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Mr. Andrew Lansley (South Cambridgeshire) (Con): It might be convenient to the Minister to know that we are not going to oppose the motion. The sooner we begin our genuine debate, the better.
Miss Johnson: I am grateful to the hon. Gentleman. I can therefore expedite matters. I believe that new clause 1 is next on the agenda.
Question put and agreed to.
19 Jul 2004 : Column 41
Orders of the Day
Health Protection Agency Bill [Lords]
As amended in the Standing Committee, considered.
New Clause 1
'(1) For the purpose of the exercise of its functions under section 2(1)(a) and (b) the Agency may prepare and publish statements of standards.
(2) The Agency must keep such standards under review and may publish amended standards whenever it considers it appropriate.
(3) The Agency must consult the appropriate authority and such other persons as the Agency considers appropriate—
(a) before publishing a statement under this section;
(b) before publishing an amended statement under this section which in the opinion of the Agency effects a substantial change in the standards.
(4) The standards set out in statements under this section are to be taken into account by every English NHS body, Welsh NHS body and cross-border SHA in discharging its duty under section 45 (quality in health care) of the Health and Social Care (Comunity Health and Standards) Act 2003 (c.43).
(5) This section does not extend to Scotland and Northern Ireland.'.—[Mr. Lansley.]
Brought up, and read the First time.
4.41 pm
Mr. Andrew Lansley (South Cambridgeshire) (Con): I beg to move, That the clause be read a Second time.
The Bill has not been the subject of detail or aggressive controversy. We are all working towards one objective, which is to reach a point at which patients in the NHS, and the public generally, are protected to the maximum possible extent. A key part of that objective is securing good-quality infection control, not least in the NHS.
It will not have escaped the House's notice that since the Committee stage there have been further developments in the control of hospital-acquired infection in particular—developments that have led Conservative Members to believe that one further change is required before the Bill completes its passage.
The Health Protection Agency's function under the Bill is to promote measures to prevent the spread and promote the control of infectious diseases both in the community and in the NHS. New clause 1 provides that when standards are published for NHS bodies, the agency—as an independent body—would have power to publish those standards. English and Welsh NHS bodies would then have legal responsibility to have regard to them in the pursuit of their duties, and they would become part of the framework of health care standards that is intended to be the subject of inspections by the Healthcare Commission in due course.
We would not have been minded to do this but for the particular nature of the Government's failure in regard to the publication and pursuit of standards relating to hospital-acquired infection. Last week the National Audit Office published its progress report on reducing the risk of hospital-acquired infection. Appendix 1
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includes details of developments in the surveillance of hospital-acquired infection since its report on 2000. A number of actions had been taken before then, which are not described in the report but include the publication of work by the working party consisting of, among others, the Infection Control Nurses Association, the British Society for Antimicrobial Chemotherapy and the Hospital Infection Society. Those bodies worked together to produce guidelines for the control of MRSA infection, originally back in 1998.
In 1999, controls assurance standards were issued, the first of which dealt with hospital-acquired infection. Given that standards against which NHS bodies were supposed to assess their performance were already in place, the regularity with which Ministers and their agencies have published guidance is astonishing. In February 2000, they published a programme of action. In May 2000, NHS Estates published standards for environmental cleanliness. In June 2000, "An organisation with a memory: report of an expert group on learning from adverse events in the NHS" was published dealing with inspection control.
Guidelines on preventing health care-associated infections were commissioned by the Department of Health and published in the Journal of Hospital Infection in January 2001. In April 2001, national standards of cleanliness for the NHS were published by NHS Estates, and the requirement for mandatory surveillance of rates for methicillin-resistant Staphylococcus aureus was issued. "Building a safer NHS for patients" was published in July 2001 as a follow-up to "An organisation with a memory". In the same month, the Government responded to a report from the House of Lords Science and Technology Committee, and in January 2002, the chief medical officer published "Getting Ahead of The Curve", in which he first recommended the establishment of the Health Protection Agency. In March 2002, national standards of cleanliness for the NHS were published by NHS Estates.
4.45 pm
Mr. Paul Burstow (Sutton and Cheam) (LD): The hon. Gentleman is rightly listing a wide range of reports, guidance and other documents published by the Government since the last NAO report. Does he share my puzzlement and disappointment that throughout those few years they have not undertaken the necessary auditing to ascertain whether any of their guidance has been applied on the ground? We therefore have a sense of déjà vu, as the Government continue to re-announce proposals.
Mr. Lansley: The hon. Gentleman is right—the publication of those documents is not the same as achieving enforcement or implementation. I shall, however, complete my argument.
In August 2002, the National Patient Safety Agency initiated the "clean your hands" hygiene project, to which I shall return in due course. The chief medical officer announced a number of additional requirements on surveillance in June 2003, and revised standards of cleanliness were published by NHS Estates in August 2003. In December 2003, "Winning Ways: working together to reduce healthcare associated infection in England" was published by the chief medical officer. In March 2004, NHS Estates published "The NHS Health Care Cleaning Manual".
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The Secretary of State published a document entitled "Towards cleaner hospitals and lower rates of infection" last Monday, although it was not listed by the NAO, because it was not told about it until it had sent its report to the printers. The Healthcare Commission, following the consultation on health care standards, is due to publish detailed criteria later this year. As the hon. Member for Sutton and Cheam (Mr. Burstow) said, one must consider why the issue has been revisited, but the NAO is to be congratulated on the thoroughness with which it has investigated those initiatives and reported to the House. It said that
"the NHS still lacks sufficient information on the extent and cost of hospital acquired infection".
The balanced score card that is used to assess the performance of NHS bodies refers to measures on cleanliness and infection control but they are no more than procedures. The question appears to be whether the requirements of "Winning Ways" have been met, not whether infection rates have been reduced, and the consequences for patient care. For example, the NAO report states that there has been
"a focus on structures and processes, and a limited emphasis on evaluating changes in patient care".
Let us consider some of the things that the Government said would be achieved, compared with what has actually happened. The NAO states:
"Seventy-one per cent. of trusts are still operating with bed occupancy levels higher than the 82 per cent. target that the Department told the Committee"—
the Public Accounts Committee—
"it hoped to achieve by 2003–04."
Fifty-six per cent. of trusts undertook risk assessment in respect of isolation facilities, but only a quarter had secured the required facilities. The NAO states that
"it is impossible to quantify with any certainty if there have been any changes in NHS Trusts' infection rates."
By that I assume that it means infection rates generally, as distinct from the very specific MRSA hospital-wide data that were published as a result of mandatory surveillance. The NAO went on to say:
"There has been no progress in introducing a national post-discharge surveillance scheme as recommended by the Committee".
There is clearly a substantial difference of opinion between the NAO and the Government on the question of the production of information and the way in which it is to be used. The NAO further states:
"Feedback of specific local infection rates to clinical staff is vital".
In its summary, which I shall quote at rather greater length as it includes several specific points, the NAO states:
"The new mandatory national surveillance schemes do not currently enable clinicians to identify and reduce risks within their own specialty. In the absence of ownership and access to such data, hospital acquired infection is still perceived as a problem for the infection control team to deal with"—
so those in the NHS with clinical responsibility do not regard such infection as their own problem—
"and consequently many of the issues identified as barriers to effective infection control practice in our original report still apply. Considerable improvements could therefore still be made in: the coverage of education and training in infection control to all groups of staff, particularly doctors; compliance with guidance on issues such as hand hygiene, catheter care and aseptic technique; antibiotic prescribing in hospitals; hospital cleanliness; and consultation with the infection control team on wider trust activities such as new build projects."
Given that the Secretary of State doubtless had access to the NAO's findings, one might have thought that his purpose in publishing the new document last Monday was to demonstrate that—even though the chief medical officer had published previous recommendations in detail—he was taking personal responsibility to ensure that what the NAO said had not been done would be done. However, that is not what happened. That new document, entitled "Towards cleaner hospitals and lower rates of infection", begins with patient environment action teams' assertions about cleanliness in hospitals. It states that these teams
"have been assessing hospital cleanliness from a patient perspective since 2000 and have found consistent improvement".
That is the position from which the Secretary of State begins, but how is that to be reconciled with the views of the Healthcare Commission? Two weeks ago, it said that
"there is only weak agreement between cleanliness scores produced by official inspections of NHS Trusts and patient survey results on the cleanliness of the in-patient facilities of those Trusts".
The National Audit Office also looked into the same issue and its report states that
"only a third of infection control teams believe that standards have improved",
where cleanliness is concerned,
"in over half of the clinical areas in their trust over the last two years".
There is no certainty, as the Secretary of State appears to believe that there is, about improvements in cleanliness.
It is curious that the Secretary of State's document seems to be designed around the proposition that increased cleanliness necessarily leads to improved infection control. I do not think that any of us believes that poor cleanliness is consistent with good infection control—we view cleanliness and such control as complementary—but I do not think that anyone has any evidence to suggest that good or improved standards of cleanliness are a sufficient condition for good-quality infection control. If we examine the professional advice given to hospitals, it is perfectly clear that there is a requirement for a range of special measures associated with infection control that go beyond any patient's individual perception of what constitutes a clean hospital for this purpose.
It is disappointing that the Secretary of State appears not to believe what the Department told him in the departmental report—effectively that common sense tells us that cleanliness and infection rates are related to one another, but that there is no hard evidence to show that that is the case. That is what the departmental report said only about three months ago. The Secretary of State, however, has clearly decided that, if he can
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convince the public that they will have clean hospitals, he can also convince them that they will also have, by extension, low-infection hospitals. Clean hospitals are very important and it is necessary that we secure them, but the Secretary of State has started to push cleanliness and infection control together as if they were entirely the same thing.
Let us examine the weight that the Secretary of State places in his latest document on the empowerment of patients and, in particular, on the hand hygiene project launched by the National Patient Safety Agency. It is mentioned on page 38 of the National Audit Office report that the project began at the John Radcliffe hospital, Oxford and that a range of pilot sites developed from that while the "clean your hands" project was being evaluated. It is due for national roll-out this year.
The John Radcliffe had 92 cases of methicillin-resistant Staphylococcus aureus between April 2001 and 2002; 114 from April 2002 to March 2003; and 127 from April 2003 to March 2004. Let us compare that record with some of the other pilot sites for the "clean your hands" project. At the Queens Medical Centre, such cases have increased from 58 to 77 over the last year; at the Royal Devon and Exeter from 36 to 50; and at St. George's Health Care NHS Trust from 75 to 93. No one would argue that there is no merit in the "clean your hands" campaign. Everything that it says is right and should be followed, but it is not sufficient. The Secretary of State appears to be treating it as if the process of trying to ensure cleanliness in hospitals is sufficient for infection control purposes. It is not.
I was deeply disturbed by the way in which the Department, presumably for presentational reasons, set out just over a week ago to try to convince the public that the Secretary of State regarded this matter as a new issue and that he would take a hands-on approach and try to resolve it. He then publishes this document, but there are aspects of "Towards cleaner hospitals and Lower Rates of Infection" that make life even worse from the NHS point of view. Previously, it had the chief medical officer's document "Winning Ways", but things have been left out of the new document—and the NAO report referred to some of them, such as the importance of reduced use of catheters in intravenous drips and invasive procedures. That is in "Winning Ways" and is referred to by the NAO, but it does not get a mention in "Towards cleaner hospitals". The prudent use of antibiotics is also important and was mentioned in "Winning Ways". The importance of emphasising infection control in undergraduate and postgraduate curricula for doctors, nurses and other NHS professionals is in "Winning Ways" but is not referred to in "Towards cleaner hospitals".
5 pm
One might be forgiven for thinking that the Secretary of State, or others acting on his behalf, had cobbled together the document at a few days' notice—including a number of things that were due to happen anyway, such as the publication of standards, the roll-out of national surveillance and the National Patient Safety Agency's "clean your hands" campaign—and published it a couple of days before the National Audit Office
19 Jul 2004 : Column 46
report to try to offset the range, depth and seriousness of its criticism of the Government's failure to achieve reduced rates of infection control.
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