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Resolved,
That this House supports the Government's strategy to enable people to save securely for their retirement and to promote retirement flexibility and informed choice; welcomes the Government's Pensions Bill and Pension Protection Fund, which
- will bring real security for over 10 million defined benefit pension scheme members if their employer becomes insolvent and their pension scheme winds up; further welcomes the £400 million Financial Assistance Scheme which will help people who have already lost out; believes that the Pensions Bill will enable many more people to save with confidence with a new proactive pensions regulator, measures to simplify pensions legislation and improved incentives to work past the state pension age; supports the pensions tax simplification proposals being taken forward in the Finance Act 2004, which will replace eight tax regimes with one simplified system; commends proposals in the Pensions Bill to allow individuals to defer their state pension and draw it as a lump sum; welcomes measures to enable people to make an informed choice in pension provision, including new pilots to provide information and advice in the workplace; condemns the inheritance of 1997, with the legacy of pension mis-selling and millions in poverty, whereby many were expected by the previous Government to live on under £69 a week; believes that the Opposition parties' policies will be unfair to the poorest pensioners, unaffordable and unsustainable; commends the Government's historic commitment to tackling pensioner poverty; and welcomes the extra £10 billion that the Government is spending on pensioners in 2004–05 compared with the 1997 system.
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Hospital-Acquired Infection
Mr. Deputy Speaker (Sir Alan Haselhurst): I remind the House that Mr. Speaker has placed a 10-minute limit on Back-Bench speeches in this debate and has selected the amendment in the name of the Prime Minister.
4.16 pm
Mr. Andrew Lansley (South Cambridgeshire): I beg to move,
That this House notes with deep concern the increased levels of hospital-acquired infection and, in particular, that the incidence of methicillin resistant staphylococcus aureus (MRSA) has doubled since 1997; welcomes the report by the National Audit Office 'Improving Patient Care by Reducing the Risk of Hospital-Acquired Infection: a Progress Report' (HC 876); regrets the lack of timely action by the Government which this discloses, including higher bed occupancies and the resultant impact of Government waiting list targets on infection control measures, lack of surveillance data other than hospital-wide MRSA and post-discharge surveillance and isolation facilities, and lack of progress on a national infection control manual; is deeply concerned that recommendations for bed or ward closures by infection control teams have been refused; and calls on the Government now to act urgently to secure the action needed to reduce hospital-acquired infections.
A week ago, the Health Minister, Lord Warner, announced what he described as the first national campaign to promote hand cleaning by health care staff. Well, 150 years on from Florence Nightingale's work in the Crimea, I think that we can fairly say that it was not the first such campaign—but what did it tell us about the Government's response to the crisis of hospital-acquired infection? Four and a half years ago, in its 42nd report in the 1999–2000 Session, the Public Accounts Committee made the following recommendation:
"Hospital hygiene is crucial in preventing hospital-acquired infection including basic practice such as handwashing. We find it inexcusable that compliance with guidance on handwashing is so poor . . . We . . . look to"
"to audit progress and report back to us by the end of 2001."
Four and a half years later, the Department of Health announces a campaign. Only now is it showing, in this limited respect, the urgency and determination to achieve cleanliness and hygiene in our hospitals that have been urged on it not only by the PAC but by others.
We do not know the extent of hospital-acquired infection and the costs that it imposes. That, too, the PAC asked for four and a half years ago—it was asked for but not achieved. What we do know is the human cost: several thousand lives needlessly lost and patients suffering weeks, even months, with their wounds failing to heal. Every Member of Parliament will know from constituents of the pain and distress that these infections cause. That is why we all want and expect the risk of hospital-acquired infection to be combated with all the energy and urgency that we can command, and why we in the Opposition brought the matter to the attention of the House immediately on its return.
The National Audit Office report, four and a half years on, lays bare the failure to act or to achieve the progress called for by the PAC and, frankly, by so many others. In June 2000, my hon. Friend the Member for Woodspring (Dr. Fox) made exactly the same points here in the House.
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I hope that we do not have a debate in which Opposition Members all say that the glass if half-empty and Government Members all say that the glass is half-full. The issue is too important for that and my contention is not that nothing has been done. NHS staff across the country are becoming more aware of the need for comprehensive infection-control measures. I and other hon. Members know that exemplary work is being done in many parts of the NHS so that patients see clean wards and can be confident of not contracting infections.
Equally, however, some places are not clean and infections are endemic, sometimes even in high-risk areas. What is deeply disturbing and lies at the heart of the debate is the fact that, far from doing everything that they could to deliver safe care to patients, the Government have not done so. Worse, they have pursued their obsession with central targets, which have frustrated the achievement of effective infection-control procedures. The purpose of the Opposition motion and today's debate is to require of the Government the urgency of action demanded more than four years ago, but which has been so sadly lacking.
The evidence is depressingly clear. In 2000, the Public Accounts Committee said that the NHS did not have a grip on the extent and costs of infection. It recommended that the nosocomial infection national surveillance scheme be developed and made mandatory. Ministers chose not to do so, as the National Audit Office report of July describes it. It says:
"Instead of developing mandatory specialty specific surveillance of bloodstream, surgical site and urinary tract infections whose information would be fed back to clinicians to improve practice, the Department focussed on trust-wide surveillance of MRSA bacteraemias and other specific organisms, together with plans for mandatory reporting of orthopaedic surgical site infection."
That is methicillin-resistant Staphylococcus aureus in the bloodstream, rather than MRSA where surgical site infections are concerned. It continues:
"This is a critical issue. Leadership and clinical responsibility is at the heart of infection control measures. Data which is not specialty specific is not leading to clinicians taking their responsibility for reducing infection, nor is it equipping patients with the key information about the incidence of infection in the wards to which they may be admitted for operations, especially if they are high-risk areas."
Mr. Andrew Miller (Ellesmere Port and Neston) (Lab): I have taken a close personal interest in the issue that the hon. Gentleman raises, and I would counsel him to be very careful about the way in which he uses statistics in this matter. For example, a small specialty unit might have only a few patients, but they may all have come in from dozens of surrounding general hospitals. Such units are almost certain to be statistically high up in the league tables. It is a distortion of the efforts made to manage controls. I urge the hon. Gentleman to be extremely careful with the data.
Mr. Lansley:
I was not planning to elaborate on that, but the hon. Gentleman makes an extremely good point. The Public Accounts Committee report—I did not originate the proposal—in a sense suggests being much more careful with the data. Let me explain to the hon. Gentleman what is happening at the moment. The currently published MRSA rates measure incidence
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rather than prevalence, so they do not tell us the likelihood of arriving at a hospital without infection and acquiring it while within that hospital or particular clinical department. We are told only about the total incidence of hospital-acquired infection—or, more particularly, MRSA bloodstream infections in the hospital.
I know how important that is, because Addenbrooke's hospital in my constituency had the second-highest incidence of MRSA. A significant part of the problem was the extent to which the hospital was admitting patients from other clinical contexts, in which MRSA had been detected. The House will be aware of many instances in which hospitals have said that their data were influenced by the extent to which there is MRSA in nursing homes, and by the number of patients from those homes being admitted to hospital.
I do not dispute that it is important to get statistics absolutely clear. We are raising this subject now in part because clinicians want the available data to be much more specialty specific and related to clinical departments. In that way, the data will not be obscured by information that is hospital-wide. Clinicians will then be able to act on the information that is under their control and to be judged accordingly by general practitioners and patients. That is an example of how patient choice will play a role.
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