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Mr. Paul Burstow (Sutton and Cheam) (LD): If I understood the Secretary of State correctly, he said that when one looks at the totality of health care-acquired infections and compares the UK's performance with that of other European countries the UK is doing better. If so, where is the evidence? As I understand it, the surveillance systems in place do not collect that information.

Dr. Reid: Our figures are based on the data that is collected and the estimates. No country is compiling data in forensic detail on all aspects. I have given the hon. Gentleman our best estimate. The rate of hospital-acquired infections—the aggregate sum that he mentions—in England is 9 per cent. Twenty-four years ago it was 9.2 per cent., based on the same estimates but perhaps less data. Historically, therefore, as a global aggregate sum, the current rate is not out of kilter with what has been the case for 24 years. Indeed, I am told by my advisers, including some very well qualified advisers, that the rate has probably been of the order of 9 per cent. for the past 50 years. The comparable rate in the Netherlands is 7 per cent., 8 per cent. in Spain and Denmark, between 6 and 10 per cent. in France and between 5 and 10 per cent. in the United States. Those are the best estimates available to me.

However, within those aggregate totals, it is true that we have a particular problem with MRSA, which we are attempting to face. In order to do so, we must understand why we have that problem. The first reason that I identified is that there are a number of strains under the generic name MRSA. At least two of those strains, which we used to call the Thames strains because they originated in this region, are particularly virulent in crossing from patient to patient. They are a different strain from those that occur in some other countries.

A second objective fact is that we have a higher proportion of patients who are susceptible to infection than we had 20 or 30 years ago, because of the increasing number of elderly in our country, largely as a result of the success of the national health service in maintaining people for a longer period.

Thirdly, infections are caused by a wide variety of micro-organisms, often bacteria from our own body. As the NHS undertakes increasingly complex and invasive medical procedures in vast numbers—remember, we are dealing with some 7.5 million treatments a year in our hospitals—and our patient population is increasingly susceptible because of age or immuno-suppression, it is perhaps not surprising that the rates of hospital-acquired infections are not decreasing.
 
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From the complex battery of reasons, I have given three that are objective circumstances. That does not lessen the seriousness of the problem, but it begins to get us towards a mature debate on the causes so that we can address them. That is surely what the entire House wants.

Linda Gilroy (Plymouth, Sutton) (Lab/Co-op): Before my right hon. Friend moves on, can he tell me whether he has made any assessment of the extent to which the accuracy and transparency of our collection of data in this country is comparable with data collection in other countries, and whether that might be another factor in the differing rates?

Dr. Reid: Yes, in general terms. In terms of international comparisons to date, we have done more than any other country to collect such data. In historical terms, I was about to say that we had done 100 per cent. more than the previous Government, but in fact we have done an infinitesimal percentage more than they did, since they did nothing at all about collecting such data. Does that mean that we have satisfactory and reliable data on detail and volume? No. I am not content with that.

That is why, as the hon. Member for South Cambridgeshire was kind enough to say, we started off with the most reliable indicator for the compilation of empirical data—the search and study of bacteria in the blood. For a host of technical reasons it is much easier to identify infections there than in a wound, because there might be a wound without bacteria, bacteria without a wound, or bacteria all round a wound, making it much harder to test. It is not as reliable for culturing as blood. For all those reasons, we did not start off with open wounds. We did not start off with respiratory or urinary infections either, because in both those cases the incidence of MRSA is much less.

We started off by testing for bacteria in the blood, and, as the hon. Member for South Cambridgeshire said, we are developing certain orthopaedic procedures.

We take the problem seriously. Indeed, it is rare, if not unique, for a Secretary of State for Health publicly to declare that the issue is one of our great challenges. It is easy not to collect data, not to declare the problem and pretend, because the data have not been collected, that the problem does not exist. I took the opposite approach—I said that the first step in tackling the problem was openly to admit that we have a problem. We have had the problem for decades, but I think that I am the first Secretary of State for Health publicly to declare it as a major priority.

The figures indicate how serious the problem is. Our surveillance shows that 7,600 known MRSA bacteraemia or blood stream infections currently exist. To put that in context, that is about one in 1,000 patients. Although we do not yet collect data from other areas, if we include the other main area of infection—surgical wound MRSA infections—the best estimate is that 23,000 incidents of infection have occurred, which is about 0.3 per cent. of patients or three in 1,000.

That is, of course, three patients too many. Some hon. Members may know a loved one or friend who has suffered pain or lost their life because of such an infection, in which case 100 per cent. of that person's life
 
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is lost. That is why we must take the matter seriously. I present the figures to put it in perspective, because some recent headlines have been so alarmist that they might discourage people from going to hospital to receive treatment for conditions that could kill them.

I accept that we do not yet have enough data on the incidence of hospital-acquired infections, but, from the data that we have, we do not believe that such infections are increasing significantly. That is not my judgment—it is the judgment given to me by my advisers—but I take responsibility for accepting it. The base data on bloodstream infections show a slight increase of the order of 5 per cent., perhaps less, over the past three years. The problem is great and the incidence of infection has increased, so we should take the matter seriously—I shall come on to how we are taking it seriously—but the magnitude of the problem is not as alarming as some stories have claimed.

Mr. Simon Burns (West Chelmsford) (Con): If I heard the Secretary of State rightly, he said that the increase was about 5 per cent. over the past three years. How does he square that judgment with the figures from his own Department and the Health Protection Agency published in July this year, which show that the increase for blood infections with MRSA was 3.6 per cent? If one adds cases of less severe infection, MRSA, and the total number of blood infections, the increase was just more than 9 per cent.

Dr. Reid: The hon. Gentleman may have misheard me. I started with the aggregate volumes of hospital-acquired infections before going on to the specific subject, MRSA, which I admit is a problem area. The figure that I just gave is for MRSA.

Mr. Burns: In order to ensure that we are speaking on the same basis, will the Secretary of State clarify that the increase was 5 per cent. over three years?

Dr. Reid: I said just less than 5 per cent.

Mr. Burns: How can that be squared with the Department of Health and Health Protection Agency figures, which show that for MRSA the year-on-year increase to July was 3.6 per cent.?

Dr. Reid: The figures are wholly compatible, unless my arithmetic has gone completely mad. As 3.6 per cent. in one year is less than 5 per cent., it is entirely possible that the total was of the order of 5 per cent. over three years. It is not crucial whether the figure is 4 per cent. or 6 per cent.—I said that is of that order, because the figures are based on estimates. If the hon. Gentleman sees a contradiction, I am more than happy to check it and write to him.

I accept that we do not yet have adequate data. One of the reasons why we do not have comparable figures going back to before 1997 is that comprehensive data have been collected only under this Government. Although we have had this problem for 50 years, with the same aggregate volume of hospital-acquired infections, previously no data were collected at all. We were not only the first Government but, to my knowledge, the first country anywhere in the world to introduce mandatory surveillance for MRSA
 
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bloodstream infections. Although we may not have done everything as quickly as the Opposition would like, it is hardly fair to say that we have done nothing: we have led both at home and internationally.

Not knowing the figures did not mean that there was nothing there—all the best estimates suggest that there was. The previous Government's laissez-faire approach meant that Parliament would not have been able to have such a debate, nor would the tabloids have been able to write the headlines. No one gave them the information to alert them to the seriousness of the problem because no one collected that information in the first place.

Although we know that not all health care-associated infections can be prevented, this is an important patient safety issue on which we are determined to take action. Contrary to some of the advice that is being thrust upon us, there is no simple quick fix to preventing these infections. We need a multi-strand approach because the causal relationship between the factors is multi-faceted. It is not just a matter of cleanliness—it also depends on the patient's age, the severity of their illness and the intrusiveness of some operations.

The two most important risk factors in contracting an infection are the severity of the patient's illness and the use of devices such as catheters which provide an entry route for bacteria. Our action plans for reducing infection rates and addressing those two risk factors are set out in two publications: a public report by the chief medical officer called "Winning Ways"; and "Towards cleaner hospitals and lower rates of infection". Copies are available in the Library. Those were informed by the advice not only of the chief medical officer, but of the chief nursing officer, both of whom have played a vital role in giving me continuing advice on the implementation of our programme of action. It is the action of any responsible Government to ensure that sound, evidence-based policies are implemented.

Although we take advice from everyone concerned, Ministers are ultimately responsible. Naturally, I therefore take responsibility for any actions that we have taken to combat the problem and any failings that people perceive in them.

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