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Dr. John Reid: I am sure that the hon. Gentleman is making a point, but I must admit that I am a bit lost about what it is. Advisers advise Ministers. The chief medical officer advises the Government. We act on that advice. Sometimes, on the basis of the information and advice that we receive, we publish documents or take action publicly, for which we are responsible. Sometimes, we directly publish documents by the chief medial officer. When advice is put into the public domain, people can read it. When advice is given to Ministers on policy issues, it is a long-standing convention of some centuries in the House that it is not published. The hon. Gentleman may not like that, but this is hardly a unique case. I am not quite sure what point he is making.
Mr. Lansley: The point is simple, and I will not detain the House too long. If the Secretary of State does not take responsibility for his own decisions but attributes them to the advice of the chief medical officer, the advice ought therefore to be in the public domain. I have searched the advice that is in the public domain and there is nothing to suggest that any chief executive who overrides an infection control team's recommendation to close a ward would be acting other than against the interests of patient safety and contrary to the clinical situation.
Mr. Lansley: The Secretary of State must let me continue; otherwise time will go on and we will intrude on the time for Back Benchers.
Mr. Deputy Speaker: Order. The hon. Gentleman is not giving way.
Mr. Lansley:
I must remind the Secretary of State that the motion refers to many other ways in which failings in action have been laid bare by the NAO report. I will not be able to detail them all, but I want to ensure that the House is aware of them.
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On isolation facilities, the NAO report said:
"In our original report, we found that isolation facilities in some NHS trusts had been significantly reduced and that many infection control teams believed that facilities for isolating patients were unsatisfactory . . . The Committee of Public Accounts specified that increased investment in isolation facilities was required. In 2001, the Department assured the Committee that the need for isolation facilities was being addressed. However in 2003, we found that while 56 per cent. of trusts had undertaken a risk assessment to determine the number and quality of isolation facilities in the last three years, only a quarter had obtained the required facilities."
Will the Secretary of State tell us what steps the Government will now take to meet that recommendation, which has not been met in the past four and a half years?
I shall mention post-discharge surveillance. The NAO report said that, four and a half years ago,
"we identified between 50 and 70 per cent. of surgical wound infections occurred post discharge but that only a quarter of infection control teams were carrying out any post-discharge surveillance and that there had been no systematic evaluation of the reliability of different methods.
The Department told the Committee that they had commissioned some research and expected to have the results in late 2000. The Committee recommended that these infections should be monitored through NINSS . . . We found that only 21 per cent. of infection control teams had carried out any post-discharge surveillance since our last report."
Will the Secretary of State tell us what he will now do to ensure that post-discharge surveillance of surgical wound infections is carried out?
"In 2001, the Department commissioned a feasibility study to consider producing a National Infection Control Manual. However there has been little progress on this to date. Responses to our survey and in our workshop showed there was strong agreement on the value to NHS staff of a national manual that could be adapted for local and specialty use. Given the strong evidence of wide local variability in the use of existing guidelines, and significant reinvention of the wheel, there is a need for templates to facilitate local adaptation of national guidelines."
The Government keep on publishing new documents and providing endless guidance, but NHS staff are looking for templates and a manual to enable those guidelines to be put into practice. Where is the manual? The Government have had four and a half years to produce one, but where is it?
In the December document "Winning Ways", the chief medical officer said that
"A rapid review process will be established to assess new procedures and products for which claims of effectiveness are made of their ability to prevent or control healthcare-associated infection."
In a debate in July, my right hon. Friend the Member for Hitchin and Harpenden (Mr. Lilley) made specific reference to several new products and processes that have been offered to the NHS. He is not able to vouch for their effectiveness—nor am I—but that is why a rapid review process should be established. Ebiox is a non-alcohol cleansing product. NewGenn—which is close to Cambridge, so I have met the company staff and used their products—also makes non-alcohol hand cleansing products, which have been used in several NHS pilots. New synthetic antibacterial agents have been developed for the treatment of MRSA. Companies have produced targeted antibiotics and even coatings for walls and doors that—[Interruption.] The Secretary
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of State appears to want to make two speeches, one of them from a sedentary position. I do not know whether those products will work, but many people want to know when the rapid review process will start, because there are means by which the NHS could more effectively combat infection that are not being adopted.
Mr. Eric Pickles (Brentwood and Ongar) (Con): I have a company in my constituency that makes a hand-washing machine that would facilitate infection control. Does my hon. Friend agree that part of the problem is that the commissioning process and the bureaucracy of the health service militates against decision making? The way in which the NHS operates has a dampening effect on innovation.
Mr. Lansley: The NHS has historically been poor at introducing new products and processes. Sometimes that is to its advantage, because in America large amounts of money can be spent on new products and processes that are not necessarily effective or cost-effective. However, when we have a problem that is getting worse and that we have to tackle, the NHS should be able to assess the cost-effectiveness of attempts to do so. After all, we have the National Institute for Clinical Excellence, which leads the world in techniques for measuring clinical effectiveness and cost-effectiveness. The monopolistic nature of the NHS should not be a constraint on the adoption of innovative techniques. Indeed, it should be a means of disseminating such techniques more rapidly, but that is not happening in the area of infection control technology.
I shall not go on because hon. Members on both sides of the House want to speak. Our motion is measured and accurate. It requires the Government to act urgently in the future because that was lacking in the past. In the circumstances, we are right to call for that. The information that clinical teams need and for which they will take responsibility must be provided. The power given to ward-based teams—ward sisters, matrons or whatever they are called—is not the issue; what is important is that they have effective control over hygiene, cleanliness and the environment for their patients. They must be able to act in line with contractual procedures that equip them to do so.
We need patient choice to incentivise hospitals to meet patients clear and increasing demands for clean and safe hospitals. That is more effective than the targets that the Secretary of State talks about. We need to get rid of the targets and the constraints that prevent hospitals and NHS professionals from meeting the requirements of patient safety, which they so much want to do. We need the Health Protection Agency to pull a range of organisations and sources of guidance together to ensure that infection control measures are disseminated within the NHS rapidly. We need a rapid review process for new technologies and processes.
My experience in different parts of the country over the summer showed me that patients are deeply concerned. As chance would have it, only yesterday a lady told me of the three months that she spent in hospital as a consequence of MRSA infection and the distress and pain that it caused her. Many other patients
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are deeply distressed about the prospect of going into hospitals that they believe—rightly or wrongly—will put them at risk of acquiring an infection.
Doctors and nurses across the country tell me that they know how to deliver infection-free environments and that they have experience of doing that. They know that they can do it if they are given the support and the freedom to deliver the requirements of patient safety without being contradicted by Government targets and bureaucracy. That is what is urgently required now, not after the general election. It is what we have called for and why we have tabled the motion. I urge hon. Members to support our motion and resist the Government's amendment, which contains no sense of the urgency for which we have called. I hope that hon. Members give the Government the same message that constituents and the public have given us over the summer—that this is an urgent requirement which needs to be reflected in Government action now.
4.47 pm
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