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1.49 pm
The Parliamentary Under-Secretary of State for Health (Mr. John Horam): I am glad to have the opportunity to reply to the hon. Member for Thurrock (Mr. Mackinlay), even though he has left me only 11 minutes to do so. He made an extremely concerned speech, on which I congratulate him. The issue causes concern not only to the hon. Gentleman and the hon. Member for Huddersfield (Mr. Sheerman), but to many people outside the House, and rightly so.
It is important to get the matter in perspective. We should acknowledge the problem, but it has existed for many years--indeed, decades. The hon. Member for Thurrock was ill advised to introduce party politics and matters such as E. coli. The problem has existed under both parties in government. It has not arisen overnight--it has been there for decades. I want the hon. Gentleman to recognise that, and I am glad that he is nodding to that effect.
The problem is containable, and the United Kingdom has an excellent record in containing it. The hon. Gentleman said that there was a failure to control the MRSA problem on the part of hospitals and the Department. That is not the case. Infection control is strong in the UK. We are a world leader in the control of MRSA and other infections.
Health authorities require all hospitals to have adequate infection control systems in place, and control teams must cover all facilities. Of course, from time to time, as the hon. Gentleman pointed out in connection with a Ministry of Defence hospital, fairly extreme isolation measures must be taken. They are taken when necessary, and our infection control methods are world leaders.
The hon. Member for Huddersfield spoke about international comparisons. One of the reasons why we are a world leader in the field is that we issue antibiotics only on prescription. Some other countries do not do that. That is one reason why they have epidemics, which we manage to avoid. We keep control at that level as well, not only through what we rightly demand of our hospitals, through the contracts that we impose on them, through health authorities and by other means. The charge of failure to control is ill founded. Hospitals take considerable measures to control the problem and are world leaders in that respect.
The matter has been debated before, as the hon. Member for Thurrock knows. The hon. Member for Leyton (Mr. Cohen) raised it in an Adjournment debate in December 1995, and the hon. Member for Newport, West (Mr. Flynn) raised it as part of another Adjournment debate a year later. The issue has therefore been discussed in Parliament. I insist that there is no indifference, ignorance or conspiracy of silence on the Government's part. I am glad to have the matter discussed in the House.
As the hon. Member for Thurrock said, MRSA is a relatively antibiotic-resistant form of the bacterium staph. aureus, which is one of the commonest and most ubiquitous of all the bacteria with which we are surrounded. As many as one in three of us are carrying it--on our skin or in our nose or throat--and normally it does us no harm. It does, however, have the ability to cause infection, which is most likely to occur if the skin is cut or if resistance to infection is lost or compromised for any other reason.
Mostly, the type of infection will be trivial, but for patients who are in hospital, it can sometimes be serious, as the hon. Gentleman noted. Many hospital patients have catheters and drips of various sorts going into their body, which provide an easy route for bacteria such as staph. aureus. Many patients have had operations, so they have a wound that can become infected. Some have poor resistance to infection because of their illness or their treatment, and are vulnerable to serious infection such as septicaemia or pneumonia. Staph. aureus can cause all those problems--a range of infections from the trivial to the life-threatening.
MRSA acts in exactly the same way as staph. aureus and causes the same range of infections. It is no worse than staph. aureus; it is simply a particular kind of staph. aureus. Eight out of 10 people who carry MRSA come to no harm at all. If it does cause an infection, the range of problems is just the same. The infections are no worse than those caused by the ordinary bacterium.
The reason why MRSA is seen as more of a problem is that, if an infection develops, it is more difficult to treat because many of the commonly used antibiotics are no longer effective against it. However, I repeat that the infection is treatable. As I said to the hon. Member for Thurrock, and as he confirmed in his remarks, at least two antibiotics are effective against MRSA.
Mr. Sheerman:
Will the Minister comment on the point that my hon. Friend eloquently highlighted: do we know how many people are dying from such an infection, and how many hospitals have a good record or a bad record? There must be public recognition of the extent of the problem. The Minister is playing it down. May we have some facts and figures, and some visibility?
Mr. Horam:
I am about to come to that. First, I should like to say, in response to the hon. Member for Thurrock, that all hospitals will have stocks of the antibiotics necessary to treat MRSA. Whether those antibiotics are used is a clinical decision. I hope that that reassures the hon. Gentleman.
On the extent of the problem, to which both hon. Gentlemen referred, I repeat that it is not new. The media have only recently taken an interest in it, but it has existed for a long time. Official figures from the Public Health Laboratory Service show that the peak of the problem occurred in 1986. I have figures from 1983 to 1996. The
problem fluctuates as various strains come and go, as various antibiotics deal with the various strains and as new ones develop. We may be at a higher point than previously, but not as high as a decade ago. The problem is not worse than it has ever been in this country.
To add to the information from the Public Health Laboratory Service, two big surveys were conducted, in 1980 and 1992-93. They show a constant proportion of MRSA in the system. It was no worse in 1992-93 than in 1980.
Let us also get in perspective the number of patients affected. I stated in a reply to one of the hon. Gentleman's questions that there were 2,107 incidents last year in the entire health service. In any one year, 8.4 million people go into the hospital service.
Mr. Mackinlay:
The Minister does not know that, does he? That figure represents only what has been voluntarily reported to him. My complaint is that his Department does not know, because it does not require screening in all hospitals and reporting by all hospitals.
Mr. Horam:
Those figures come from the Public Health Laboratory Service, which, as the hon. Gentleman knows, is a well-established service that serves the needs of hospitals and which they have an obvious self-interest in developing and complying with. There is trust and confidence in the service, which provides us with a reasonable feel for what is happening on the ground floor.
It is not right to say that there is no information. I have given quite a lot of information to the hon. Gentleman. There is a plethora of information, because the PHLS makes weekly and monthly reports on infections such as MRSA. It is unfair of the hon. Gentleman to say that there is any kind of cover-up. A wealth of information is available from a tried and trusted system.
The hon. Gentleman accuses the Department of not doing enough about the problem. We are improving our information. We are piloting a new system of national surveillance, and 40 hospitals in total have taken part. From next month or shortly afterwards, bloodstream infections will be reported. In July, wound infections will be reported. In addition to the extensive information already available, that new information will become available.
There are differing expert opinions on the validity, practicality and worth of large-scale screening. The practical problems are plain. Screening for MRSA requires swabs from different parts of the body on different days. It takes at least a fortnight to go through the testing procedures. If someone is going into hospital for an emergency operation, we cannot tell him to wait for a fortnight while we find out whether he has MRSA. There are practical problems, which the hon. Gentleman should understand.
Where there are vulnerable people in vulnerable wards, screening takes place. That is a good example of a practical approach to deal with the worst of problems. A new national surveillance scheme is to be introduced--
It being Two o'clock, the motion for the Adjournment of the House lapsed, without Question put.
Sitting suspended, pursuant to Standing Order No. 10 (Wednesday sittings), till half-past Two o'clock.
Read the Third time, and passed.--[Queen's Consent, on behalf of the Crown, signified].
Order for Third Reading read.
To be read the Third time on Tuesday 25 March.
Motion made and Question proposed,
That--
19 Mar 1997 : Column 862
(1) the Promoters of every Private Bill which has originated in this House or has been brought from the House of Lords in the present Session of Parliament shall have leave to suspend any further proceeding thereon in order to proceed with that Bill, if they think fit, in the next Session;
(2) the Agent for the Promoters of any such Bill intending to suspend any further proceeding thereon shall give notice to the Clerks in the Private Bill Office not later than five o'clock on Thursday of their intention to suspend further proceeding thereon, or, if the Bill, having passed this House, is then pending in the House of Lords, of their intention to proceed with the same Bill in this House in the next Session: provided that all fees due upon any such Bill up to that day be paid;
(3) a list of all such Bills, with a statement of the stage at which they have been suspended, shall be prepared by the Clerks in the Private Bill Office and printed;
(4) every such Bill which has originated in this House shall be presented to the House not later than the third day on which the House sits after the next meeting of Parliament;
(5) there shall be deposited with every Bill so presented a declaration signed by the Agent for the Bill, stating that the Bill is the same, in every respect, as the Bill with respect to which proceedings have been suspended at the last stage of its proceeding in this House in the present Session;
(6) every Bill so presented shall be laid by one of the Clerks in the Private Bill Office on the Table of the House on the next meeting of the House after the day on which the causes of Her Majesty's calling the Parliament have been declared thereunto;
(7) every Bill so laid on the Table shall be deemed to have been read the first time and (if the Bill has been read a second time before its suspension) to have been read a second time and--
(i) if such Bill has been referred to the Committee on Unopposed Bills in the present Session, it shall stand so referred;
(ii) if such Bill has been referred to a Committee during the present Session and not reported by that Committee to the House, the Bill shall be committed and--
(a) all Petitions against the Bill which stand referred to the Committee on the Bill shall stand referred to the Committee on the Bill in the next Session, subject to the determination of any outstanding objection to the locus standi of any petitioner; and
(b) any minutes of evidence taken before the Committee on the Bill shall stand referred to the Committee on the Bill in the next Session;
(iii) if such Bill has been reported by any Committee, it shall be ordered to be read the third time unless it has been reported with Amendments in the present Session and has not been considered as so amended, in which case it shall be ordered to lie upon the Table;
(iv) if such Bill has been read the third time before its suspension, it shall be deemed to have been read the third time;
(8) paragraph (2) of Standing Order 166 relating to Private Business (First reading) shall not apply to any Bill brought from the House of Lords in the next Session and upon which the proceedings have been suspended in this House in the present Session;
(9) when any Bill which has been brought from the House of Lords in the present Session, and upon which the proceedings have been suspended in this House, is brought from the House of Lords in the next Session, the Agent for the Bill shall deposit in the Private Bill Office a declaration, signed by him, stating that the Bill is the same, in every respect, as the Bill which was brought from the House of Lords in the present Session and, as soon as a certificate by one of the Clerks in the Private Bill Office that such a declaration has been so deposited has been laid upon the Table of the House--
(i) unless the Examiner has reported pursuant to Standing Order 74 relating to Private Business (Examination of bills brought from House of Lords, etc.), the Bill shall stand referred to the Examiners;
(ii) if the Examiner has so reported, the Bill shall be ordered to be read a second time, or, if it has been read a second time, it shall be read a second time and committed; but
(iii) if the Bill has been reported by a Committee with Amendments in the present Session it shall be committed to the Chairman of Ways and Means who shall make only such Amendments to the Bill as have been made thereto by the Committee in the present Session, and shall report the Bill to the House forthwith, and the Bill shall be ordered to lie upon the Table;
(10) where a Bill has been brought from the House of Lords in the present Session and the period prescribed by paragraph (1) of Standing Order 171A relating to Private Business (Petitions against private bills) has not elapsed before Friday, any Petition presented during the present Session in pursuance of that Standing Order shall be void, and the period of time prescribed by that Standing Order shall apply to any Bill brought from the Lords in the next Session in pursuance of this Order;
(11) any Bill which under the provisions of this Order is deemed to have been read the first time, or the first and second time, or the first, second and third time, shall be recorded in the Journal of the House as having been so read;
(12) without prejudice to the provisions of paragraph (7) of this Order, only those Petitions against any Bill which stood referred to the Committee on the Bill and which have not been withdrawn or have been deposited pursuant to paragraph (b) of Standing Order 126 relating to Private Business (Reference to committee of petitions against bill) shall stand referred to the Committee on the same Bill in the next Session;
(13) in relation to any Bill to which this Order applies Standing Order 127 relating to Private Business (Right of audience before committees on opposed bills) shall have effect as if the words "under Standing Order 126 (Reference to committee of petitions against bill)" were omitted;
(14) where any Standing Orders have been dispensed with in respect of any private Bill in the present Session or in the last Session, those Standing Orders shall be deemed to have been ordered to be dispensed with in respect of any such Bill presented or brought from the Lords in pursuance of this Order;
(15) any Standing Orders complied with in respect of any Bill originating in the House of Lords upon which the proceedings have been suspended in that House shall be deemed to have been complied with in respect of such Bill if the same is brought from the House of Lords in the next Session, and any notices published or given and any deposits made in respect of such Bill for the present Session shall be held to have been published, given and made, respectively, for the Bill so brought from the House of Lords in the next Session;
Hon. Members:
Object.
(16) no further fees shall be charged in respect of proceedings on a Bill in respect of which fees have been incurred in the present Session.
That this Order be a Standing Order of the House.--[The Chairman of Ways and Means.]
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