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National Service Men

7.14 pm

Mr. Simon Hughes (Southwark, North and Bermondsey): It gives me great pleasure to present a petition on behalf of the National Service Veterans Alliance in relation to the 2.2 million of our fellow citizens--all men--conscripted for national service between 1945 and 1963--[Interruption.] The hon. Member for Greenock and Inverclyde (Dr. Godman) says that he was among them--so were my two older brothers.

Like many colleagues, I support the objective of the petitioners. The petition states:

There are 10,000 petitioners and it is with great pleasure that I present their petition to Parliament.

To lie upon the Table.

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Hospital Hygiene

Motion made, and Question proposed, That this House do now adjourn.--[Mr. Kevin Hughes.]

7.15 pm

Dr. Jenny Tonge (Richmond Park): I have wanted to highlight the problem of cleanliness in national health service hospitals for some time and, because of what I shall say, it is fortunate that tomorrow is the anniversary of Florence Nightingale's birthday and also international nurses day, as I am sure the Minister is aware.

By tackling dirt and disorder in the hospitals in the Crimea, Florence Nightingale became, and still is, a national heroine; she is a personal heroine of mine, and always has been. It is worth remembering that, in the first winter of the Crimean war, 40 per cent. of wounded men who were brought to the barrack hospital at Scutari died; it was a no-hope place. The death rate among the general population in Great Britain at that time was 35 per 1,000 people--only 3.5 per cent. After six months' work by Florence Nightingale, the death rate among the wounded in the barrack hospital was 3 per cent. That was an astonishing achievement in a short space of time.

If one wants to learn quickly how Florence Nightingale achieved that, I recommend a trip to the Florence Nightingale museum, which is just across the river in the entrance to St. Thomas's hospital. It is a delightful gem of a place that celebrates the life and work of Florence Nightingale, a formidable lady who, without modern medicines--and despite the often fatal interventions of members of my profession--saved thousands of lives.

Florence Nightingale was in the Crimea for only two years, but she returned to England and for nearly 60 years did the same work in hospitals here. She completely transformed nursing and medical care. She introduced simple hygiene measures, scrupulous cleanliness in her hospitals and efficient nurse training. That is all described in her book, "Notes on Nursing", which is still available, and in many other writings; she was a prolific author and always published her findings. Ministers in the Department of Health should read her book if they have not done so already--I hope that they have.

Florence Nightingale's most quoted remark is quite beautiful. She said:

That was a revolutionary remark in her time. Some 140 years after the founding of the school of nursing at St. Thomas's hospital by Florence Nightingale, we can no longer say that hospitals do no harm. In hospital, 9 per cent. of patients acquire infections--that is nearly one in 10. Unfortunately, no data are collected centrally on the number of deaths that result from hospital-acquired infections, but probably about 1 per cent. of all deaths are from that cause.

The incidence of resistant bacteria has increased. Methicillin resistant staphylococcus aureus--MRSA--is now a huge problem and I pay tribute to my hon. Friend the Member for Twickenham (Dr. Cable), who has raised that issue on several occasions and asked many questions about it. It is resistant to most antibiotics and can kill debilitated patients very quickly. Incidents of MRSA infection--which are defined as three or more patients affected at one time--rose from 342 in 1992 to a peak of

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2,364 in 1997. I am glad to say that the number of those incidents is beginning to fall, but we must watch it carefully. The National Audit Office estimates that hospital-acquired infections cost the health service £1 billion a year, which is an awful lot of funding. Only today, I heard that two London teaching hospitals have recently had to close wards because of MRSA infections.

We may not be able to see the bacteria, but spending time in a health service hospital--as I still do--soon reveals why there are so many incidents of infection. I sometimes feel that I am walking into a third-world hospital because the standards of cleanliness are so bad. There are dirty corridors and filthy wards. Swabs and tissues are left lying around patients and uneaten food is left about. One of my constituents complained that the drip stand holding the drip bottle going into her arm was caked in blood all the time that it was in use. Toilets and bathrooms are dirty.

My constituents and others have also seen those things. Indeed, many hon. Members approached me when they found out that this Adjournment debate was to take place to say that their constituents had given them similar examples. An elderly friend of mine who was recently admitted to a well-known hospital for major surgery acquired bedsores and an MRSA infection within a week of her admission.

Florence Nightingale must be turning in her grave. After all that progress, we are slipping back to the dirt and carelessness of previous centuries. Antibiotics and disinfectants are no longer our saviours. What a nonsense it all is. I have worked as a doctor in the health service for many years, and the reasons for the dirtiness are staring me in the face. First, and importantly, cleaners are no longer employed directly by the trusts and are not under the supervision of ward sisters--I am sorry, that is not politically correct, I mean the senior ward nurses--where we are lucky enough to have them.

There is another arrangement instead, of which I have hands-on experience and which used to drive me mad. The trust contracts out the cleaning to the best tenderer, standards slip after the first few weeks as the company cannot live up to expectations, and the ward's senior nurse has to contact the cleaning manager, who contacts the contractor, to renegotiate stiffer terms. There is then a six-month trial period, standards begin to slip again and the whole process starts once more. That is a scandal, as are the wages paid to some of those cleaners.

It does not help that the cleaners are no longer part of the ward team. They are no longer appreciated or properly supervised. We must bring back directly employed cleaning staff under the supervision of ward sisters and senior nurses. The Royal College of Nursing and the British Medical Association are calling for that, and I hope that the Government are listening.

Medical and nursing staff themselves are not all blameless. I hate to criticise the angels of the NHS--not just nurses, but junior hospital doctors as well--but I must do so. One of the recommendations in the NAO report is that staff should wash their hands, which, apparently, they do not do very often. Eight per cent. of trusts in the NHS do not even have a policy on hand washing. Why one should need such a policy escapes me. Just before I came into the Chamber, I had a phone call from a nurse saying that what I had been saying earlier was absolutely right.

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She told me that, again and again, she sees nurses failing to wash their hands before going on to the next patient. That is not a very nice fact.

The NAO's wonderful report recommends hand washing in recommendation 25, but, in case anyone cannot read, it also has a comic strip that shows in pictures how to wash one's hands--quite extraordinary. The report's next recommendation states that routine procedures such as ward cleaning are also important--surprise, surprise; it has taken a long time to come up with those remarkable observations. I find it unbelievable that, in 2000, 150 years after Florence Nightingale, the NAO has to tell people working in the NHS to wash their hands and keep the wards clean.

Nurses and doctors must have more practical training. Theory is all very well, but we appear to have lost touch with practical procedures. We cannot have staff flitting around hospital wards like little mosquitoes, spreading disease between patients. Discipline, hygiene and proper practice must be insisted on. Again, the senior nurse on a ward, who once ruled supreme in such matters, must supervise the nurses on the ward and ensure that those things are done. I have to say that the good old hospital matron used to carry out spot checks relentlessly to ensure that proper practice was observed.

We must do something about the problem. I know that the Government are extremely concerned about the issue, and I have no doubt that the Minister will mention the NAO report and others--but the evidence makes depressing reading. I have been through the whole report: it speaks of infection control teams, infection control nurses and infection control doctors and how many beds they should supervise; it speaks of clerical support to collect statistics and managers to write reports about the teams and the statistics; it speaks of computer hardware and software, and electronic patient record systems; but the only real sense it contains is in the recommendations that should not have had to be there--those on hand washing and cleaning.

Clinical staff would say that more doctors and nurses are needed. It is all very well criticising doctors and nurses for not clearing up after they have carried out a clinical procedure, or for not washing their hands before going on to the next patient, but if their pager is going off and they are rushing off to a patient who will die if they do not get there immediately and there are not enough doctors and nurses to go around, corners sometimes get cut or they forget to do those things. We need better pathology departments, and--hint, hint--better-paid technicians to perform screening tests on patients, and staff to enable infections to be isolated before they spread. I have to pay another tribute to my hon. Friend the Member for Twickenham, who introduced a debate in the House on pay and attracting more technicians and scientists into hospital laboratories.

In a fax sent to me today, the BMA neatly summed up the case, saying

which include--

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Medicine has progressed in an amazing way in the past 100 years: we do things in health service hospitals now that were undreamt of 30 years ago, when I was a student; I cannot believe the progress that has been made. However, with all the advances, we appear to have thrown out common sense and good clinical practice. Please, let us bring Florence Nightingale back before it is too late.

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