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19 Sept 2002 : Column 405W—continued

NHS Hospital Trust Mergers

David Wright: To ask the Secretary of State for Health what criteria he applies when deciding whether NHS hospital trust mergers may proceed. [67187]

Mr. Hutton: Proposals to merge National Health Service trusts are given careful consideration at all stages to ensure the best interests of patients. Among the criteria considered by my right Hon. Friend, the Secretary of State before agreeing that trust mergers may proceed are:

Assurance that patients' interests are fully safeguarded;
Assurance that clinical quality will be maintained, or improved, uniformly across the whole area;
Evidence derived from the health impact assessment;
Outcome of local public consultation;
Evidence of support for the merger from within the NHS;
Any specific service issues;
Implications for staff;
Financial considerations.

Patient Environment Inspection Programme

Mr. Burstow: To ask the Secretary of State for Health if he will make a statement on the process used to grade hospitals on the 19 elements of the patient environment inspection programme, with specific reference to how each element is weighted in the final assessment. [71861]

Mr. Hutton: Since publication of the NHS Plan, patient environment action teams (PEATs) teams have undertaken four rounds of assessment visits to acute NHS trusts each evaluating performance and progress against 19 separate elements. Scores are combined to produce a

19 Sept 2002 : Column 406W

rating. Each element of the patient environment was scored on a scale of one to four, where one is poor and four is excellent.

On the question of weighting; whilst every aspect of the assessment is important, we recognise that patients will see some areas as of greater importance than others. For this reason, in determining the final rating a hospital receives, particular attention is paid to the hospital's performance in areas of ward cleanliness, tidiness and decoration and the condition of ward furniture so that defects in these areas are not masked by good performance in other areas of assessment.

The clean hospitals programme has had a clear impact on standards of cleanliness, decoration and supporting services. Hospitals up and down the country have responded magnificently to this, the biggest clean-up campaign in the history of the National Health Service, to the extent that by October last year there were no hospitals in England where cleaning standards were found to be less than acceptable. The latest round of PEAT visits have recently been completed and the results will be available shortly.

MRSA

Mr. Burstow: To ask the Secretary of State for Health, pursuant to his answer of 10 May 2002, Official Report, column 403W, on hospital acquired infection, what plans he has to make representations to the International Classification of Diseases to include MRSA as a distinct code for encoding death registration data. [71349]

Mr. Lammy [holding answer 22 July 2002]: A world health organisation technical group is developing a proposal to use additional codes to identify antimicrobial resistance in infectious diseases. Subject to official ratification, this is likely to lead to an updating of the international classification of diseases.

Hand Hygiene

Mr. Burstow: To ask the Secretary of State for Health what assessment he has made of compliance with hand hygiene protocols in NHS hospitals; and if he will make a statement. [71860]

Mr. Hutton: Guidelines on hand hygiene were issued to the National Health Service in January 2000 and trusts are expected to have a policy in place for compliance with hand hygiene which should be audited by the local infection control team. Details of the arrangements in place at each trust are also available to the Commission for Health Improvement as part of its clinical governance review process and to the Audit Commission in their reviews of provider care.

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Laundry Facilities

Mr. Burstow: To ask the Secretary of State for Health what plans he has to increase the number of laundry and changing facilities in NHS hospitals; and if he will make a statement. [71862]

Mr. Lammy: Laundry and changing facilities/services are arranged by individual hospitals/trusts in relation to their local needs, as are the requirements for storage of linen and laundry

Infection Control

Sandra Gidley: To ask the Secretary of State for Health what plans he has to (a) increase the availability of (i) isolation or (ii) single rooms in NHS hospitals and (b) increase the use of barrier nursing with respect to infection control issues. [71865]

Ms Blears: National Health Service hospital trusts are expected to have a policy in place for the isolation of patients with infectious diseases and are responsible for determining the level of provision of isolation and single rooms. The use of isolation facilities and barrier nursing, like other treatment decisions, will depend on the clinical judgement of the local infection control team and the clinicians involved in treating the affected patients.

Sandra Gidley: To ask the Secretary of State for Health what changes he plans to NHS infection control policy following the identification of rancomycin resistant staphylococcus aureus in the United States. [72000]

Ms Blears: Vancomycin resistant staphylococcus aureus (VRSA) can be contained by good infection control procedures. The national controls assurance

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standard already requires trusts to have effective infection control policies therefore no specific policy change is required.

Minimising the development and spread of new strains such as VRSA requires prudent prescribing as well as strict adherence to infection control measures. These are two of the reasons why we are developing targeted action plans for healthcare associated infections and antimicrobial resistance under "Getting Ahead of the Curve", our strategy for combating infectious diseases.

Sandra Gidley: To ask the Secretary of State for Health how many cases of methicillin resistent staphylococcus aureus were identified in (a) England and (b) each NHS region in each of the last six years, including the most recent year for which figures are available. [71842]

Ms Blears: The mandatory reporting of methicillin resistant staphylococcus aureus (MRSA) bacteraemias by National Health Service acute trusts began in April 2001 and these data are published in the communicable disease report weekly. The first year's data are now available and these form a benchmark for future analysis.

However, data for the last six years on MRSA bacteraemias voluntarily reported to the public health laboratory service by microbiology laboratories are available and these are shown in the table.

Laboratory reports of staphylococcus aureus isolated from blood and their susceptibility to methicillin, annual totals 1996–2001.

Laboratory reports of Staphylococcus aureus isolated from blood and their susceptibility to methicillin: England, annual totals 1996–2001

		2001			2000			1999
	S. aureus	Methicillin resistant	per cent.	S. aureus	Methicillin resistant	per cent.	S. aureus	Methicillin resistant	per cent.
London	1220	488	40	1078	532	49	1004	450	45
North West	1324	416	31	986	347	35	1077	350	32
South East	1746	728	42	1402	596	43	1250	415	33
West Midlands	1935	811	42	1725	771	45	1153	498	43
Northern and Yorkshire	1648	466	28	916	414	45	708	265	37
Eastern	1462	603	41	1145	487	43	1113	442	40
Trent	1240	441	36	1209	411	34	978	284	29
South West	1277	476	37	909	372	41	897	300	33
England	11852	4429	37	9370	3930	42	8180	3004	37

		1998			1997			1996
	S. aureus	Methicillin resistant	per cent.	S. aureus	Methicillin resistant	per cent.	S. aureus	Methicillin resistant	per cent.
London	1032	420	41	1159	447	39	970	327	34
North West	1070	289	27	1037		0	878	105	12
South East	1307	392	30	1220	335	27	1077	234	22
West Midlands	940	396	42	893	336	38	785	267	34
Northern and Yorkshire	890	280	31	700	143	20	498	36	7
Eastern	994	364	37	766	271	35	674	159	24
Trent	615	189	31	601	154	26	429	58	14
South West	698	191	27	700	191	27	508	87	17
England	7546	2521	33	7076	1877	27	5819	1273	22

19 Sept 2002 : Column 409W

Adverse Patient Incidents

Bob Spink: To ask the Secretary of State for Health (1) if he will make a statement on the Serious Hazards of Transfusion report (2000-01); and what strategy he has to reduce the number of mistakes made in patient identity.[73030]

(2) what action he has taken following the SHOT report to adopt new systems and technology to prevent patient identity errors. [73114]

(3) what (a) strategies, (b) systems and (c) technologies he plans to introduce to reduce the number of adverse patient incidents in the NHS; and if he will make a statement; [73045]

(4) if he will make a statement on the Spoonful of Sugar medicine management in NHS hospitals, Audit Commission report of December 2001, and what strategy he has to reduce the human and financial costs of mistakes in the NHS. [73029]

(5) if he will make a statement on the National Patient Safety Agency 17 June report; and what strategy he has for reducing the percentage of NHS hospital admissions that experience adverse incidents caused by human error; [73044]

(6) what estimate he has made of the overall cost to the NHS of adverse patient incidents in each of the last five years for which figures are available; [73115]

(7) what estimate he has made of the number of NHS beds lost due to adverse patient incidents in each of the last five years. [73116]

Mr. Lammy: The Department does not collect information on the number of extended hospital stays as a result of adverse events nor figures on their financial cost. However, as reported in An Organisation with a Memory—a report of an expert group on learning from adverse events chaired by the Chief Medical Officer, it is estimated that there may be around 850,000 adverse events each year in the National Health Service which research suggests may lead to three million preventable additional hospital bed days. It is estimated that extended hospital stays as a result of adverse events costs the NHS approximately £2 billion a year.

The Government established the National Patient Safety Agency in July 2001 to improve the safety of NHS patient care by promoting a culture of reporting and learning from adverse events, and to manage the national reporting system to support this function.

By collecting and analysing data on adverse events the agency will be able to identify trends and patterns of avoidable adverse events, provide feedback to organisations to enable them to change their working practices, help develop models of good practice and systems solutions at national level and support ongoing education and learning.

From September 2001 the National Patient Safety Agency ran a pilot in a small sample of trusts designed to test the system for collecting data on adverse incidents and near misses from the NHS.

On 18 June 2002, the National Patient Safety Agency held a conference and presented initial findings of the pilot. The results of the data collection are preliminary

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and few conclusions can be drawn from this data at this stage. The agency will publish audited figures when they are available. The agency will be working to implement a national reporting system across the NHS from 2003.

This will provide us with a firm evidence base on the scale of the problem and its financial consequences—a baseline allowing us to understand the real extent and nature of adverse events, and act on that knowledge.

The Department has set a specific target which requires the NHS by 2005 to reduce by 40 per cent. the number of serious errors in the use of prescribed drugs. The Department will shortly be publishing a report highlighting processes and individual medicines that are commonly involved in medication errors. The report will also identify a range of measures that professionals and NHS organisations can use to systematically drive down the risk of medication errors across the NHS.

The Department has broadly welcomed the Audit Commission's report on medicines management in NHS hospitals, A Spoonful of Sugar. Chief pharmacists and their staff play a key part in medicines management and it is helpful to see this role highlighted. The report reinforces the Department's medicines management performance management framework.

Ms Blears: The fifth report (2000–01) on the serious hazards of transfusion (SHOT) was published on 10 April 2002 and again indicated that blood transfusion in the United Kingdom is very safe, and amongst the safest in the world. Although the number of serious events reported, 315, had increased by 7.5 per cent. this must be seen against a total of over three million blood components transfused annually and increased participation in the scheme. Since the previous report, for 1999–2000, participation in SHOT by National Health Service (NHS) trusts has increased from 72 per cent. to 92 per cent. of all hospitals. We will be looking to SHOT and the new national patient safety agency to help us take a more comprehensive approach to improving patient safety in the NHS.

We are committed to modernising the NHS and working on systems that are shown to reduce error in clinical practice, are safe, and capable of being used effectively and universally. To this aim, there are pilot projects looking to improve the identification of patients and issue of the correct blood. The results will help to inform future research and developments in this area to improve patient care.

In July 2002 new guidance was issued to the NHS on "Better Blood Transfusion—Appropriate Use of Blood" www.doh.gov.uk/publications/coinh.html. This sets out a programme of action for the NHS to; ensure that Better Blood Transfusion is an integral part of NHS care. The guidance includes an objective to improve the safety of the blood transfusion process and calls on the NHS by December 2002, to ensure that policies on patient identification are in place, implemented and monitored throughout the blood transfusion process from prescription, sampling, laboratory testing and issue of blood to collection and administration of blood transfusion.

Bob Spink: To ask the Secretary of State for Health what (a) technologies and (b) systems he plans to introduce in the NHS to reduce the risk of the wrong drugs or inappropriate quantities of drugs being given to patients; and if he will make a statement. [73118]

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Mr. Lammy: It is recognised that the manual writing of prescriptions and the manual dispensing of drugs is associated with a significant error rate. Measures to combat this include the following.

In primary care technologies are already in place within general practitioner's (GP's) clinical practice system to help identify the risks involved in prescribing of drugs to patients. PRODIGY is a computer-based decision and learning support system contained within the GP practice system, which offers a series of recommendations in prescribing and organisation of treatment for conditions.

In secondary care information for health the strategy for information services in the National Health Service recommended the introduction of electronic records into all acute trusts. Electronic prescribing systems were specifically mentioned as part of those electronic records. It is intended by 2008 that all acute trusts will have electronic prescribing systems, most acute trusts by 2005. The use of these systems will lead to a reduction in errors that can occur.

In the pharmacy, "Pharmacy in the Future—Implementing the NHS Plan", emphasised the need to re-engineer hospital pharmacy services to be more efficient, timely and safe and more patient focussed. Use of modern automation technology was seen as one way of facilitating this. This was reinforced in the Audit Commission report "A Spoonful of Sugar". Consideration is currently being given to the commissioning of a national specification for automated dispensary systems for the NHS and earmarking of funding for their introduction.

Bob Spink: To ask the Secretary of State for Health what estimate he has made of the level of compensation to be budgeted for by the NHS in respect of adverse patient incidents in the (a) current and (b) next financial years. [73117]

Mr. Lammy: Compensation is only paid where there is a liability to do so, and payments are usually made following settlement of clinical negligence claims. According to the National Audit Office Summarised Accounts for the National Health Service (2001) a provision of £4.4 billion was calculated for liabilities relating to all current clinical negligence claims and ones which may arise from incidents which have incurred but not yet been reported. These liabilities will include compensation as well as legal and other costs which are not identified separately in the accounts.

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