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Mrs. Iris Robinson (Strangford) (DUP): The right hon. Gentleman will know that one way of creating public confidence in the set-up of hospitals is to ensure that instruments are properly sterilised. He may be aware of the recent disclosure in Northern Ireland whereby endoscopic instruments were found to have bodily fluids retained within them. As a result, many hundreds of people had to be recalled to have investigative procedures carried out to check that they did not have infections. It is important that NHS staff correctly follow procedures to ensure that instruments are properly sterilised, to give confidence to people in Northern Ireland.

Dr. Reid: Yes, I am aware of the incident that the hon. Lady mentioned. We have tried to tackle the matter in several ways. At one stage, we tried to introduce disposable instruments, but they led to complications that resulted in injury, discomfort, pain and further problems. The hon. Lady is right that the instruments that are used constitute an important element of hygiene, especially since the treatments are becoming
 
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increasingly intrusive as we find more treatments that, on the face of it, relieve pain, but are so intrusive that they create a further risk.

I was trying to explain that we are considering a multi-faceted problem. Other important risk factors include the age of the buildings and increasing antibiotic resistance. It is not simply a matter of cleanliness, which I shall tackle later. Any balanced and objective assessment would recognise that the age of our hospital buildings and the fact that people have perhaps overused antibiotics, leading to the mutation of organisms, which become more resistant, are important. Those reasons are not exclusively associated with a particular Government of a particular political persuasion.

Buildings are part of a legacy that we inherited and we hope that the risks that they present will diminish, because we have the biggest building programme in NHS history. However, that cannot be completed overnight. We must also consider the design of buildings. Many countries have far more single rooms in hospitals, making isolation easy.

Of course, cleanliness is also essential. Everyone makes that point. To be fair, the hon. Member for South Cambridgeshire pointed out that we have known that since the time of Florence Nightingale, and perhaps even before then. Cleanliness is not less important nowadays, but, ironically, it and the standard of hygiene may have to be far greater, even though we have new hospitals, because the resistance of the bugs that we are trying to kill is much greater. Getting rid of them is not as simple as spreading a bit of Dettol or a few antibiotics around.

Mrs. Angela Browning (Tiverton and Honiton) (Con): I worked in theatre in the 1970s. In my experience and that of other friends and colleagues, who have been senior nurses—call us old bats if you like—the standard of cleanliness on the wards is not as good as it was years ago, because of procedures. To give one quick example, some nurses use their hands to open pedal bins and then deal with patients. We are not considering rocket science. We simply need discipline and good management of nursing and other staff, including doctors, on the wards. That has deteriorated and perhaps the greatest proponent of explaining the reason for that is Claire Rayner.

Dr. Reid: I would not even begin to think of the hon. Lady as an old bat, a young bat or any sort of bat. Her comments are not batty—I agree with every word that she said.

Let us consider other problems that might affect cleanliness. The age of hospitals matters. In the 1970s, some of our hospitals were 35 years younger. Hospital design matters, as does the fact that we have had long waiting lists, which we are trying to reduce. Staff shortages are important because people have less time. The points that the hon. Lady made about cleanliness also matter. As she said, it is not rocket science. That is why we are trying to introduce gel and the placing of such items at the foot of the bed. We are trying to emphasise to nurses, who are better trained than ever in many matters, that the basics are important.
 
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I dare say that some people would write to me and say that the process of contracting out cleaners that the previous Conservative Government introduced opened the way for cheapness as a substitute for cleanliness. A host of reasons exists, but I do not believe that any of us are, at heart, interested in identifying them in a party political way. We are all trying to ensure that the practical measures, which the hon. Lady mentioned and which may help us to combat lack of cleanliness or hygiene are put in place.

This morning, a meeting of NHS matrons took place on the subject. Yesterday, my right hon. Friend the Minister addressed NHS chief executives and told them that cleanliness was a huge priority. Cleanliness and hygiene are not extras in the NHS but the fundamental premise on which we treat patients.

Therefore, cleanliness is essential, and we are working to improve both infection control and cleanliness, since even in the absence of clear evidence, common sense suggests that there is a link between the two. There is not statistical and scientific evidence to show that, but my intuition and common sense tell me, as the hon. Lady tells me from her experience, that there must be such a link.

Such work is not always easy in an area in which, we believe—and the Opposition urge us to go further on this—that we should decentralise control. We are being asked to ensure the application of national standards of hygiene and cleanliness in a context in which we are decentralising power to the front line. That is not easy, but it is essential, and that is why we are doing it from the centre.

If the hon. Lady wants us to set that as an objective, and to drive it with guidelines and targets, I am with her. Her Front Benchers are not. They want such an outcome to arise spontaneously, like something out of the "Book of Revelations", but I think that we should insist on a national standard of cleanliness in our hospitals. That is why we have set a new objective for the reduction of MRSA, which is the responsibility of every member of a hospital from the top down. We have strengthened the role of the Healthcare Commission in that area. We have introduced the National Patient Safety Agency "clean your hands" campaign—the non-rocket-science, basic practice, which the hon. Lady recommended. We have introduced a matron's charter to put matrons back in charge, and ward sisters more in charge, of what happens in wards. In addition, we are prepared to learn not only from best practice at home but abroad. We are therefore bringing in experts from other countries, which sometimes have a significantly lower rate of MRSA than this country. We are also trying to improve the design of hospitals. All of that is under way, in addition to introducing extra staff and resources.

Mrs. Browning: I cannot let the Secretary of State get away with suggesting that I said that there should be targets. In the 1960s and 1970s, we did not need targets to maintain good practice on hospital wards. It was achieved through management, procedures and training. That does not require the setting of targets.

Dr. Reid: I merely point out to the hon. Lady, with great respect—this in no way diminishes her
 
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contribution to the national health service at that time—that the aggregate rate of hospital-acquired infections in the 1960s and 1970s was exactly the same as today, and perhaps higher, according to the advice that I am given. The problem is that, within that aggregate total, some of the bugs that we are fighting are more and more resistant, with dreadful consequences.

Mr. Mark Francois (Rayleigh) (Con): Like many other Members who have participated in the debate, I have had casework involving MRSA, so this issue is also important to me. In the event that an infection control team makes a formal recommendation to close a ward because of a serious infection on it, and there is a tension in the hospital management because that may affect waiting lists, should the advice of the infection control team take precedence and the ward be closed?

Dr. Reid: I do not know the specific example to which the hon. Gentleman refers. If he asks me about general principle, clinical priorities and clinical need take precedence over everything else. That is the nature of the national health service. That is why the position on waiting times and waiting lists is determined by clinical need. That is why, on the four-hour target for accidents and emergencies, if a doctor says that a person should stay for more than four hours for clinical reasons, we allow that, and it is not counted. There should be no doubt about that. He will understand why I cannot comment on a specific example, the details of which I do not know. As a general guide, however, all of us in the House would agree with the proposition that clinical need should guide the actions of those who work in the national health service.

We agree that more needs to be done. As the recent National Audit Office report recognises, however, our work has moved infection control up the NHS agenda with a priority that no previous Government have given to it. That is precisely why there is public debate on the issue at present. In July, we introduced the new objective—the new target—on which I know that Opposition Members do not agree, although God knows how we are supposed to get rid of MRSA by removing as an objective of the NHS the combating of MRSA. That seems a perverse logic, but it is the logic of their position.

That will not improve patient safety; it will do the opposite. We know that having an objective, a target, according to which managers, staff and hospitals are judged when information is issued to the public, must ensure that the issue is given greater priority in the NHS and in hospitals. The National Audit Office report concluded that the introduction of mandatory MRSA surveillance raised the profile of infection control not just with staff on the wards, but with senior managers. We expect the new target to operate in a similar way.

Let us briefly consider the alternatives that have been put to us. I have explained to the House that the aggregate number of infections is no greater than it has been for 50 years. The first misrepresentation of the position is the claim that it is much greater than it was; the second is that the problem is entirely due to the fact that we are treating more patients in the NHS more quickly. I remind the House that the awful length of the waiting lists with which we have to deal must make dealing with them a priority—and also that they are a legacy of neglect of the NHS.
 
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We do run the NHS at a very high bed occupancy rate. That is because it is treating more patients and cutting waiting lists. Of course increased activity means that we need to work even harder to reduce the risk of infection, and that is what the NHS is doing.

We believe that it is possible to be both clean and efficient. We believe that it is possible to achieve targets, and good infection control. The Opposition seem to be arguing—I am sorry if I have gained the wrong impression—that we should keep more people waiting longer to go into hospital, with all the distress, anguish and, no doubt, deaths that that may entail. They seem to suggest that making people wait longer than they should for treatment is, somehow, a logical, fair and effective way of combating the increase in MRSA and other hospital-acquired infections.

Let me say to the Opposition that people should not be made to choose between lingering in pain and increasing the risk to their health by remaining on a waiting list, and going into hospital more quickly than is normal and incurring a risk of contracting MRSA. As I have said, we believe that it is possible to be clean and efficient, and we must ensure that that is achieved.

We will be actively helping NHS staff to achieve the aims specified by the chief medical officer in "Winning Ways". The requirement for each trust to designate a director of infection prevention and control does not mean the creation of another bureaucrat, as the caricature suggests. No additional post is being established. What we are saying is that responsibility must be taken at the top, rather than trusts passing it down to the nurse at the bottom.

We know that health care-associated infection is a vitally important subject—an issue of great public concern. We are tackling it. We will restore patients' confidence that NHS hospitals are clean, safe environments with infection firmly under control. Our approach is the same as it has been throughout. We are increasing capacity and reducing waiting times, and we are confident that clear objectives and a sustained management focus will achieve results.

This is, however, a complex issue, which does not lend itself easily to populist, or popular, instant solutions. It is complex in medical terms, and it calls for the hard work and care that are the hallmark of NHS staff. It will only be solved by extra capacity and by newer hospitals, better design, more research into drugs, more nurses and shorter waiting lists. All those things are just as essential as the key issue raised by the hon. Member for Tiverton and Honiton (Mrs. Browning)—that of cleanliness and hygiene.

The problem will not be solved by party-political rhetoric from the Opposition, from me, or from anyone else. I began with a long quotation from a Conservative, which I thought quite apposite and fairly balanced. Certainly the problem will not be tackled by the introduction of charges, a reduction in the number of doctors or the taking of money from the NHS. Nor will it be helped by a constant backdrop, or refrain, of criticism of NHS staff who are trying to perform a very difficult task—and, in my opinion, succeeding.

That is why the Government will reject all those options and will continue to give the support, staff, money, capacity, resources, research and guidance on hygiene and cleanliness that is required to improve all
 
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our hospitals. If we achieve a sustained reduction in hospital-acquired infections, that will be for the first time not only under this Government, but in 50 years. The project is therefore worthy of common support and effort across the House, and I thank the Opposition spokesman for giving us the opportunity to exchange ideas on constructive ways to tackle the problem.

5.30 pm

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