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The Parliamentary Under-Secretary of State for Health (Ms Gisela Stuart): I congratulate the hon. Member for Richmond Park (Dr. Tonge) on securing a debate on this important issue. It provides me with an opportunity to demonstrate the Government's commitment to improving the cleanliness of hospitals.
Hospital cleanliness matters to patients, to visitors and to staff. It is as important today as it was in the time of Florence Nightingale, the 180th anniversary of whose birth falls tomorrow, as the hon. Lady said. I cannot promise that we will resurrect Florence Nightingale, but we can do a lot to re-establish some of the principles that she espoused. We will be celebrating the anniversary as part of international nurses day tomorrow, so this is an opportune moment for me to pay tribute to the contribution that nurses have made throughout the years to the comfort and care of patients.
Cleanliness matters for patient comfort and service quality. When we are ill, we have a right to expect high-quality medical care. It is vital that that care is provided in the best possible surroundings. No one should receive treatment or have to recuperate in a dirty or uncared-for environment. Our hospital staff, too, want and deserve an efficient, well-run, clean working environment, because without it they cannot deliver proper care, and in most cases that need for cleanliness is met.
We need to put the matter in perspective. Last year, the second national survey of national health service patients in England asked 112,000 patients suffering from coronary heart disease about their experiences in hospital. We specifically asked about cleanliness in toilets and bathrooms, and 93 per cent. rated them as fairly clean or very clean. We know that we must raise the standards of those few that do not match the majority.
Only this week, my right hon. Friend the Secretary of State for Health stated his commitment not only to consult but to listen and act on the public's views. Through the national plan, patients and the public will be able to have their say on creating a 21st-century NHS. We would be pleased to hear people's views on this important issue.
There are three strands to making our hospitals cleaner. First, people must know what standards they are expected to achieve; secondly, they must have the tools to achieve them; and thirdly, there must be evaluation and monitoring of whether they are being achieved. When this Government came to power, there was a notable absence of all three strands. However, we saw the importance of the issue and we are taking action.
We have made it absolutely clear that clinical governance is as important as corporate governance, and I can demonstrate that we mean business. The Commission for Health Improvement will provide robust, independent scrutiny of NHS arrangements, through a rolling programme of clinical governance reviews.
The commission's expertise and focus will be clinical but its remit will also include important non-clinical, organisational factors. It will work closely with other external review and inspection bodies such as the Health and Safety Executive and the Audit Commission to ensure the comprehensive clinical and non-clinical monitoring of NHS hospitals. Additionally, NHS Estates can offer expert guidance and advice to the commission where the quality of facilities management is in question. Its regional office teams will review performance of non- clinical support.
A vital component of our commitment is our initiative on controls assurance, which will set the framework for standards. The programme sets out national standards in key quality areas. It is part of our overall aim of reducing unacceptable variations across the country and driving up standards. One standard covers infection control and is directly relevant to this debate. Furthermore, we are already developing explicit standards on hospital cleanliness.
The existing controls assurance standards already require a whole hospital approach to infection control. They clearly state that infection control committees should have facilities managers as full members. One specific criterion requires prevention and control of infection to be considered as part of all service development. Trusts are further directed to have robust agreements for service provision, whether in-house or through contract, with regular monitoring of standards. The standards and guidance were issued last year and are expected to deliver improvements in performance.
Improving the environment is not just about cleanliness. In his speech to the Royal College of Nursing, my right hon. Friend the Secretary of State announced that ward sisters will control a budget of at least £5,000 to improve their ward environments. That will give them direct power to make the changes necessary to modernise hospital wards, which could include painting walls or replacing worn carpets. Responsibility will hence move away from managers to those who work on the wards.
Better-maintained and better-cleaned wards will ensure that patients feel better, and research shows that where patients rate their environment more highly, they get better more quickly; staff morale also benefits.
We have also helped staff to improve their own services. We have endorsed the excellent work carried out by the Infection Control Nurses Association and the Association of Domestic Managers in producing "Standards for Environmental Cleanliness in Hospitals". The hon. Lady's debate is timely. I have a copy of those standards, hot off the press, which will be distributed by NHS Estates and posted tomorrow to every chief executive in the NHS. After the debate, I shall be happy to give the hon. Lady the first copy to go into public circulation.
The standards are explicit statements of best practice. They have been produced by people working in the NHS. As the hon. Lady commented, people who work in the system know best where it is going wrong and how we can improve it. They understand the problems and know the realities involved in keeping hospitals clean. From tomorrow, all NHS hospitals will be able to use the standards.
Some people argue, and the hon. Lady suggested, that one of the reasons for poor standards of hospital cleanliness is the system of compulsory market testing. In some cases it may be true that standards have fallen because of that, but NHS trusts are required to achieve a high-quality service for their patients. When market- testing a service, the trust should award the contract to the bidder who best meets the quality standards required and offers value for money. On-going evaluation of cleaning standards will be set against the national standards.
Dr. Tonge: I thank the Minister for giving way. May I press her a little further on that point? She must realise that with the tightness of their budgets, trusts invariably go for the cheapest tender, rather than the one that offers the best-quality service.
Ms Stuart: I hope that the hon. Lady will be reassured that the NHS Executive is currently reviewing the policy on market testing. Also, we have put more money into the NHS trusts. We must be clear that we expect value for money, which entails meeting the cleaning standards.
We want to encourage the domestic staff. The hon. Lady mentioned that for some time, cleaning staff have not felt that they were part of the team. They must be seen as part of the ward team delivering services to the patient, and must not feel that their contribution is not appreciated. They should realise that it is an extremely important contribution. It is easy to forget that domestic services staff are the second largest staff group in the NHS, and their contribution is invaluable.
The proposed guidelines will highlight the importance of securing best value for patients. They will stress how important it is to decide what is required in terms of quality and patient satisfaction, as well as cost. In a sense, who provides the service matters less than the quality standards being delivered. If the required quality standards are not reached, the work should be given to someone who can deliver it effectively. Chief executives and trust boards are held accountable for the performance of their support services.
NHS Estates has endorsed a series of good practice guides designed by the Health Facilities Consortium. The guide on cleaning and domestic services has a scoring system for quality, and clear performance measures. It allows trusts to compare performances and to evaluate their own performance.
I share the hon. Lady's incredulity at the National Audit Office report and the comic-strip guidelines about how to wash one's hands, but they are clearly needed if there is a failing. However basic it may seem and however much we may lay ourselves open to ridicule, if that is the way forward, we will take it. Hospital-acquired infection is an important topic, and the report is much appreciated. It is clear that we now treat patients who probably would not have been treated only a decade ago. They are often very sick and vulnerable to infection, and the medical procedures that they undergo may be invasive. The nature of the care they receive may present a greater opportunity than in the past for infections to gain a foothold.
We are taking infection control seriously. Within the controls assurance programme, we have developed 15 infection control criteria. They include the requirement to ensure that infection control teams are in place. The teams are usually led by a medical microbiologist,
Along with those clear guidelines for what trusts should do and how they can achieve it, we have promoted training opportunities for those who make it happen. We know that people who are confident in their expertise will have greater job satisfaction, and will deliver higher standards. That is why I am so keen to support training initiatives for housekeepers and domestic staff. Both the facilities good practice guides and the standards for environmental cleanliness emphasise the role of training, and we expect all trust chief executives to act on them.
That brings me to our final strand of work, which involves improving monitoring, evaluation and implementation. We are tackling that at all levels--from that of the individual housekeeper on the ward to that of data-gathering for the whole NHS. At grass-roots level, we want people to take pride in their work. We know that when people feel ownership of their environment, they take better care of it. We know that training people to explicit standards enables them to judge their own performance. One of the criteria in the Health Facilities Consortium good practice guides relates to the number of domestic staff with national vocational qualifications. By encouraging training, we are encouraging all housekeepers and cleaners to evaluate their own service.
Our latest figures tell me that each acute trust now has an infection control team, but in the past there have been problems. There have not always been clear lines of accountability, and a significant number of trusts have reported that they do not have adequate support. We have therefore taken steps to help infection control teams to carry out their work, and also to monitor progress. The NHS action plan enshrined in health service circular 2000/02 identifies the need to ensure robust arrangements, with specific targets to cover issues related to infection
Local evaluation is essential, but we must also monitor progress at the centre. All trust chief executives were required to complete baseline assessments in March this year against the controls assurance standards. They must report them to regional offices by July, outlining the actions that they intend to take. We have also introduced monitoring arrangements led by regional directors of public health and performance management. They will be charged with maintaining the reporting system, supporting trusts and--importantly--establishing early warning systems. We have asked the NHS Executive board to monitor progress. We need to measure costs, but also to ensure that management systems are in place.
There is, however, another issue that is worth considering. Even if cleaning had no infection control aspects and did not cost money, it would still matter to this Government, for the simple reason that it matters to patients. It is just not good enough for patients to have to receive care in dirty wards. It is not good enough for visitors to have to negotiate piles of cigarette ends outside hospital entrances, and it is not good enough for staff to carry out their work in substandard conditions.
Those considerations are not just the icing on the cake; we are determined to put them high on the agenda of every trust. I know that the hon. Lady's constituents will be pleased to learn that their local hospitals are receiving practical help from us, in the form of clear standards. That clarity, along with clear lines of accountability, will ensure that dirty hospitals are stamped out.
I thank the hon. Lady for raising the issue, and for giving me an opportunity to assure the House--and her constituents--that across the board we are committed to improving cleanliness, and that we have the means to ensure that that aim is achieved.