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Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): As has been noted already, the issue of hospital-acquired infection is an extremely important topic. However, the Opposition have attempted to skew the debate to make a narrow party-political point. They want to use hospital-acquired infections to support their proposition that we should get rid of targets in the NHS, and in particular those for waiting lists.

I have never been asked by any constituent to get rid of targets for waiting lists. They are very keen on them, because they want waiting lists to be reduced, and they need the targets to make sure that that happens. However, the logic of the Opposition's approach is that, to reduce the incidence of hospital-acquired infections, we have only to reduce the number of people treated in hospital. It is indisputable that treating fewer people would reduce the rate of hospital-acquired infections, but the consequence is that more sick people would remain untreated and would ultimately die from their untreated conditions. The Opposition's position on this matter is therefore completely fallacious.

A year or so ago, my own hospital, Milton Keynes general, had a serious problem with hospital-acquired infections. I would argue that that was because the hospital's bed-occupancy rate was incredibly high, mainly due to the fact that the hospital was too small for the population that it serves. That remains so, despite the large numbers of additional beds that have been provided as a result of funding by this Government.

Primarily, the hospital is too small because for the 10 years before 1997, when the Conservatives were in charge, no extra beds were provided, despite the fact that the population was growing by between 2 and 3 per cent. every year. It was undercapacity that added to the problems contributing to the high rate of hospital-acquired infections, rather than our policy of at least trying to use existing capacity to the ultimate to treat patients, and encouraging hospitals to do that by publishing targets that they were supposed to meet for waiting lists.

The second point in the Opposition argument was that the Government were not giving NHS staff enough freedom to take the measures necessary to deal with infection. I notice that the Opposition did not really produce any evidence for that claim—I have to say that their evidence is not strong. What they suggest is complete rubbish and, again, I cite examples from my hospital.

About a month ago, the Secretary of State visited Milton Keynes general hospital and I was able to be there, too. One of the conversations that he held was with a senior nurse about the measures that staff had put in place to try to deal with the problem of hospital-acquired infections. The senior nurse had responsibility for co-ordinating the policy and he described all the steps that had been taken, which indeed are not rocket science but had been learned from experience elsewhere. The staff did not feel constrained in the slightest in taking the initiative to implement those measures, either by the Government's policies or by our waiting list targets.
 
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It is complete rubbish for the Opposition to suggest that removal of targets would make staff freer to act. It would make no difference to their implementing sensible policies for disease control. However, removing targets would make a real difference to the number of patients who are treated, to the service provided to my constituents and to the pressure on everybody at the hospital to continue to drive up standards across the board.

My final point is about the impression that the Opposition have tried to give that hospital-acquired infections are new and growing phenomena, and that they are somehow a consequence of the Government's policies on NHS targets. Hospital-acquired infections are not new. Indeed, I can give an anecdote from personal experience. As a very young child, which was several decades ago, I was in hospital for a considerable time and during my stay I acquired every childhood disease that one could catch in a small period of time. The advantage was that when I finally left hospital, cured of the orthopaedic condition for which I had gone in, I no longer had to worry about catching childhood diseases because I had natural immunity to every single one of them. I cite that merely as a truism that everybody knows: hospital-acquired diseases have always been a problem. In part, they are a problem because people in hospital are, by definition, not in the best of health. They are more susceptible to infection; many of them bring infection in with them and they are in an environment where infections, even with the best methods of control, are unfortunately more likely to be passed around than outside.

These days, there is an additional problem. Because more people are being treated outside hospital in the community, hospital populations are more ill than they used to be, so that in itself is likely to mean that patients are more susceptible and that cross-infection is likely to be greater. Furthermore—a reason that has been ignored completely—there has been a rise in antibiotic resistance, especially multi-drug resistance, which does not only concern practice in the UK. Unfortunately, such resistances spread between countries. There is irresponsible practice in antibiotic use worldwide. Antibiotics have been used for conditions that were not serious enough to warrant them. In this country and elsewhere, they have been doled out by GPs, possibly due to untoward pressure from patients, to treat conditions where the patient should have been told to go home because the infection would clear up. Members of the public also use antibiotics irresponsibly when they do not finish the full course.

The most extreme case of irresponsible public use of antibiotics, not in this country, is the well-known example in south-east Asia, where prostitutes treated themselves with low levels of penicillin, as a prophylactic, to try to protect themselves from sexually acquired infection. All that they managed to do was to turn themselves into incubators for drug-resistant venereal diseases, not only to the huge detriment of themselves, but to the enormous detriment of everyone else.

Such practices have led to the unfortunate situation where an increasing number of infections are now resistant to all the common antibiotics. That is the really serious problem, which has led to added pressure on our hospitals and other health resources, so we must have
 
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even higher standards of hospital hygiene than in the past to ensure that those problems do not get out of control. I very much regret the fact that the Opposition have used this very serious topic simply to make the party political point that they want to get rid of targets and waiting lists. That is a complete diversion from what we ought to be discussing, and they should be much more responsible on such issues in future.

5.56 pm

Mr. Simon Burns (West Chelmsford) (Con): A number of hon. Members and the Secretary of State have stressed the importance of cleanliness in the hospital environment in seeking to tackle the growing problems of MRSA in our hospitals. I certainly accept that that problem cannot and will not be eradicated overnight, but efforts naturally have to be made to ensure that more is done to minimise and reduce the incidence of the problem, and I believe that cleanliness in our hospitals is a key factor in achieving that.

During my brief remarks, I should like to highlight my own hospital, Broomfield, which is part of the Mid Essex hospital trust. The hospital was the subject of an article in the British Medical Journal earlier this summer because it has managed in a relatively short time, using excellent practice, to eradicate infections completely on the one ward—I emphasise that it is one ward, not the whole hospital—where the problem was growing. I refer to the orthopaedic ward.

In 1998, the orthopaedic unit was moved from a dedicated orthopaedic hospital to a district general hospital—Broomfield—and a dramatic increase in the incidence of patients on the elective ward who acquired MRSA was noted. In 1996, before the transfer, there were three new cases of MRSA on the elective ward. By the year 2000, after the transfer, the figure had increased to 29.

Staff on the orthopaedic ward analysed the situation and came to the conclusion that the increase was associated with elective orthopaedic beds also being used indiscriminately by emergency patients. To test their conclusions, they started to follow the British Orthopaedic Association guidelines and separate elective from emergency work, introducing an MRSA-free zone. Strict admissions criteria were introduced for elective orthopaedics. No inter-hospital transfers were allowed. All patients due to have elective orthopaedic operations were screened at a pre-admission clinic, and any positive patients were given eradication therapy and admitted to one of the trauma wards for surgery, rather than to the elective ward. The practice of admitting day cases to the elective ward was stopped.

In addition to the standard precautions, a strict code of dress was instituted so that nursing staff wore disposable aprons and gloves for each interaction with patients; alcohol hand rub was installed by every bed—and staff had to use it before and after every consultation; medical staff had to leave their jackets at the door to the ward and wore clean white coats that were washed regularly; and visitors were not allowed to sit on the beds.

The results of those procedures were dramatic. In the year before ring-fencing, 417 lower limb arthroplasty operations were carried out; in the year after, there were 488—an increase of 17 per cent.—without any increase in theatre capacity or the number of beds.
 
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But the total number of all infections in post-operative patients fell from 43—nine of which were MRSA—out of the 417 cases, to 15 out of the 488 cases, with no cases of MRSA.

It must be emphasised that that achievement is confined to the orthopaedic ward, because there has been some confusion, to the detriment of the local hospital, about whether MRSA has been eradicated in all the wards. That is not the case. However, the example shows that if proper procedures are adopted and rigorously enacted, they can have a positive and dramatic effect on the problem. I congratulate the nurses, doctors and consultants, as well as the management of Broomfield hospital. They have introduced a positive procedure that should be studied by other hospitals in the NHS so that it can be emulated and copied to reduce the incidence of MRSA.

6.1 pm

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