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The Secretary of State for Health (Dr. John Reid): I beg to move, To leave out from "House" to the end of the Question, and to add instead thereof:
"welcomes the Government's commitment to ensure that patients can have confidence that National Health Service hospitals are clean, safe environments with infection firmly under control; congratulates the Government on its action plans for reducing infection rates, 'Winning Ways' and 'Towards cleaner hospitals and lower rates of infection', which include the new target for a year-on-year reduction in MRSA, and the designation of directors of infection prevention and control to bring about local change; notes that the National Audit Office report concluded that the introduction in 2001 of mandatory MRSA surveillance raised the profile of infection control with senior managers; expects that the new target will act in a similar way, and deplores therefore the suggestion that the target be abolished; acknowledges that improving patient safety is a difficult medical issue that calls for the hard work and care that is the hallmark of NHS staff; welcomes therefore the 77,500 extra nurses and almost 19,400 extra doctors that have become a part of patient care since 1997; and therefore congratulates the Government on a comprehensive programme of investment and reform that has equipped the NHS to deliver improvements in patient safety, and to reduce hospital-acquired infections."
Although we use these words often, I welcome the opportunity to discuss the subject and the Government's approach to reducing health care-acquired infections. The hon. Member for South Cambridgeshire (Mr. Lansley) gave a reasonably balanced speech, although at its centre was a mistake also made by the Leader of the Opposition, which is to imply, if not to state specifically, that hospital-acquired infections, especially MRSA, are the result of party political decisions of the Labour Government.
It is important to get the matter in perspective. We should acknowledge the problem, but it has existed for many years—indeed decades. The Leader of the Opposition was ill advised to introduce party politics on a matter such as MRSA. The problem has existed under both parties in government. It has not just arisen overnight; it has been there for decades. I use those words advisedly—I notice that there is some opposition to them—because they are not mine; they are the words of the Conservative Health Minister, the hon. Member for Orpington (Mr. Horam), in Hansard on 19 March 1997, after 18 years of a Conservative Government. I have substituted "MRSA" for "E. coli" and "the Leader
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of the Opposition" for "the hon. Member for Thurrock", who was advising the Government not to make the issue party political. People will notice that what was, in a set of objective circumstances, giving rise to a decades-long problem in the dying months of a Conservative Government, has suddenly become a new issue as a result of the Labour Government some seven years later.
It is far too serious to treat the problem as a party political one, or to undermine it by exaggerating the novelty of the problem. The situation is serious enough without trying to imply that it is more serious than it is. In a sense, that undermines the credibility of the problem.
The Government's approach to the matter sits in the context of our efforts to update and improve the NHS. It cannot be seen in isolation of them. Some of those efforts are criticised by the hon. Gentleman, but I remind the House of them. There is more capacity and more money being put into the NHS in a sustained way than ever before: an average of 7.6 per cent. growth in real terms during the past four years. That has helped to expand capacity and, compared with 1997, the figures speak for themselves. There are more staff than ever: 77,500 more nurses and 19,000 more doctors working in the NHS. Sixty-eight major new hospitals have been built, are under way or are planned. That point is relevant, and I shall return to it later.
As a result—without in any way diminishing the deaths and misery caused by hospital-acquired infections—there are now 280,000 fewer people on the in-patient waiting list, compared with March 1997, and hardly anyone at all is waiting more than nine months for a hospital admission. More importantly, health outcomes for patients in general have improved. Premature deaths from cancer are down by more than 10 per cent., and coronary heart-related premature deaths are down by 23.4 per cent. Those are staggering changes. Out of fairness to NHS staff, let us remember that there are thousands of people alive today who would not have been had the NHS not introduced its reforms, and had we not introduced our improvements to the NHS. Staff have worked hard to achieve all that, so let us give them credit.
That is the context within which we are facing the challenge of hospital-acquired infections, a major one by any standards, and specifically, MRSA. What is the objective position as regards hospital-acquired infections? Almost by definition, hospitals are places where infections are concentrated. That has always been the case; it is not a phenomenon restricted to the current time or Government. What is the volume of hospital-acquired infections? I notice that the hon. Gentleman made no reference to the volume of such infections in comparison either historically or internationally.
Our estimates show that up to 9 per cent. of in-patients acquire an infection of some kind. They also show, as far back as we have reliable data, that that has not changed materially since 1980, not 1990. In 1980, the number of those infected stood at 9.2 per cent.; today, it is estimated to be 9 per cent. I shall go further. The advice I have is that, as far as we can make out, the total volume of hospital-acquired infections as a percentage has not substantially changed for the past 50 years.
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What has changed within that overall total is the main type of bacteria or organisms that we have to deal with. Today, it is MRSA, but if one goes back to the 1950s, one finds it was staph aureus—the methicillin-sensitive organism. In the 1970s it was E. coli, in 1980 it was pseudomonas and in 1975 it was klebsiella. A mutation has occurred. As we have been successful in controlling some types of infections through antibiotics—and perhaps the overuse of them—others have grown to present the problems we have today.
I do not wish in any way to diminish the seriousness of the problem, but I caution against historical exaggeration of such infections as a novel problem with which we have had never had to deal before and which is exclusive or enhanced under a Labour Government.
Health care-acquired infections are not just a problem in this country. The estimated rate of infection here is 9 per cent., compared with 7 per cent.—admittedly, a lower figure—in the Netherlands, 8 per cent. in Spain and Denmark, and rates of 6 to 10 per cent. in France, and 5 to 10 per cent. in the United States. In giving those figures I do not wish to diminish in any way the scale of the problem. I want to make sure that we take it seriously by avoiding exaggeration. However—
Mr. Lansley: I understand what the Secretary of State is saying, but he will accept that the incidence of MRSA in particular has risen dramatically since the mid-1990s. I entirely accept, however, a number of bacteria constitute MRSA and that they have developed over time. Indeed, I have corresponded with him about the need to prepare for the possibility, hopefully remote, of an outbreak of vancomycin-resistant Staphylococcus aureus. In the international context, we are lucky not to have experienced an outbreak of severe acute respiratory syndrome, but some countries have combated MRSA, as they did SARS, with a dramatic change of culture within their health care systems. For example, a Dutch strategy was based on the policy of search and destroy set out in "Winning Ways". Clearly, other countries with an increasing incidence of MRSA responded in completely different ways, and the Secretary of State must explain why that was not the case in Britain.
Dr. Reid: I shall come on to that. We have set the record straight and got rid of the tabloidy misrepresentations of a novel problem in certain quarters. I am not saying that the hon. Gentleman was guilty of such behaviour today, although the Leader of the Opposition, in search of another bandwagon, jumped on that one without much success. We do not diminish the seriousness of the problem by putting it in the correct context, which helps us to identify the challenge facing us. However, as I was about to say before the hon. Gentleman intervened, it is true that MRSA infection has become more of a problem in the United Kingdom. It has replaced problems previously caused by E. coli and other organisms that I mentioned. There are complex reasons for that, including some unknown ones, but it is possible to identify a number of the interrelated causes.
The hon. Member for South Cambridgeshire asked me to grapple with the reason why MRSA is more prevalent in the UK, even though the overall infection rate is lower here than in some countries. Part of the
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answer is that the strains responsible for most infections in the UK are different from those in many other countries. [Interruption.] I do not know whether the hon. Member for Westbury (Dr. Murrison) is asking about strains of infection. He is much more qualified than I am, but I am advised that about 12 to 15 years ago, we witnessed the development of Thames strains—two particularly virulent forms of MRSA that are not common in other countries, but which are particularly well adapted to spread between patients compared with other strains.
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