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Mr. Leigh: I shall give way to my hon. Friend the Member for South Norfolk (Mr. Bacon).
Mr. Bacon: I was interested in what my hon. Friend said about academic freedom. Does he agree that, far from compromising the BBC's editorial independence, scrutiny of its finances by the CAG could enhance its independence? Since the CAG has had oversight of the finances of universities, there has been a growth in academic freedom. There are now joint honours degrees in basket weaving and sociology and a professor of in-flight catering. By analogy, surely the BBC should welcome the chance of greater independence that scrutiny brings.
Mr. Deputy Speaker: Order. That was an overlong intervention.
Mr. Leigh: My hon. Friend has made an interesting and worthwhile point, and I look forward to hearing him develop his arguments.
Similar arguments apply to whether the CAG should have access to the Financial Services Authority, which was established as a company limited by guarantee with many of the attributes of a public body. Its purpose is to protect the public's interests. It is funded by a compulsory levy on the 34,000 firms in the financial services sector.
I was shocked to discover that the CAG, Parliament's watchdog, has no access to the FSA. As the Equitable Life saga showed, the citizen has a direct interest in the authority's work. It is crucial that there is some accountability to Parliament for the way in which it discharges its functions. Parliament has no power to obtain independent evidence on its activities. That is a matter of some urgency, and I look forward to hearing what the Chief Secretary has to say about it. Greater transparency would bring benefits, so that another Equitable Life fiasco could be avoided.
Mr. George Osborne (Tatton): Is it not striking that, of all the issues on which I have received correspondence from my constituents, the Equitable Life case is the one on which I have received the most, yet as a Member of Parliament I am not able directly to examine the FSA's work? That concerns many of my constituents. I fully support what my hon. Friend has suggested.
Mr. Leigh: I am grateful to my hon. Friend for his support. We look forward to hearing what the Government intend to do about these sensitive issues that are of huge importance to many people.
We have a clear agenda for the future. We shall focus on issues that directly affect the public, and shall ask the questions that they want to ask on topical issues. We are shortly to consider access to and quality of higher education. We have work in hand on the millennium dome and the inappropriate adjustments to NHS waiting lists.
We will be asking how the foot-and-mouth crisis was handled, about the financial implications for the taxpayer of the events at Railtrack, about the lessons that can be learned for the future management of and investment in
the railways, whether the way forward for London Underground—when it is eventually decided—provides the best value for money, and what lay behind the suspension of individual learning accounts. We will aim to get to the bottom of those matters, and offer recommendations for improvement.I am glad to stand here today as Chairman of such a distinguished Committee. Our Committee has a long history, but the careful stewardship of my predecessors has ensured that it has remained relevant. We have a serious role to play in improving the administration of government, and I am delighted that my colleagues on the Committee are so adept at what they do. By holding to account those responsible for delivering public services, the Committee aims to ensure that there is a vital check from which the general public can take much confidence. It is a great privilege to chair the Committee.
Mr. Deputy Speaker: Order. The Chairman of the Committee has been given a certain licence in introducing his first report, but I will not necessarily apply it as widely to other Members.
2.29 pm
Mr. Gerry Steinberg (City of Durham): I do not present as sleek a figure as I had hoped following the obesity report. Obviously the recommendations are not working.
I greatly enjoy serving on the Committee. The work is the most interesting that I have experienced in nearly 15 years as an MP. The Committee does a genuinely worthwhile job. I must admit that I have served on other Select Committees that I felt were a waste of time, because Governments—Labour as well as Conservative—never seemed to listen. This Committee's work seems very relevant, and we receive positive responses, which makes our work worth doing. I become cynical as I grow older, but serving on the PAC strikes me as an excellent way of spending my time.
I thank all the Committee's staff for doing a tremendous job, and for being so helpful and obliging. Sometimes people who are getting old, as I am, forget what they have done. They forget that they already have their papers, and ask for them again. We never have any problem on such occasions, because our staff are so helpful. I also thank the National Audit Office for its help and expert advice. Its outstanding professionalism goes without saying, and it makes life a lot easier.
Yesterday we received a delegation from the South African Public Accounts Committee, which asked, among other things, whether we were given any secretarial support. I said that we were not, but I should have said that we can call on 750 auditors at any time. We could be described as the most-briefed Committee in the House, with the best possible support.
Let me join the Committee's Chairman, the hon. Member for Gainsborough (Mr. Leigh), in extending my thanks and good wishes to Ken Brown, the Clerk, who retired earlier this year. His influence and personality will remain with the Committee for many years. He is greatly missed, and I wish him a long and happy retirement. He was a genuinely nice man, and there are not many people of whom that can be said. I thought a great deal of him.
I wish good luck to our previous Chairman, the right hon. Member for Haltemprice and Howden (David Davis), who has taken what must now be an almost impossible job. Did I say that I wished him luck? I am not sure that I wish him too much luck—a little bit of luck, perhaps.
I also congratulate our new Chairman on his recent appointment following the general election. We are monitoring him carefully to see that he does his job well. So far we have given him 9½ out of 10, so he is okay.
Unlike the Chairman, I do not want to trawl through all that we have done. I want to concentrate on three reports on the national health service and some of the issues in them that we have identified as giving cause for concern. Many of those issues were discussed at a valedictory hearing with Sir Alan Langlands, the departing chief executive of the NHS.
It is clear to me that the NHS executive has experienced great difficulties in overseeing and monitoring the activities of many NHS bodies. Consequently, management failings have caused serious problems in the service, resulting in the wasting of billions of pounds over the last 10 years or more. In, I think, 1996, the previous Government introduced regional executives, but I do not believe that they ever succeeded in doing the job that they were meant to do. In my view, their purpose was to link the centre with those working at local level; but they were unaccountable, and often failed to pass on authoritative guidance from the NHS executive to trusts. In many instances, the priorities of both this Government and the last were not apparent locally.
One example of the executive's lack of success in preventing management failings is the control of hospital-acquired infection in acute NHS trusts. Our Chairman mentioned that. A hospital-acquired infection may result in prolonged or permanent disability, and a small proportion of patients die. Such infections add to patients' discomfort and to the length of their stay in hospital, which itself causes problems.
Hospital-acquired infection was the subject of a PAC report entitled "Inpatient Admission, Bed Management and Patient Discharge in NHS Acute Hospitals", about which I shall say more shortly. It was a damning report, which severely criticised the management at all levels. As the Chairman said, the cost to the taxpayer is some £1 billion a year—an incredible amount. In view of that, and in view of the suffering experienced by about 100,000 patients each year, one would have thought that trust managers would make the problem a priority. According to a National Audit Office report, however,
- "in a number of NHS Trusts Chief Executives may have a low level of awareness of infection control issues and . . . may be unaware of the extent and cost of hospital acquired infection and how it is being addressed in their NHS Trust".
In many NHS trusts, hospital-acquired infection has generally had a low profile. Although the Department of Health has launched initiatives, particularly in the past two years, we found that a quarter of trusts' service agreements with health authorities did not cover infection
control services, and that when they were covered they were often inadequate. We found that, contrary to guidelines issued by the Department in 1995, direct involvement of chief executives in strategic management and supervision was very low. We also found that 21 per cent. of trusts had no infection-control programme, and that only 11 per cent. of the programmes that did exist had been approved by chief executives.That is a perfect illustration of the NHS executive's failure to convey the seriousness of some NHS problems. We noted that there was scope for savings of some £150 million a year if infection rates could be reduced by a mere 15 per cent., but that the issue was not taken seriously by senior managers of trusts. Not only is this costing the taxpayer huge amounts; tragically, people are losing their lives.
Last Thursday, going home in the train, I was making some notes in preparation for my speech. Incredibly, when I opened the Evening Standard I was confronted by an article on this very subject. It was headed:
- "Doctor's campaign against 'filthy' wards"
- "GP takes action after hospital superbug kills his wife".
- "A retired GP has launched a campaign to improve hygiene in hospitals after his wife died from a superbug she picked up on a 'filthy' ward while recovering from a routine operation."
- "His wife Patricia, 73, died in St Helier Hospital in Carshalton last month from the superbug methicillin-resistant streptococcus aureus, or MRSA, an infection which kills 5,000 hospital patients a year and is a factor in the deaths of 15,000 more.
Dr Arthur says the real figure may be much higher.
The scale of the problem is highlighted in the fact that, at the time of Mrs Arthur's death, St Helier had a dedicated MRSA ward, designed to keep affected patients in isolation—but it was full.
She had gone to St Helier for surgery to remove a benign obstruction in her bowel. Her husband said: 'The operation was a success and she was discharged after eight or nine days.
I noticed she had a bit of a cough but she seemed fine. However, when we got home she seemed to become ill and within 10 hours I could see she was going downhill fast. We went back to the hospital and they did some tests. The doctor came back and told us that it was MRSA.'
Mrs Arthur died from the infection four days later.
Dr Arthur, from New Malden, has little doubt how his wife became infected. He said: 'The ward she was on was absolutely filthy. There were sweet papers, fluff, old bits of Elastoplast and the tops of disposable syringes behind the bed when we came in, and still there when we came out.
I ran my finger along the windowsill by my wife's bed. There was a thick layer of dust and a vase with dead flowers. There were cleaners around but they seemed to be cleaning the middle of the floor and not bother anywhere else.
I was told there was a ward for MRSA patients but that was full, so people with the infection were remaining in normal wards and infecting other patients.'
St Helier Hospital was the subject of a damning report last August by the Commission for Health Improvement, which said levels of cleanliness were 'seriously compromised', with wards smelling of urine and mortality rates significantly higher than the national average.
A Department of Health spokesman said: 'The Government takes the issue of hospital-acquired infections very seriously and believes infection control and basic hygiene should be at the heart of good management and clinical practice in the NHS. A compulsory national surveillance service is being developed and a first phase, focusing on MRSA, was launched in April 2001.'"
Everything that Dr. Arthur says was borne out in our report. Over the past eight years, isolation facilities have been significantly reduced, which must have contributed to the problem quite significantly. The majority of hospital-acquired infections are caused by bacteria. Some infections spread from person to person. Antibiotics have been used successfully for more than 50 years to control and to overcome bacterial infections. That has led to the emergence of highly resistant strains of bacteria. They are commonest in hospitals where high antibiotic usage allows organisms to evolve. The close concentration of people with increased susceptibility to infections allows the organism to spread.
MRSA poses one of the biggest threats to infection control in hospitals. In some, it is endemic. Cleanliness is paramount but I was staggered to read in the report—I could not believe it—that effective hand washing or hygiene was very poor in hospitals. It says:
- "A number of studies have generated data that confirm that Doctors who decontaminate their hands between seeing patients reduce hospital infection rates. Yet many observational studies, mainly conducted in intensive care units, show low rates of hand washing especially among Doctors. Insufficient washbasins, supplies of liquid soap and paper towels, are some of the reasons that have been given for this."
As I have said, the PAC has commented on the need for better co-ordination within and between NHS organisations. In our report on in-patient admissions and bed management, we were concerned at the delay in many hospitals in discharging patients owing to poor co-ordination within hospitals and with outside agencies, which meant that some hospital beds were occupied virtually unnecessarily.
The NAO report highlighted 20 areas where performance at many trusts could be improved to match the lead of others. That would result in fewer cancelled operations and shorter waiting times for emergency patients, and reduce delays in discharging patients from hospital, which in turn would yield significant savings and free up resources for improving other aspects of patient care.
Often patients are brought into hospital far too early. Incredibly the report showed that if there were a 10 per cent. increase in same-day admissions, it would release about 180,000 bed days for alternative use. Few hospitals had effective systems for monitoring and co-ordinating key resources such as beds and theatre time.
In particular, the Committee was concerned that in more than 90 per cent. of trusts bed managers obtained their information on bed availability only through physical inspection and telephoning wards throughout the day. That seems archaic in a modern NHS. On any given day, around 6,000 over-75s who are ready to be discharged from hospital are blocking beds and costing the NHS £1 million.
In fairness, the Government have recognised the scale of the problem and are taking action. For example, only last week, my local social services department was informed that it had been allocated £1.886 million to ease bed blocking in the next financial year. There is a severe problem. The Government are doing something about it but we must ensure that even more is done.
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