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Mr. Paul Burstow (Sutton and Cheam) (LD): I, too, am grateful for this opportunity to debate a very important issue. As has been suggested, much of what we are referring to in respect of controlling infection and tackling MRSA and other infections in hospitals is not rocket science. It is basic, scrupulous attention to hygiene and cleanliness—basic good practice.
Often bandied around in debates such as this, in the press and elsewhere, is a figure that has been around for quite a few years, and which was cited in the first National Audit Office report in 2000. Every year, the death toll arising from infections acquired in hospital is about 5,000. An additional 15,000 people may well die as a result of infections, but that figure is even less hard than the 5,000 figure. So since 1997, about 35,000 people have lost their lives as a result of infections that they picked up in hospital.
The Secretary of State was right to rehearse the fact that this phenomenon did not commence on the first day of the Labour Government in May 1997; it has been with us for a long time. However, that is not an excuse or reason not to do more now to address a problem that many of our constituents still feel is not under control. The truth is that we do not know the scale of the problem. The Secretary of State gave various figures, many of which are based not on the mandatory systems of surveillance that I acknowledge the Government have introduced, but on estimates. I hope that, after the debate, he will place in the Library all the calculations and the basis for those estimates, so that we can consider the figures objectively and in the clear light of day. It would be useful to see precisely how some of them were arrived at.
It is worth considering some of the research published over the last few years. I shall cite one or two examples, not least of research that was undertaken and published by the Public Health Laboratory Service, as was, in 1999. It found that patients who pick up health care-acquired infections in a hospital tend to stay in that hospital for about 2.9 times longer than a patient who does not suffer from such an infection. So those beds are being occupied by people who, had they not acquired an infection while in hospital, would not be occupying them. Those beds could be being used by other patients, so capacity is being wasted in the NHS because of poor practice. On average, the stay of a patient who has acquired an infection in hospital is an extra 14 days, according to the 1999 research. It also estimated the cost of the additional treatment required as in the region of £3,000 per patient. No wonder the NAO estimated the cost of hospital-acquired infections as being £1 billion.
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In his response to the official Opposition's motion, the Secretary of State gave no indication of what the Government intend to do to address the NAO's criticism of the Government and the NHS for failing, since the NAO's first report in 2000, adequately to address the lack of an estimate of the cost of hospital-acquired infections. The figure in that report is still the only one that exists, and it would be useful to know whether work will be done on that.
The Secretary of State said that at any one time, nine in every 100 patients are likely to have a hospital-acquired infection, but that information dates back to 1996; we have no up-to-date figures. Probably the most surprising figure—again, it comes from the 1999 PHLS research—is that, after factors such as age and diagnosis have been taken into account, a person who acquires an infection in hospital is 7.1 times more likely to die in hospital than someone who is not suffering from an infection.
We must show that we are taking the issue seriously, without spreading alarm and despondency, but in a realistic way.
The Secretary of State cited various figures, but we have no information on the actual number of deaths—the figure of 5,000 is based yet again on estimates. We do not have an accurate and reliable way of collecting the information, and the death certificates themselves do not include it. What plans do the Government have to commission the specific research that would be necessary to determine how much MRSA and other health care-acquired infections contribute to the likelihood of patients' dying and how many die annually? It would be useful to get a true fix on the problem.
Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): I am having slight difficulty in following the hon. Gentleman's point. Obviously, additional statistics can always be helpful, but surely we do not require statistics to demonstrate the common-sense point that a hospital-acquired infection can hardly be conducive to a patient's health and should therefore be avoided at all costs.
Mr. Burstow: I do not think that there is any dissent anywhere in the Chamber from that self-evident point, but there is concern about the rising figures and the considerable number of people who die, and it would surely be sensible to ensure that we have sound, reliable data that can be used to reassure people that the NHS is a safe place to get treatment, as sometimes it is portrayed as far from that.
The spotlight in these debates tends to focus on MRSA, but as the Secretary of State acknowledged, other bacteria can and do wreak havoc in our hospitals. The NAO rightly covered all the infections, and the motion, which frankly is a good summary of the NAO progress report from July, identifies a number of the criticisms but does not move the debate on much.
The NAO report makes depressing reading. It found that progress by both the NHS and the Department of Health in getting to grips with the infections was patchy: there was some good progress by individual trusts, and the Government had made positive responses to some of the recommendations in the 2000 report, but the picture was not consistent. The Department has issued reams of
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guidance to the NHS on the control of infection, and the chief medical officer, in "Winning Ways", said that the Healthcare Commission
"will be asked to make infection control a key priority when assessing hospital performance".
However, that does not mean that the commission will publish a national report on infection control and hospital infections. Indeed, there has been no national audit of compliance with infection control standards in the NHS and Health Ministers have confirmed in writing to me that the Government have no plans to undertake one.
When I undertook my own survey of the NHS a couple of years ago to find out how trusts were doing in undertaking compliance with the guidance that had up to then been issued by the Department, I was passed a copy of an e-mail sent to press officers in NHS trusts by the Department's press office. It said:
"Dear colleagues,
You may wish to be aware that the following is the Department of Health's 'line to take' for our press office to respond to enquiries about completing this questionnaire survey. I would be grateful if you could let me know if you are dealing with any enquiries from your professional colleagues."
"A Health Service Circular which set out a programme of action for the NHS on the management and control of Hospital Infection was sent to all hospitals in England in February 2000. A revised 'infection control' controls assurance standard, issued in October 2001 and national standards of cleanliness for the NHS, issued in April 2001, together cover many of the questions in Paul Burstow's survey. In addition, both the Patient Environment Action Team visits and the Commission for Health Improvement regular review visits assess hospitals against both standards and publish their reports.
The Department is mindful that the NHS should not be overburdened by responding to requests for information"—
"from a variety of sources".
What really puzzled me was that, having asked written question after written question and having been told time and again that the information was not held within the Department, it was surely not unreasonable for an MP to try to seek the information at a more local level. The message seemed to be that ignorance was bliss.
When "Winning Ways" was published last December, the chief medical officer provided a possible reason why the Department was not keen on my survey. What he had to say then was:
"Despite the extent of the guidance issued to the NHS, such data as are available show that the degree of improvement has been small."
Surely ensuring compliance with the guidance issued by the Department of Health over the last few years should be a matter of concern to Ministers. The Secretary of State says that the guidance is a key part of driving improvements forward from the centre, but how can the centre be confident that it is happening if it is not auditing compliance on the ground?
The Secretary of State also talks about a target for reducing MRSA bloodstream infections. Quite apart from our arguments about the Government's obsession with targets and tick boxes, infection control professionals are expressing some serious concerns
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about the Government's target. The Infection Control Nurses Association told me that the method of collecting data in connection with the target is seriously flawed because it fails to exclude patients who acquired their infections in the community—in care homes and elsewhere—or at other hospitals. It also compares infections acquired in a given year with the bed data for the previous year, which makes it hard to get a proper fix on whether or not performance is improving. If a trust already has a low infection rate, the target penalises it most unfairly—typical, perhaps, under this Government. The focus of the target is solely on one bacterium—MRSA—and it excludes all other organisms that can and do cause problems in the NHS.
Other resistant bacteria also pose a threat, which is why it is important to have information about them. Currently, however, there is no requirement to undertake surveillance and report on those other infections. The matter has already been debated across the Dispatch Box, but it needs to be repeated. Back in 2000, the National Audit Office made some very important recommendations about the need for a clear picture—not just nationally or trust by trust, but in relation to specialties. As paragraph 3.3 of the NAO progress report of July this year states, there is
"still a lack of robust information on the majority of infections at both local and national level. As a result it is still not possible to say whether there has been any tangible measurable progress."
It went on to point out that its original recommendations had made it clear that there should be
"specialty specific surveillance of bloodstream, surgical site and urinary tract infections"
and that such information should be "fed back to clinicians".
I heard what the Secretary of State had to say about the advice he was given about whether moving forward with mandatory surveillance should be the first priority, but I am puzzled that in the NAO progress report of July this year, the Department's concerns and the reasonings behind its introduction of mandatory surveillance across trusts were not rehearsed. That is most puzzling; there must have been discussions at official level. Perhaps when the Minister replies to the debate, he can explain why the Secretary of State's explanation offered today was not covered by the NAO in its progress report earlier this year.
Paragraph 3.11 of the report continued:
"The main concerns on mandatory MRSA surveillance were that the denominator data was inappropriate as it was collected across the whole hospital, and as a result, clinical staff did not relate to it, and trust management considered it to be a problem for the infection control team rather than clinicians."
Surely that is the key theme: there must be a feedback loop to the clinicians so that they can identify where the problems are and start to make the necessary changes. At the moment, the system does not offer the information necessary to do so. That is why putting something along the lines of the NAO recommendations in place should surely be a priority for the Government. I have heard nothing yet about the degree of urgency that the Government attach to that.
My survey produced at least anecdotal evidence that MRSA and other hospital-acquired infection patients are often treated on wards because of a lack of isolation facilities and staff. There are Government guidelines on
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the management of patients with infections and they recommend the use of isolation facilities for certain infections.
However, the guidance admits that the provision of isolation facilities and single rooms in NHS hospitals is sadly lacking. It states:
"Experience has shown that many hospitals find the present allocation of isolation-single rooms inadequate to deal with the increasing numbers of infected and immunocompromised patients. Hospitals with 10 per cent. of their bed contingent as single rooms often find that this number is inadequate to cope with every infectious patients. Where this is the case, risk assessment is used to inform decisions regarding patients to nurse in single rooms."
I asked some parliamentary questions to find out where the Government had got to with their programme of expanding the numbers of single rooms so that there was more scope for isolation. Ministers have stated that NHS trusts were individually responsible
"for determining the level of provision of isolation and single rooms."——[Official Report, 19 September 2002; Vol. 390, c. 407W.]
I was told that the Government circular relevant to this matter
"required trusts to undertake a risk assessment to determine the appropriate provision of isolation facilities within each trust"——[Official Report, 2 February 2004; Vol. 417, c. 687W.]
However, surely Ministers should not be in the dark about the progress being made in this matter, or about the level of front-line preparedness to deal with hospital infections. Surely, that knowledge is essential if they are to cope with threats such as severe acute respiratory syndrome. In his strategy for combating infections, the chief medical officer stated:
"NHS trust chief executives will ensure that, over time, there is appropriate provision for isolation facilities within their healthcare facilities."
I asked Health Ministers, in questions, how that was going. I was told:
"As the creation of new isolation facilities is generally linked to local plans for rebuilding and refurbishment it is not feasible to set a national timetable. Over-time is not specifically defined but provides flexibility for chief executives to implement realistic, timed work programmes for isolation facilities."—[Official Report, 12 March 2004; Vol. 419, c. 1819W.]
The Government talk about providing more isolation facilities, but they do not have a grip on what is going on on the ground.
This is an important debate about the Government's record after seven years in office. The Secretary of State has told us that the estimates show that things have not got better, and that we still have a serious problem with infection. He has made it clear that the Government have not acted on all the recommendations in the NAO report. The case that he made on surveillance is not sufficient justification for not getting clinicians into the loop.
Reference has been made in the debate to Florence Nightingale. However, this is not rocket science. It is a question of scrupulous attention to basic hygiene, such as hand washing. It is about effective screening, robust surveillance, and giving clinicians the information that they need to adapt, and to learn from mistakes. None of that is present in the Government's approach, and that
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is why we must relearn the lessons that Florence Nightingale taught more than 140 years ago. In that way, we can start to reduce the death toll in the NHS.
5.47 pm
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