compliance.

To increase hand hygiene standards in our hospitals, basic behavioural psychology dictates that we need accurate and timely feedback to drive behavioural changes. Yet direct observation audits are often only completed quarterly or, at best, monthly.

The Government have had a big focus on patient safety and there has been a renewed focus over the past five years, from initiatives to reduce prescribing errors to the commitment to halve gram-negative infections by 2020. If my right. hon. and hon. Friends will permit me, I must thank the Secretary of State for driving those initiatives and for his personal commitment in trying to make the NHS the safest healthcare system in the world.

Looking to the future, the Secretary of State said that the 10-year plan for the NHS must enable it to be “more teched up”, so my question to the Minister is: what role can and should technology play in raising standards of infection prevention in the NHS? Electronic hand hygiene monitoring offers the potential to improve health outcomes and save money at a time when health services are coming under increasing pressure. Improving hand hygiene requires behavioural changes that are reliant upon frequent, accurate and relevant feedback. In his review into NHS productivity, Lord Carter discussed the need to have,

“real-time monitoring and reporting at NHS leaders’ fingertips”.

Electronic monitoring can deliver real-time, accurate data to drive behavioural changes. There are currently pilots in electronic monitoring technology in two acute hospital trusts in England. The Care Quality Commission has noted the innovative practice to improve hand hygiene using technology as an area of “outstanding practice”. However, the technology is not new; it has been in use in the US for several years.

The UK has one of the safest healthcare systems in the world, but 5,000 patients a year dying from hospital infections is 5,000 too many. Does the Minister acknowledge that, to improve hand hygiene and reduce the number of infections in our hospitals, using direct observation as a means of monitoring hand hygiene is no longer appropriate or effective? Finally, does the Minister agree that using technology, if adopted in the right way, offers an excellent opportunity to improve patient safety and reduce the £l billion in associated costs of hospital infections?

Photo of Nigel Mills Nigel Mills Conservative, Amber Valley 9:54, 15 May 2018

I congratulate Jim Shannon on securing this debate. It reminds me of a debate on much the same topic that we had a few months ago. Its aim was to find out from the then Minister when the Government might enforce the strategy they had announced. It is a pity that we are repeating that debate a few months later and we still do not have the answers. The case has been set out very clearly by the previous speakers. There is not much advantage in repeating it, but, just to reinforce the point, we are talking about 5,000 deaths annually. The World Health Organisation estimates that half of those are preventable through effective hand hygiene. I do not know of other situations in UK life where we could have 2,500 people die each year unnecessarily and that would not be a national scandal. We would do anything we possibly could to fix it. There are things we can do to save a large proportion of those lives that are not very difficult or expensive. Our strong message today is: let us get on and do them.

I accept it will not be easy. We are not talking about finding the number of people who do not practise any hand hygiene and making them practise it; we are talking about making sure that as many health staff as possible get up to the very high levels of compliance with hand hygiene rules, rather than being in the middle. I suspect that no health service staff are deliberately not cleaning their hands as often as they ought to. We know they work in high-pressure situations. They do their very best for patients, and occasionally some behaviours creep in that perhaps should not. The important thing is to have processes in place that can identify when performance is perhaps slipping and then remind people, gently and constructively, how important hand hygiene is. That is why we need accurate and sensible monitoring.

We all know what happens when a colleague in a team says, “We have got to do one of these audits today. I’ll go round and watch to make sure you are all practising the right hand hygiene.” We all know what will happen. We have all been in those situations. We are all very careful to make sure we wash our hands as best as we possibly can. We all think we know the same rules, so we all comply with the same things. The person observing probably does not know the rules any better than those being observed. It is no surprise, therefore, that we end up with near 100% compliance. In fact, it is a surprise that we do not end up with 100% compliance in that situation. It is like the driving test. I have never looked in my mirror as much in my life as on my driving test, because I know I am being checked on that.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

Is there not a simpler approach? Should not the audit be unannounced and carried out by people like secret shoppers, which is a technique that we use in Scotland?

Photo of Nigel Mills Nigel Mills Conservative, Amber Valley

Yes, that would be clear progress. However, I sense that we would notice an unknown person walking round the ward with a clipboard, which might make someone behave more carefully. I am not sure how easy it is to stop the word going round the hospital that such work is being done, but I accept that that is better than one member of the existing team doing it. The question is: can we find a better way of monitoring compliance and getting the data we need, so that we can work out what is happening, see what the trends are, and see whether they are reflected in infection rates? As hon. Members have pointed out, there are various techniques on the market to do that electronically.

Simply counting how many times the ward dispensers are squeezed will not work because we need to know the type of ward, how many patients there are and how sensitive the work is to know how many times people need to squeeze the dispensers. We need a system that says, “On a ward carrying out this sort of activity with this number of patients, we would have expected this level of hand hygiene-compliant moments, and we actually got this many squeezes on the dispenser. That is only a quarter of what it ought to have been. That tells us there is a big problem on this ward.” Or it might tell us that we got 80%, which is probably a sensible level to get.

In my constituency is the Deb Group, a large employer that produces hand hygiene gel and monitoring techniques. I accept there are many rivals on the market and many different ways of monitoring. Some people prefer to have each member of staff wear a badge with a sensor that can tell how often that member of staff approaches a hand hygiene gel dispenser, so that we can monitor at an individual level rather than a ward level.

All those ideas are out there. We need the Government, and presumably the Care Quality Commission or NHS Improvement, to say to hospitals, “We want you to collect real data. We don’t want you to do stupid observations that give you 99% compliance, which we know is meaningless, just so that you can tick a box to say that you’re compliant. We want you to collect real data. We don’t mind how you do it, and we’re not going to punish you, take money off you, or put you in special measures if that data shows that you’re at 25% or 35% compliance, and all your rivals are at 97% because they’re doing it wrongly. We want you to do it properly, get the data, use the data, and improve your performance where you can see that it is linked to infections being too high.”

When the CQC reviews hospitals and other health environments, it should check that hospitals are collecting that data sensibly and using it to improve performance. The CQC should be very serious about that when it assesses a hospital. Can we see that hospitals know what their performance is, have a plan in place to improve it, and are improving it, and that infection rates are falling? It would be a serious matter if hospitals were not doing that work properly—if they were just having a quick half-hour assessment now and again, and producing data that they must know is complete rubbish.

We have the right plan; we know what we want hospitals to start doing. Let us get it in force, and task the CQC to ensure that hospitals are doing it. Let us set out clearly what we want hospitals to do and ensure that they are not too scared to go down that line, thinking that their data will suddenly get worse and they will be punished for it. Let us do what we know we need to do, and hope that we do not have to come back in another couple of years to talk about the fact that 2,500 people have died because we have not managed to put something in place that is easy and relatively cheap, and that we know works.

Photo of Douglas Ross Douglas Ross Conservative, Moray 10:01, 15 May 2018

It is a pleasure to serve under your chairmanship, Mr Howarth. I, too, congratulate Jim Shannon on securing the debate. Naturally I wanted to take part; this issue is important to my constituents in Moray, as it is to those of all other right hon. and hon. Members. Furthermore, the hon. Member for Strangford is an assiduous contributor in this place. Indeed, some of my debates have been supported by him, so I was keen to reciprocate the support that he gives to others by coming along today.

The role of healthcare is, in essence, to treat and heal patients. That is why healthcare-associated infections, where someone acquires an infection in a hospital or another healthcare facility, can be so cruel. They can also be especially dangerous. Healthcare-associated infections, or HCAIs, lead to comorbidity and can interfere with the treatment that people are in hospital for in the first place.

Naturally, in today’s debate, which is looking at UK-wide issues, I want to focus, as I am sure Dr Whitford will, on what we are doing in Scotland, and I will pick up on some of the points that have been made about sharing best practice across the country. It is particularly concerning that in Scotland, according to a Health Protection Scotland report, the incidence of HCAIs in intensive care units is higher than other parts of hospitals, with an incidence rate of 2.7% in 2016. Likewise, surgical site infections are among the more common HCAIs, with, for example, an incidence rate of 1.37% in the first 10 days after a caesarean section. Surgical site infections can be especially painful for patients, and in some cases can even require further medical intervention afterwards.

Healthcare-associated infections are distressing, painful and often dangerous to patients, and are costly for the NHS. Such infections frustrate, complicate and even undo the hard work of our medical staff. They exacerbate the strain on hospital resources, and cost money in compensation payments. In 2016-17, for example, 89 wards and 97 other bays were closed across Scotland due to outbreaks of norovirus. Clearly, action is necessary to prevent and control infections in hospitals and other NHS facilities. By reducing the incidence of HCAIs, the NHS would no longer need to treat those infections, and would avoid the complications that are caused in the treatment of the disease or disorder for which the patient was originally admitted to the hospital or healthcare facility.

Moreover, reducing instances of healthcare-associated infections will help to reassure patients seeking treatment in the first place. Unfortunately, some people, especially elderly people, worry about the possibility of picking up an infection while in hospital. That can lead to reluctance to seek treatment in the first place, which can be very dangerous. It is vital that we work to reassure people that an NHS hospital is a safe place where the risk of infection is low.

In Scotland, the picture for progress on preventing HCAIs is mixed, and there is more to be done by the Scottish Government in that area. In positive news, there was a decreasing year-on-year trend in the incidence of clostridium difficile infections between 2013 and 2017. However, the incidence of HCAIs in intensive care has crept up slightly, from 2.5% in 2014 to 2.7% in 2016, while the incidence of ventilator-associated pneumonia increased by more than 26% in the same period. There has been some good work, but there is room for improvement.

The NHS faces a number of challenges with respect to preventing infection—from the density of people in one place to the threat of superbugs and resistance to antibiotics, as we heard earlier. It is thanks to the hard work of our NHS staff across the country that infection rates remain as low as they are. There has been a discussion about unannounced hospital inspections. The main hospital in Moray, Dr Gray’s, was subject last November to an unannounced inspection. The findings were reported earlier this year. Importantly, it was found that the standard of domestic cleaning and compliance with standard infection control precautions was good. However, the head of quality care at the healthcare environment inspectorate said:

NHS Grampian must ensure the environment is maintained and, where possible, refurbished to allow effective cleaning and reduce the risk of infection.”

Despite all the great work by the staff in Dr Gray’s and other hospitals, their hands are slightly tied behind their back if we have older, crumbling buildings that need capital investment. There is much more that we can do to support our staff, who want to do the best for patients but are sometimes hamstrung by the conditions in which they work.

There is still room for improvement, and the Scottish Government must ensure that staff have the support they need to make further inroads in the fight against HCAIs. That should include the Scottish Government and NHS Scotland working with their counterparts elsewhere in the United Kingdom to share ideas and good practice, as Mr Campbell highlighted in his intervention. This issue does not stop at the border; we can learn from one another. Will the Minister explain how health departments across the country share best practice and work together to ensure that we deal with this important UK-wide issue?

There must be zero tolerance for failings, such as poor hygiene that can put patients’ health and lives at risk, as we heard in the very emotive speech made by my hon. Friend Andrea Jenkyns. Remarkably, as recently as 2013, one in 10 senior medics in Scotland were not complying with hand hygiene standards. That is a worrying message, and the situation must improve.

We should be proud and thankful that we live in a society where we have high-quality universal healthcare, with a low risk of infection. However, in every part of the United Kingdom we must not stop striving to control, and hopefully prevent, such infections from occurring in future.

Photo of Lee Rowley Lee Rowley Conservative, North East Derbyshire 10:08, 15 May 2018

It is a pleasure to serve under your chairmanship, Mr Howarth. I, too, congratulate Jim Shannon on securing the debate. As my hon. Friend Douglas Ross said, the hon. Gentleman has attended some of the debates that I have led in previous months, so I am grateful for the opportunity to speak in a debate that he has introduced. I know the topic is important to him, and he made a great and passionate case when introducing the debate.

Like my hon. Friend Nigel Mills, I am not sure whether I can do justice to some of the issues that have been outlined. I do not wish to repeat things that have been said in a far better way than I could say them—I am by no means an expert in this area. My hon. Friend Andrea Jenkyns and I have known each other for many years. I know how difficult it was a number of years ago, with the loss of her father, and what a passionate advocate she has become for infection control and resolving some of the issues that have been mentioned. I cannot hope to match some of the discussion that we have had today.

As a relatively new Member of Parliament, I have been surprised in the 10 months since the election by the number of people who have come to my surgery to raise these sorts of issues. I am not new to politics—I was a councillor for eight years before becoming a Member of Parliament—and perhaps because previously I was looking at a different section of government and how it operated, but I was taken aback by the harrowing stories and challenges that many constituents have highlighted and have been willing to share with me.

There are a couple of issues in particular that have come through. The first is anaemia and the second is sepsis, which the hon. Member for Strangford has raised, and I have tabled some parliamentary questions on them. On anaemia, the best way to prevent infection is to prevent people from going into hospital in the first place. We need to reduce admissions, but it is a challenge to achieve that in our health service. One reason why many people are admitted is that they have undiagnosed illnesses, they experience problems and they automatically go to A&E. They present in a way that could be avoided.

The Anaemia Manifesto Steering Committee estimates that around 4 million people live with iron deficiency. It can be a secondary diagnosis, which means that people present with symptoms that they think are something else, but which in fact are anaemia. That costs the NHS up to £50 million every single year. Recognising and acknowledging that, and doing more work on anaemia, might help to address some of the admissions issues we have. Anaemia is the fourth most common cause of admissions for people over 75. It is, by common consent, an underdiagnosed and undertreated condition, and addressing that could be a route to reducing infections, by reducing the number of people in hospital in the first instance.

Sepsis has been discussed. I have heard about a number of cases about sepsis in my surgery: a lady with a young child whose life has been completely changed as a result of contracting sepsis, and who now has a completely different outlook and different requirements in how she lives her life, because of the limitations that sepsis has created; and a family who lost their mother to a sepsis infection that was not identified early enough. I could see the pain on their faces when they were talking about this hugely personal challenge that they had faced and which was created by sepsis.

There is recognition of the problem, and the Department of Health and Social Care is doing an incredible amount to raise sepsis awareness, and to move forward the acceptance that more needs to be done, but there remain challenges in diagnosis, in ensuring effective monitoring when people are in hospital, and in appropriate and adequate treatment. I am aware of the sepsis action plan and the public information campaigns on sepsis that are under way and which no doubt will continue. My parliamentary question was answered a number of months ago; it remains the case that there is a gap in understanding and focus in the health service on sepsis. I am sure that the Department of Health and Social Care and the Minister are seeking to close that gap as quickly as possible, but there is more work to be done, particularly with more than 100,000 cases a year and the deaths that the hon. Member for Strangford has outlined.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Gentleman for his kind comments earlier. To underline the number of deaths, Northern Ireland had a peak in 2008 of 191 deaths where C. diff was mentioned on the death certificate. That has been reduced to 67. It comes down to the hard core of problematic infection that is still there. That is where we are looking for some direction from the Minister.

Photo of Lee Rowley Lee Rowley Conservative, North East Derbyshire

I absolutely agree. I think everybody would recognise that there is more work to be done.

I will not take up any more time. I welcome the commitment from the Government on matters such as sepsis. There is acknowledgment across the House and from the Government, I hope, that there is more to be done in this area—there is public concern and a desire for public focus—and that process is already under way. I hope it can be restated and redoubled. We all recognise that there is further progress to be made so that we are not here in five or 10 years’ time, debating the same subjects, listening to the same stories in our surgeries.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care) 10:14, 15 May 2018

I pay tribute to Jim Shannon for securing this important debate. As he said, it is only a few weeks since the World Health Organisation’s “Save Lives: Clean Your Hands” campaign and we are talking about how to reduce healthcare-associated infections. Most hon. Members have rightly focused on hand-washing and hand hygiene, because it is crucial, but that alone will not tackle hospital infection. It is not just about hand-washing; it is about the cleaning of wards.

We started to see the rise in MRSA, MSSA and so on after we started to outsource cleaning. I remember watching a young man cleaning with a machine in the Royal in Glasgow. He looked about 20, and if anyone who has a 20-year-old son can tell me that he knows that there is such a thing as corners, I would be delighted to admit defeat. We need people who are committed to the space. I was very glad that my hospital in Ayrshire never outsourced. We kept ward maids who had their own patch, in which they took pride, and there were supervisors who came along—a bit like someone’s mum-in-law with a white cloth—checking under the beds and the trolleys and on top of the curtain rails. It is really important that the environment is clean.

Bed occupancy is another issue. We know that the NHS in England has been under pressure for quite a long time, because the number of beds has halved over the past 30 years. England has one of the lowest bed ratios in Europe, at 2.4 per 1,000. Bed occupancy has been more than 95% and the recommendation for a safe level is 85%. The average in Scotland in 83%. That will vary between rural and urban areas, but if there is no time to clean the bed between patients, the risk increases. If the hospital is under pressure with a queue down in A&E, people are going to cut corners.

As Douglas Ross mentioned, the fabric of the building is crucial. If something is cracked or broken or old or wooden, it is not possible to clean it properly. That is why we have the Healthcare Environment Inspectorate in Scotland, which—believe me—turns up unannounced, poking around in every nook and cranny, looking under trolleys and wheelchairs, in the toilets and the shower rooms. That also includes external unannounced observation of people washing their hands.

I will turn to staffing levels. Across the UK we face nursing workforce challenges. Although we are struggling with a 4.1% nursing vacancy rate in Scotland, in England at the moment it is more than 10%. That creates pressure on everyone else on the ward. As Nigel Mills said, there is a temptation, if not to do no hand hygiene, perhaps not to spend long enough with the gel on the hands and not to take quite the same quantity.

It is important to remember that clostridium difficile is caused by the overuse of antibiotics. It may spread from patient to patient due to poor hand-washing, but the initial problem was overuse and prolonged use of broad-spectrum antibiotics. It is very important that that is controlled. We need to think about sources, such as pressure sores and intravenous access, whether it is a peripheral drip or a central line. An important one at the moment is the management of urinary catheters. How long is it left in place? Is it too long? If it needs to be in longer, is it being changed regularly?

We also need to monitor surgical site infections. In Scotland, two wounds are monitored so that we are aware of whether things are improving or worsening. Although the hon. Member for Moray complains about a 1.37% wound infection rate after C-section, that has actually decreased over many years, and for hip replacements the rate is 0.63%. Some of that is not due to hand-washing. I have been a surgeon for more than 30 years and have seen the change from big interrupted black silk sutures that allowed penetration points for infection, to subcuticular invisible mending that means that the wound seals very quickly, using better dressings and glue to seal the wound so that there is less risk of external ingress. There is also a plan to add bowel surgery and vascular surgery—a dirty operation and a clean operation—because that is how we can monitor if something more general is going wrong.

Like the rest of the UK, in Scotland since about 2000 we have been trying to tackle infections. We lost our white coats and had to wear short sleeves—I still do. We were not allowed watches—I still do not wear one—and hand-washing and hand gel were promoted. Nevertheless, in 2007-08 an appalling outbreak of clostridium difficile in the Vale of Leven Hospital affected more than 150 people and caused 34 deaths. That wake-up call made us realise that tackling healthcare-acquired infections cannot be done in isolation; it must be part of a quality improvement and safety drive.

We created Healthcare Improvement Scotland, and in 2008 we established the Scottish patient safety programme, which was based on principles from Boston but was the first national patient safety programme. It is a structure on which we can hang evidence-based practice about many of the challenges that put patients at risk. It involves not the great and the good sitting in an office, but frontline champions from all health boards and all areas. It is driven by outcome data, which is shared, published, peer reviewed and actioned. We have to make hand-washing, like patient safety, part of daily practice; it must not sit on a shelf in a folder.

The Scottish patient safety programme was started to tackle all risks. I came across it as a surgeon, because it was used to tackle surgical errors such as wrong-site surgery and drug errors—patients being given the wrong drug—but it also addressed healthcare-acquired infections and hand hygiene. We had ward champions and unannounced audits carried out by people from other wards. I agree that, unfortunately, the worst performers in every audit were the doctors. That is why we had to publish the results, put them on the doors of the ward and literally name and shame. We also did a lot of education with relatives, because they come in from outside. In recent years we have made our hospital grounds smoke-free to try to tackle the issue of staff and patients forming a mug of smoke that people have to walk through to get to the door.

All infection-control measures are brought together in one manual, the “National Infection Prevention and Control Manual”, which means that everything is in one place. If there are five or six different initiatives and guidelines, they can sometimes be slightly different and can end up causing confusion.

Jack Lopresti, who is no longer in his place, mentioned the important issue of antimicrobial resistance, which will make it harder to tackle infection. Our behaviour in healthcare is helping to drive it. We are threatened by a post-antibiotic era. Alexander Fleming came from Ayrshire, and it would be horrific to think that the antibiotic era might last less than 100 years. Antibiotic stewardship is critical, and it is part of our patient safety programme. The Scottish Government are now also working with vets, because part of the issue is the use of antibiotics in animal husbandry. It therefore comes under the title of the “one health” programme.

The purpose of the Scottish patient safety programme was to reduce deaths, and within just three years there was a 9.3% drop in hospital standardised mortality rates and a 24% drop in deaths in intensive care. The hon. Member for Moray said that there is an infection rate of 2.7% in intensive care, but we have to remember that those are the sickest, most complex patients, and they are therefore most at risk of having or bringing in an infection. There was a 90% drop in ward clostridium difficile rates within three years. Deaths from C. diff dropped by 79% between 2007 and 2015, and those from MRSA dropped by 87%.

Many hon. Members mentioned sepsis. We have all seen the horrific cases in the media, and 40,000 deaths is more than many cancers, which get a lot more attention. In Scotland we established the Sepsis Collaborative, which ran from 2012 to 2014. It focused on just one measure: the national early warning system, which was about delivering antibiotics intravenously to the patient within an hour. Every hour’s delay increases the death rate by more than 7.5%. In 2010 an audit showed that fewer than 25% of patients were getting an IV antibiotic within an hour, but by 2014 it was more than 80%. The aim was to reduce deaths by 10%, but during the time of the programme there was an almost 20% reduction.

All parts of the UK have seen a dramatic fall in C. diff and MRSA, but all have seen a rise in E. coli, which is a bug that lives in the bowel. It is largely driven by catheter infections and it concerns older patients. It is one of the challenges we face, because many of these bugs will be resistant. There is actually a higher mortality rate from E. coli than from MRSA.

One of the differences in approach is to look at healthcare-acquired infections not by themselves, but as part of patient safety. In Scotland there are no financial incentives to meet standards, either for the hospital or for the staff; it is just pure clinical competitiveness. Nurses and doctors go to work to do a good job, and if we give them the tools, the education and the training, they will do that. We also have to give them time and support. Having a more complex quality improvement structure makes it easier to share good practice. That is what we are talking about today. We want to see a change in approach, not in a protocol folder on a shelf, but in the DNA of staff.

Photo of Justin Madders Justin Madders Shadow Minister (Health and Social Care) 10:26, 15 May 2018

It is a pleasure to serve under your chairmanship, Mr Howarth. I congratulate Jim Shannon on securing this extremely important debate and on his insightful contribution. He has a reputation for being one of the most prolific Members of this House, both here and in the main Chamber. He has pursued this issue assiduously during his time here, and his comments made clear his commitment to improving patient safety. His contribution was wide-ranging and fecund, and he highlighted the good timing of the debate, given that 5 May is World Hand Hygiene Day. There is a particular focus this year on sepsis, to which a number of hon. Members referred. We should reflect seriously on the staggering figures they mentioned: there are 30 million infections worldwide a year and 44,000 deaths in this country, and we could save between 5 million and 8 million lives a year through greater awareness and control. We all want to tackle sepsis very seriously.

The hon. Gentleman was right to say that there will not be any political disagreement today, as we all want the very best outcomes in this area. He was right that good progress has been made, particularly over a longer period, but it could be argued that we have plateaued. The infection rate remains too high. I am sure that we all agree that the figure of 6.4% across the NHS is far too high. He talked about the human and financial cost—he mentioned the figure of £1 billion. He made the fair point that this has downstream effects, as beds are occupied unnecessarily. It is always regrettable if any patient is in a bed because of something avoidable, particularly given that the number of beds across the NHS is at an historic low.

I was pleased to hear from Andrea Jenkyns. She has spoken on a number of occasions about this important subject, and she spoke again about the personal tragedy of her father’s death. She has been a consistent and vigorous campaigner on the issue since she came to this place. This is the first time I have heard in such detail the appalling circumstances surrounding her father’s death and the basic hygiene breaches that took place. I doubt that any member of the public, let alone any trained medical professional, would consider what happened there to be acceptable. That highlights the difficulties we sometimes face in tackling these issues.

Nigel Mills made a considered and thoughtful speech about a wide range of issues. He referred to the World Health Organisation’s figures, which suggest that about half of the associated deaths in this country are preventable. He was right to say that in no other area would we be prepared not to tackle such a figure with great vigour. I agree with him that staff are not deliberately flouting hygiene standards, but the pressure of work sometimes means that standards slip. From the vacancy rates referred to by the Scottish National party spokesperson, Dr Whitford, and from regular staff surveys, we know how much pressure staff are under in the NHS. The hon. Member for Strangford highlighted accurately the difficulties with the existing audit processes and how they are not necessarily the best. He summarised perfectly the false comfort that we derive from the belief in 100% compliance rates. We know from what we have heard today that when audits are not taking place, compliance is considerably less than 100%.

Douglas Ross had clearly done a lot of important and excellent research to come up with all those statistics across a whole range of environments. He showed that there is no uniform picture in tackling infection control and suggested that the condition of the buildings might sometimes be an impediment to best practice. He rightly said that that is an area where many things can be learned from across the border, or indeed across the world—best practice should be disseminated.

Lee Rowley talked about the need to reduce hospital admissions as one way of reducing infection rates. He mentioned anaemia in particular: apparently 4 million people have an iron deficiency and anaemia is the fourth most common cause of admission. He also mentioned sepsis and the possible gap in understanding or focus in the NHS, although we have heard today that a lot of awareness-raising is going on in that area.

It has been almost two and a half years since we last discussed this issue—January 2016—so today’s debate provides us with a useful opportunity to take stock of progress. We heard about a number of recent positive initiatives but, as the hon. Member for Strangford said, levels of healthcare-acquired infections remain stubbornly high, and in some cases they are increasing. Reductions in the rates of MRSA and C. diff are welcome, but the increase in MSSA and E. coli over the past five years is worrying. Furthermore, about one in every 16 patients will still acquire an infection while being cared for by the NHS in England, and every one of those infections requires additional NHS resources and, more importantly, leads to great patient discomfort and reduces patient safety.

According to the most recent figures from Public Health England, the fatality rate is 28.1% for MRSA cases, 19.7% for MSSA, 14.7% for E. coli and 15.1% for C. diff. We cannot overstate the seriousness of acquiring one of those infections. Furthermore, the Department of Health and Social Care reported recently that, sadly, E.coli infections led to the death of more than 5,500 patients in 2015, at an estimated cost to the NHS of £2.3 billion. The impact on patients and their families is devastating, while the growing threat of antimicrobial resistance adds to the significance of the issue.

In the US and Europe alone, antimicrobial-resistant infections are estimated to cause more than 50,000 deaths a year, and that figure is projected to increase significantly, as we have heard. A report by the World Health Organisation states that resistance is frequent among bacteria isolated in healthcare facilities, with antibiotic-resistant bacteria causing over half of all surgical site infections. We cannot overstate the importance of tackling the issue.

Healthcare of course carries inherent risks, and even if we were to take every possible preventative step, it would still be possible to acquire an infection. However, as I mentioned last time we discussed the matter, it has been estimated that about 30% of infections could be avoided by better application of existing knowledge and good practice. Much of that improvement could be realised through improved hand hygiene practices. Although we have known that for decades, the method of monitoring hand hygiene in hospitals remains outdated, inaccurate and, as we heard from the hon. Member for Morley and Outwood, flawed.

The monitoring method relies on direct observation by nurses, which leads to compliance rates being overstated and takes up hours of nursing time when staff on the wards are already overstretched. Staff naturally wash their hands much more frequently when being observed directly, which results in clearly overstated compliance rates of 90% to 100%. Academic research has found that typical compliance is actually between 18% and 40%. The international best practice to which the hon. Member for Strangford referred demonstrates that electronic monitoring of hand hygiene can decrease the risk of infection by 22%, which would not only save the NHS money, but save lives. We therefore welcomed the November 2016 commitment by the Secretary of State that staff hand hygiene indicators would be published for the first time by the end of 2017. However, as we heard, that deadline has lapsed and we seem to be no nearer to seeing implementation. Will the Minister tell us when we can expect to see the detail of that long-overdue improvement?

On 19 March, in a written response, the Minister mentioned that Public Health England had carried out some initial analysis with the available data, but that the data was incomplete, so it does not truly reflect hand gel usage. I accept that it might not provide an accurate representation of the NHS as a whole, but will the Minister set out what the analysis that he has received has found, and whether any of that information might be useful in the interim until the full dataset is available? Two ongoing pilots into the use of electronic monitoring technology within the NHS have also been mentioned. Has he made any assessment of those pilots? What plans do the Government have to look at universalising good practice, if it is shown to be as effective as early reports suggest?

As with any type of infection, healthcare-acquired infections can trigger sepsis, particularly in people who are already at risk—for example, those with chronic illnesses such as diabetes, or those who are immuno- compromised, such as those receiving chemotherapy. The majority of cases do not derive from a hospital setting, but with 150,000 cases a year and 44,000 deaths, many of them preventable, sepsis is a critical safety issue for the NHS. The challenge is to recognise it in its early stages, before multiple organ failure sets in, and to implement rapid treatment. If it is left untreated for hours, the chances of death increase rapidly. Sepsis in its early stages is often dismissed as something less serious, so I ask the Minister to advise us on what processes are in place to monitor patients at risk from sepsis. What steps will he take to ensure that treatment is started without delay?

In conclusion, around the world and in this country we spend vast sums of money on researching innovations to tackle illnesses and improve our welfare, but tackling hospital-acquired infections better would potentially put us in a position to prevent thousands of unnecessary deaths each year through the most basic of steps and the dissemination of best practice.

Photo of George Howarth George Howarth Labour, Knowsley

Before I call the Minister to respond to the debate, I remind him gently that it is customary to leave a short period at the end of the debate for the mover of the motion to wind up.

Photo of Steve Barclay Steve Barclay Minister of State (Department of Health and Social Care) 10:38, 15 May 2018

As always, Mr Howarth, it is a pleasure to serve under your chairmanship.

I join the shadow Minister, Justin Madders, in congratulating Jim Shannon on securing the debate, which provides an opportunity for the House to emphasise the importance of raising standards of infection prevention and control in the NHS. He was kind to pay tribute to the Secretary of State for his work on patient safety, and on putting that front and centre in his priorities. As the hon. Members for Ellesmere Port and Neston and for Central Ayrshire (Dr Whitford) acknowledged, that is a point on which the House is united in a common cause. How we reduce infections is of real importance to our constituents, as my hon. Friend Lee Rowley said, and that is reflected in our surgeries, because it impacts on the lives of those we represent. There is therefore a great deal of common cause.

The debate is timely because it was World Hand Hygiene Day on 5 May, which is an initiative that the World Health Organisation started in 2010 to remind us all, including patients and family members, to practise good hand hygiene, to help reduce the spread of infections. The hon. Member for Strangford was right to challenge the Government to reinvigorate our approach to hand hygiene. A number of initiatives are under way in Government to address exactly the points that he raised. Public Health England has been raising awareness, and NHS Improvement has begun a number of initiatives, such as its NHS provider bulletin and a hand hygiene theme in its executive masterclass. Other ways of raising awareness include the Royal College of Nursing’s glove awareness week. The hon. Member for Central Ayrshire said that it is all about taking practice from guidance or files and embedding that into the DNA, the culture and the way people operate, who include visiting relatives and staff at all levels, including doctors as well as nursing staff.

A number of hon. Members, including my hon. Friend Nigel Mills, raised technology and what more we can do. One theme of the debate was whether the Government are doing enough to drive forward the use of technology. I recognise the limits of direct observation and how behavioural change may respond to those. That is why the Government are actively looking at the extent to which technology can facilitate this area.

We have carried out an initial assessment; indeed, the NHS Improvement director of infection prevention and control, Dr Ruth May, and her team recently visited the Royal Wolverhampton NHS Trust, which has been trialling an electronic monitoring system to make an initial assessment of that. Their feedback is that the system is reliant on existing technology, and that many IT systems would not be able to support that. A number of practical issues need to be addressed before one would have a roll-out of technology. I reassure the House that Dr May and her team are actively looking at that issue. We all recognise the impact, not just on patient safety, but on the cost of infections and unnecessary deaths. We are actively looking at the issue of technology.

The hon. Member for Strangford also asked if we could publish more. To pick up on the remarks of the hon. Member for Central Ayrshire on the way information is published in NHS Scotland, dialogues are already taking place. I am happy to ask officials to ensure that, as part of the collaboration that is already under way in NHS Improvement with colleagues in the Scotland and England NHS, we look at best practice to ensure that we are working with and maximising the learning from both sets of NHS.

Public Health England has carried out some initial analysis of the available data to determine the suitability of the data available for publishing. Currently, the data is incomplete and will not truly reflect the usage of hand gel. We are exploring how to improve that data. The hon. Member for Central Ayrshire commented that transparency on what is being done and on variance in performance around infection rates is a key driver of prevention.

Photo of Philippa Whitford Philippa Whitford Shadow SNP Spokesperson (Health and Social Care)

The Minister may know that as a breast cancer surgeon, I was involved in developing the breast cancer standards for Scotland. The only action was peer review—putting everyone’s performance up at an annual conference. No one wants to be at the back of the class; in actual fact, seeing genuine performance drives up quality.

Photo of Steve Barclay Steve Barclay Minister of State (Department of Health and Social Care)

The hon. Lady is right that peer review is always a powerful motivator. That sort of transparency drives behaviour, so we need to ensure that we do that in an effective way that does not alarm patient families, because of the publication of data that could be misrepresented by those who have different objectives. The need to get more publication of data is an important point, which the hon. Member for Strangford and others raised, on which we need to do further work.

David Simpson asked in his intervention about the specific issue of patients going outside to smoke, and whether there was an associated infection risk, for example through drips. I am advised that there is no additional risk of infection, as long as the drip is well managed. If colleagues have specific issues about the infection risk associated with that, that is the nature of the debate and helpful to know.

My hon. Friend Douglas Ross spoke of the pain and distress to patients caused by infections, and the important link to buildings. Although that is relevant in Scotland, to which he referred, I accept that the point would also apply to the England NHS. The state of the buildings and the maintenance programme have a part to play, not just in the Scottish NHS, but in the England NHS as well.

The hon. Member for Strangford asked whether hand hygiene could be a national marker of care quality. The Department is considering how we could do that effectively. The points he raised were heard and I will ensure that they are addressed. As and when we have any update, I will be very happy to share that with him.

Overall, a great deal of progress has been made. We are committed to reducing the number of infections. Since 2010 we have made excellent progress on MRSA and C. difficile. In the 12 months ending March 2018, MRSA cases were down 54% on the 12 months ending May 2010, and CDI infections were down 47%. Considerable progress has been made, but as the hon. Member for Central Ayrshire mentioned, although we have made progress in slowing the rate of increase of E. coli infections, there is more to be done to bring that rate down. NHS England has the challenging objective to bring that down by 20% as part of its mandate. As a result of slowing that down, there were 2,400 fewer cases of infections than there would have been with the previous trend.

Clearly, there is more to be done on E. coli and it is an area of considerable focus in the team. Those cases also have a fiscal cost of between £3,000 and £7,000 per infection, but the much more material cost is the patient safety issue and the harm that accrues as a result. NHS Improvement is leading this programme, aimed at a 20% reduction in E. coli bloodstream infections in 2018-19. It is an ambitious but important target. NHS Improvement has begun working with the medical director of NHS England, Steve Powis, on setting up pilots with local health economies across England to engage and assist in the reduction. That may be an issue that my hon. Friend Andrea Jenkyns wishes to pick up with me after the debate—how we can work together, given her powerful but extremely sad experience of the events that befell her father.

Colleagues recognised the considerable amount of work on antimicrobial resistance, which is an important factor in treating infections. Our latest estimate is that over five years, there could be an extra 6,000 deaths attributable to pan-antibiotic resistance. Lord O’Neill’s review on AMR said that drug-resistant infections will cost the world 10 million extra deaths a year and $100 trillion by 2050. Those are pretty scary figures, but they underline the importance of preventing infections occurring in the first place.

That brings me on to patient safety. Following the tragic events at Mid Staffordshire and the subsequent public inquiry led by Sir Robert Francis, the NHS embarked on a journey of improvement based upon three strands: better regulation, greater transparency and a culture of learning. Assessing the risk of, and preventing, detecting and controlling the spread of, infections, including those that are healthcare associated, is addressed by the fundamental standards of care, enshrined in regulations, that all Care Quality Commission registered providers are expected to meet. A number of colleagues mentioned the role of the CQC as part of the checks and balances that need to be in place.

In November 2016, the Secretary of State launched new plans to reduce infections in the NHS, including the sepsis commissioning for quality and innovation. Through that, we have incentivised hospitals to improve their sepsis care. Independent CQC inspections have focused on E. coli rates in hospitals and in the community. In addition, we have appointed a national infection prevention lead to ensure a sustained focus at national level, improved training and information sharing, so that NHS staff can cut infection rates and, through the National Institute for Health and Care Excellence’s 2017 guidelines, highlight standard principles and advice on good hygiene.

Considerable progress is being made. Data published in 2017 suggests that four in 10 of all E. coli blood infections cannot be treated with commonly used antibiotics. Infection prevention and control is a key element of tackling antimicrobial resistance, and hand hygiene plays an important part in that. We are working extensively with stakeholders, including the royal colleges, academia and the research community, industry and our expert advisory groups, to inform our next steps.

Several colleagues, including the hon. Member for Ellesmere Port and Neston, mentioned sepsis. We have made significant progress since our focus to improve sepsis practices increased in January 2015. There is new NICE guidance and a new national CQUIN measure to incentivise providers to improve the identification and timely treatment of sepsis. The hon. Member for Central Ayrshire was absolutely right about the time-critical nature of that treatment. That work is already delivering change. The most recent data, which is for the third quarter of 2017-18, shows that emergency department assessment for sepsis has increased from 52% to 92%, and in-patient assessment has increased from 62% to 84% since April 2016.

Considerable progress has been made, which reflects the renewed focus across the NHS, in England and Scotland, on the time-critical nature of sepsis treatment, but we know there is more to do, which is why a new cross-system action plan was launched in September 2017. That plan outlines a range of activities to ensure that the NHS is on the highest possible alert to tackle that devastating condition. Indeed, just recently, on 25 April, NHS Improvement issued a national early warning score 2 patient safety alert to support providers to adopt the revised NEWS2 to detect deterioration in adult patients, including better identification of patients likely to have sepsis.

My colleague the Minister for Care, my hon. Friend Caroline Dinenage, hosted and gave a speech at the launch of Health Education England’s paediatric sepsis e-learning package, which, again, is about raising awareness at an early stage. That training package was informed by clinicians and by parents whose children sadly passed away from sepsis, so we can learn from those tragic events and ensure that warning signs are better picked up at an earlier stage.

As several Members recognised, hand hygiene plays a key role in infection prevention and control, in supporting patient safety and in our efforts to address antimicrobial resistance. Considerable progress has been made—MRSA has more than halved and C. difficile has reduced by just under half since 2010—but, as the hon. Member for Central Ayrshire rightly said, E. coli remains a key area for renewed focus. We have successfully slowed its growth, but we now need to reduce it significantly. Part of the challenge is that a lot of it occurs outside the hospital setting, in the community.

I look forward to working with colleagues from across the House on this shared objective in an area where shared practice, from both England and Scotland, can help. We can learn from each other and from Members’ experiences in their constituencies. We will continue to embed hand hygiene practice and promote awareness of it in the NHS, not just through World Hand Hygiene Day but through debates such as this one.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health) 10:54, 15 May 2018

I thank all hon. Members for their significant and helpful contributions. The shadow Minister mentioned that everyone was on the same page and saying the same thing. I love debates of this type, because they show that we can all work in a cross-party way and make significant and helpful contributions. Let me look at the thrust of what we are trying to achieve. We are trying to bring deaths down—we have got them down to a certain level—and to implement a constructive strategy and policy to move forward with diagnosis and monitoring. Members also referred to the desire for increased public focus, and to the failure of buildings.

I am sure Members will not mind me saying that we are blessed to have Dr Whitford here. I think we all acknowledge that she brings a wealth of knowledge to this place. I say that sincerely—I mean it, as I think we all do. We can all benefit from what she knows and from what is being done in Scotland.

The Minister told me before the debate that he was standing in for a colleague. He stood in very well, and I thank him for his constructive responses to every one of our comments. Much progress has been made. We are encouraged that a strategy is in place to try rigorously to reduce infection. Members’ contributions were all helpful, constructive and positive, and I hope that the debate leads us to where we all want to be, with disease reduced and perhaps someday done away with in all hospitals. The Minister referred to a shared objective. Yes, everyone in the House has a shared objective, and we all hope that together we can make it happen. I thank each and every Member for their contribution, and I wish them well.

Question put and agreed to.


That this House
has considered raising standards of infection prevention and control in the NHS.

Sitting suspended.