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Westminster Hall

Wednesday 13 October 2004

[Mr. John McWilliam in the Chair]

MRSA (Hospitals)

Motion made, and Question proposed, That the sitting be now adjourned.—[Ms Bridget Prentice.]

9.30 am

Mr. John Lyons (Strathkelvin and Bearsden) (Lab): May I first say how grateful I am that MRSA has been chosen as the subject for discussion today? I welcome the opportunity to open the debate and thank colleagues for participating in it. It is important for me to put on record our sympathy and condolences to people who have been affected by MRSA. The National Audit Office has reported that about 5,000 people a year are killed in hospitals, a fact that is obviously of major concern to politicians, staff and, of course, patients. It is creating a situation in which constituents throughout the country are now worried about even going into hospital, something that we must take on board and change. We can do that only by improving the problem of MRSA in all acute trusts in the United Kingdom.

The NAO's excellent report deals extensively with MRSA. The point of the debate is not to blame particular staff in any part of the UK. We commend staff who are battling each day against MRSA. By staff, I mean not only clinicians and nurses, but cleaning and catering staff who are trying to improve the way in which they work. We can strengthen that effort by saying continually that cleaners, catering workers and porters are every bit as important as the clinicians and nurses. They all form part of an effective staff team in hospitals, a point that we must reinforce.

Furthermore, when we discuss MRSA, there is always an attempt to make political capital from it, something that we must resist today. The problem of MRSA is not down to a Labour Government or a Conservative Government; it is not about politics. It would be a tremendous mistake for people to play a political game with MRSA. It is far too important for that. The only political point that I want to make is that when sisters, matrons and nursing staff are asked what they feel about MRSA, they say that are unhappy about not having control of cleaning staff. Cleaning is a central and crucial issue in the fight against MRSA.

Surveys carried out by the Royal College of Nursing and other organisations have highlighted the fact that they would like control of cleaning to be in the hands of ward sisters and matrons, so that they can determine the level of cleaning and when, where and how it is carried out in conjunction with the cleaning management and its staff. That is a central point. The problem arises because of contractors. Sisters and matrons have no say in the cleaning of wards by contractors, and that is a major mistake. If hospital staff want more cleaning to be carried out, they are told that it cannot be done because it is not in the contract, so they must accept a level of cleaning that they may consider inadequate and poor. We must discuss that issue. I want to see the removal of
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contractors from hospitals. I want sisters and matrons to have control of the cleaning staff so that they can determine the level of cleaning in a ward or other parts of a hospital. Such practice would not be going against contractors, but would give control to an in-house cleaning team and the nursing and clinical staff who work with it. It is as simple as that.

Dr. Andrew Murrison (Westbury) (Con): I have been following the hon. Gentleman's remarks with great interest. What would he say to the spokesman at the Department of Health who said this week that there was no correlation between the contracting out of cleaning and the incidence of MRSA?

Mr. Lyons : I am not an expert, so I do not know whether there is a correlation. All I am saying is that, even in those hospitals where there have been improvements, nursing staff are deeply unhappy about the fact that they cannot be involved in the issue of cleaning. We will never overcome the problem in the longer term if we do not deal with cleaning because it is central and everything else depends on it. I am only reflecting the survey evidence from nursing staff who feel strongly about the matter.

Jim Sheridan (West Renfrewshire) (Lab): There may or may not be a direct correlation between the contracting-out of services and the lack of proper cleaning in our hospitals, but does my hon. Friend agree that when services are contracted out we bring in people on extremely low wages and with poor conditions? At the end of the day, one gets what one pays for, as I know from my own practical experience.

Mr. Lyons : My hon. Friend is right, and I thank him for that point.

All I am saying is that in a busy ward or intensive care unit nursing staff may feel that extra cleaning is needed from time to time to try to keep on top of any problems, and I commend them for that. However, it is important that the cleaning staff and others are able directly to respond to that request. The last thing that we want is clinicians and nurses making requests that can be denied because of contract arrangements. That is a major mistake.

I want to put on record my thanks to Stephanie Dancer, a microbiologist in Glasgow, for her advice on MRSA when I was preparing for this debate and, above all, for her dedication to the NHS and its staff. She works enthusiastically, day by day, to try to combat MRSA in every possible way.

I shall try to be brief because a number of hon. Members want to contribute and it can only assist us if more people are involved. I have said before that the historical context is simple: MRSA has been around for a long time. It has existed, and increased, under Conservative and Labour Governments. That is a fact of life and there is no political point to be made. I congratulate the NAO and Sir John Bourn on the first-class report that they produced in July. It deals with the matter in a balanced way and encourages best practice where it exists, but tackles the issue of acute trusts and others who are falling down when dealing with MRSA. As I said at the outset, 5,000 lives a year are involved at a cost, according to the NAO, of £1 billion a year to the NHS.
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Some Members of Parliament have gone on record as saying that this is a major political issue and should be a central debate during the general election. They are playing politics, and it would be better if they looked after the general hospital rather than the prospects at the general election. Such comments are untimely and undermine the fight by staff to try to reverse the trend of MRSA in some of our acute trusts.

One point in the NAO report that I support and commend is that on inspection. The situation in the UK is patchy. There have been major improvements in dealing with MRSA, but some parts of the UK seem to have been unable to reverse the increasing trend of MRSA in their hospitals. We need an independent watchdog to keep the pressure on acute trusts from year to year to ensure not only that they are talking about making improvements but that they are actually making physical improvements, producing results and achieving more than just statistics. People must be able to see that there has been an improvement in their trust. I am sure that we all know the story of our own local trusts and what they are doing and not doing.

I want to concentrate on four issues: hand hygiene, antibiotic prescriptions, hospital cleaning and rapid testing for MRSA in hospitals. In recent years, hand hygiene has become critical for staff in acute trusts and other parts of the health service. It is an issue for everyone: clinicians, including consultants, nursing staff, catering staff, and cleaning and portering staff. No one can be exempt from the need for clean hands when dealing with patients and equipment. It is clear that equipment in hospitals, and wards in particular, carries MRSA, and we need to reinforce that point. Good practice exists in some trusts, but others need to up their game: they need to do more and make major improvements. Basic cleanliness can stop the spread of MRSA. It is not a recommendation; it must be a common obligation on staff. No one is exempt from hand cleaning and hand hygiene, and everyone needs to heed that message.

The NHS is doing a lot of work on hand hygiene; for instance, it is introducing alcohol-based gel dispensers, for which I salute it. Those are working very well, and we need to ensure that they are not just a flash in the pan, but a persistent and consistent part of cleanliness in our wards throughout Britain. The position is best summed up by Mr. James Johnson, the chairman of the British Medical Association, who said that is has become

He continues:

His words should become a watchword in every trust in the country.

Mrs. Patsy Calton (Cheadle) (LD): It is not just medical staff and people from the hospital who come into contact with patients; it is also visitors and relatives. I would be happy if the hon. Gentleman included them in the list of people who need to be careful about hand hygiene.
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Mr. Lyons : I thank the hon. Lady for that point. When I was preparing for this debate, a number of MPs came to me and said, "John, it's all very well talking about the staff, but the whole question of patients needs to be addressed, as well." To be fair, the Patients Association is trying to reinforce the message. Whether we like it or not, visitors to hospitals carry MRSA. People go into a ward—I have been in one myself recently—and sit on the bed. There is all sorts of contact that one would think inappropriate in that situation. There is a need not only for discipline among staff, but to ensure that visiting becomes part of the hygiene regime.

Mr. Russell Brown (Dumfries) (Lab): The general public feel that if there is a family member or a friend in hospital, it is their duty to go and visit them, perhaps even if they do not feel 100 per cent. fit themselves. They may carry germs and illnesses into the hospital. Does my hon. Friend agree that that is the wrong kind of environment for such a person to go into?

Extended visiting hours also cause a problem. In my local hospital, people can visit some wards from 2 in the afternoon until 8 in the evening. That sounds fine, but in reality it cuts down on the time available to cleaners to do their job properly in the wards.

Mr. Lyons : My hon. Friend makes a valid and important point that trusts need to recognise. Hopefully they will acknowledge it in the regimes that they are establishing in their hospitals.

I am not an expert on antibiotics and their prescription, but there seems to be growing evidence among professionals and microbiologists that we need to do something about those that are being used to fight MRSA. Some of the antibiotics that we have been using for some time are becoming ineffective as strains of MRSA seem to be getting stronger. A review is needed of the antibiotics that have been used and are being used. We need to ensure that the curriculum for undergraduate training includes something about MRSA and the prescribing of antibiotics to fight it. That would give us a major fillip in our effort to defeat MRSA.

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): Does my hon. Friend agree that there is also a need for even greater public education about antibiotics; that the more a specific antibiotic is used the more likely bacteria are to evolve drug resistance; and that the public need to be educated that antibiotics must be used sparingly if they are to retain their usefulness in circumstances where they can save lives as opposed to merely helping us to recover more quickly from minor ailments?

Mr. Lyons : My hon. Friend makes a valid point. As the professionals say quite readily, the consumption of antibiotics may be driving up the incidence of MRSA in some locations.

Clinicians need specialist training on how best to treat MRSA. If there is best practice in one part of the UK, let us share that knowledge to assist everyone in their approach. We must have a full study of possible new treatments for MRSA. Good creams and lotions have
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come on to the market, and we must say to the National Institute for Clinical Excellence that we need to fast-track those inventions to ensure that we tackle the problem on all fronts. I hope that that can be done quickly.

It is not only MPs and politicians who worry about antibiotics but specialists, microbiologists and clinicians. Steve Davis, microbiologist and specialist adviser to the Institute of Biomedical Science, has highlighted the problem whereby some antibiotics that have been used in the past are no longer strong enough to defeat MRSA. We must review the entire strategy for recommending and prescribing antibiotics in order to provide not more but better antibiotics, to try to reduce antibiotic use in acute trusts.

Cleaning is a central issue, and we will make no improvements until we deal with it. Evidence from an RCN survey showed that 42 per cent. of the nurses questioned highlighted the use of agency cleaners as a problem, and they also mentioned inadequate cleaning of hospitals. Some 49 per cent. thought that the use of agency cleaners was one cause of the rise of the superbug. We must ensure that we reflect the views of professionals who are on the wards day to day trying to deal with this issue.

Anne Picking (East Lothian) (Lab): I am sure that my hon. Friend remembers the time, when I was part of the NHS, when the cleaning staff were part of a team and they felt part of a team. When they come in from an agency and are viewed merely as a member of the cleaning staff, they do not feel part of that team. They do not feel the same obligation, and sometimes they do not have the proper materials to do the job as well as they could. I found that when the cleaning and portering staff were part of the whole team, they did a better job. Does my hon. Friend agree?

Mr. Lyons : I do; it is important to give staff proper recognition. We all know from our constituencies that if we do not have decent cleaning staff in our schools we face major problems, and it is the same in hospitals. Cleaners need to feel part of the staff, and progress is being made on that , but we must do more so that they feel part of the clinical collective on the ward who are fighting MRSA and helping the patients whom we represent.

This issue is not just about the management of the ward, or the sister and the matron. We must ensure that there are adequate numbers of cleaners, that there is adequate time for cleaning and that there is flexibility in the cleaning team. If a sister, staff nurse or matron thinks that a ward needs a deep clean, she should be able to make that decision along with the clinicians and not be told, "I'm very sorry but that's not in the contract so you can't have it." Health service staff need that flexibility 24 hours a day, seven days a week, 52 weeks a year. There is a serious concern that we get to Friday and think that we can lower our guard on Saturday and Sunday. I am saying the opposite: the standard of cleaning that we have from Monday to Friday is needed over the weekends as well. We need to make sure that we have 365 days a year of best practice in every hospital.

The chief medical officer, Sir Liam Donaldson, said:

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Of course they do; that is the central thrust of my contribution today. The evidence is good in some areas and patchy in others.

This debate is not about pointing the finger; it is about encouraging some hospitals to become more focused and to match the best practice in others. There are brilliant examples of best practice, where people have been totally focused. This debate is about commending staff, saluting their work and helping patients, but it is also about telling others that they need to be more focused and determined in fighting MRSA so that we have good practice throughout the UK.

We need a better system of identifying MRSA. At present, it takes something like 48 hours for most acute trusts to identify it. It may take even longer if someone is admitted late on a Friday and the hospital has no facility to identify the infection over the weekend. We must change that. We need services to be available every day to clinicians, microbiologists and others involved.

We need to consider capital investment in equipment that can do that work for us. The Chancellor has produced billions of pounds for the health service; we all know that, and give it due recognition. The beauty of the polymerase chain reaction equipment, which can cost £40,000 or £50,000, is that it will give a result on MRSA in an hour, and it would be a valuable investment for any location. People may say that that is expensive. I think that the money is there, but trusts need to prioritise spending and see that that would be a good way of working. Perhaps NICE can look at that and make a recommendation. At the end of the day, the quicker we can identify MRSA, the quicker clinical staff can take decisions about the isolation of the person affected and protect high-dependency and high-risk patients.

I ask Members to use this debate to be constructive about what is happening in our hospitals, but at the same time—and without being overly critical—to say that we need more from hospitals that are not doing enough. As I said at the outset, I commend staff. They are doing an excellent job in some locations, but we need others to be more focused so that we can now build on the improvement that has been achieved and defeat MRSA.

9.53 am

Mr. Archie Norman (Tunbridge Wells) (Con): I congratulate the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) on instigating the debate and making a knowledgeable and constructive speech, with almost all of which I am in agreement.

MRSA is not just a serious problem today, but a growing one. The incidence of MRSA has grown rapidly in the past 10 years, and some experts believe that if we do not take action it could double during the next five or 10 years. Obviously we hope that that does not occur. MRSA is clearly a serious and central problem, which will reward investment. It is important to remember that the cost of MRSA to hospitals at the moment is very great. That is not just the cost of treatment; it involves bed occupancy and a cost to patients and patient lives.

Although I do not believe that capital investment is the key to the problem, all the evidence is that investment in MRSA control procedures will save money for the NHS. Some hon. Members will have read
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the article in the British Medical Journal this July which outlined the experiment in Chelmsford where intensive steps were taken to manage MRSA in particular wards. One interesting thing about that experiment, although it is hard to draw generalised conclusions from it, is that a 17 per cent. increase in the throughput of patients was achieved as a consequence of that control.

What is striking is that the incidence of MRSA is very variable, and that is the main theme of my contribution. The incidence varies widely between countries—we know that this country has a very high incidence, possibly the highest—but it also varies between like-for-like hospitals in the NHS. Indeed, it varies within hospitals. In my local trust, the apparently modern facilities in Maidstone have a high incidence of MRSA, and, curiously, the old-fashioned facilities in Tunbridge Wells have a low incidence.

It is also clear that the incidence of MRSA varies between sectors. For instance, BUPA hospitals report that they have a negligible incidence of MRSA. There are particular reasons for that, and it is clear that they have advantages. However, I am making a point not about private versus public, but about the fact that there is wide variability. That is not the result of scientific or biological factors; it is the result of way in which hospitals are managed.

Many of the factors that the hon. Gentleman mentioned are to do with the approach to cleaning, discipline and the standards of hygiene that run through the hospital organisation. At heart, this is a management issue. From the chief executive downwards—through the consultants, the medical director, the modern matrons and sisters and right down to the cleaners—there must be a set of habits and disciplines and a way of working that are continuously enforced, measured and monitored. People must be rewarded for that way of working and made to feel that they are getting ahead of the problem.

That sort of culture must be created if we are to tackle MRSA. It cannot be done by spraying leaflets and propaganda around the place or by putting up posters. I am not against those things, but they simply are not the solution. I am sceptical about the idea of creating a watchdog or MRSA tsar for hospitals. I honestly believe that that misses the point, which is that the way in which hospitals are managed and operated from top to toe is of central importance.

In the early days of the NHS and pre-NHS—before we had antibiotics—hospitals were obsessive about discipline. One reason for that rather old-fashioned approach, with matrons in starched white uniforms and so on, was precisely that one could not treat hospital-acquired infections with antibiotics. Of course, people have forgotten about that time 50 or 60 years ago, and we cannot go back to that era, but there is a lesson to be learned.

So many of the little things that made up those disciplines have vanished. We can all see that if we walk round a ward. The hon. Member for Dumfries (Mr. Brown) mentioned visitor access. On balance, for quality of patient care and comfort, it is an attractive idea that people can visit their relatives at any time of the day or night. However, it is not a practical idea if one
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wants to regain control of the ward environment. I am not advocating that we go back to strictly limited visitor hours, but sisters, nurses and cleaners clearly say that they need strictly enforced times without visitors so that they can get control of the ward. There must be enough hours when the wards are uncluttered by visitors for the cleaning to be done, for consultants to do their visits, for problems to be cleared up and for patients to be attended to and cleaned.

The sister and nurses on the ward would be able to prepare for visitors' arrival, and visitors absolutely would have to adopt the same disciplines as any doctor or nurse coming on to the ward. There must be hand washing and caution about what they do and do not touch. They must be aware of what they are wearing and their cleanliness when they arrive. Cleanliness must be a total culture. It cannot be something that just one person does. It is not just to do with putting alcohol-based solution around the place. That is a good idea, but it is not enough.

I share the view of the hon. Member for Strathkelvin and Bearsden that if we do not measure the problem, we will not solve it. It is possible to walk into one ward and believe that it is entirely clean, then walk into another ward and think that it is inadequately cleaned, yet find that the latter has a lower rate of MRSA. Cleanliness is not just visual and superficial.

At the moment, far too many of our measures of cleanliness are just that—visual and superficial; for example, the patient environment advisory team inspections, which the Government like to cite as evidence that we have clean hospitals, are basically visual measures and too superficial to measure the incidence of MRSA. That must change because it is clear that those inspections are missing the point. According to the inspections, in 2003 no NHS hospital had a poor cleanliness record, yet we have a continuously rising and internationally high level of MRSA. That cannot be an acceptable measure; it simply shows that we are missing the point and risk reinforcing complacency.

I make the point, which the Minister may want to respond to, that 78.7 per cent. of hospitals were described as having "good" cleanliness records. They do not. That is simply missing the point and it must change. Investment in measuring MRSA incidence and propensity in the wards is required. It means that there must be a more laborious process than simply wandering around and having a look. I recognise that that will be more expensive, but I strongly believe that it will pay off.

I know that we are not meant to be fond of targets in the NHS, but I see no harm in measuring to see whether we are succeeding. That is entirely sensible. For ward sisters to be able to say, "Actually, my ward's done pretty well—last year I had a high level of MRSA and this year a much-reduced one", seems to me entirely reasonable and admirable and a requirement of good ward management.

In that vein, of how to regain control of the ward and how managers can seek to take responsibility, I want to touch on the hon. Gentleman's point about cleaners. I share the view that there is a problem with cleaning contractors in many NHS hospitals. I do not share the view that that cleaners must be employed by the NHS or
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by those hospitals, but I entirely accept that if cleaning is a subcontracted service, it is more difficult, and requires greater effort, to ensure that cleaners are managed as though they were employees. If sisters are to have control of their ward environment, they must have the capacity to clean.

Cleanliness in wards is not a question of a daily routine that can be prescribed in a contract. It is a function of incidents that happen, responses that must be made when patients arrive, or must be moved, perhaps unexpectedly, and when they have accidents or problems. In hospital life, that happens all the time, so if one is responsible for a ward, having the capacity to clean at one's fingertips is critical. That will only happen if there is sufficient flexibility in the contracts and motivation, good will and a sense of teamwork.

I want to touch on that as well. One of the things that concerns me, not just in the NHS, but in many organisations, is the tendency to regard subcontracted functions as delegated-out functions—in other words to think, "They're no longer things that we own. I'm a ward sister, it is subcontracted and is not mine." With that goes a desire to cut cost, which is understandable, and a reduction in status. I strongly believe that cleaning in hospitals must be regarded as a specialist occupation and that cleaners must be regarded as worthy of as much respect as a hospital consultant or chief executive.

Only when we start treating our people that way, and listening to what they say about the cleaning routine and equipment, will we create an environment in which they feel motivated to deliver a better outcome. Whether or not they work for a contractor, cleaners need to be aware of the problems and to be trained in tackling them. They need to know that they have got measures of performance, and that they are part of the team and welcome to come to work. They may be cleaning the floor, but that is a worthwhile job and they make a decent contribution that the team appreciates. All too often, cleaners do the job only because it is a way of earning a daily crust. That is why things will not work.

Jim Sheridan : The hon. Gentleman remains unconvinced that subcontracting-out is the problem. Does he share my experience, which is that in hospitals, including those with contractors, the cleaner is part of the team? They build up a relationship with the nurses and doctors and know exactly what their responsibilities are. That does not exist under subcontracted-out services, because in reality there is a different cleaner in each ward every day. People do not take ownership of responsibility.

Mr. Norman : The hon. Gentleman touches on an important point. One of the great problems with cleaners is that it is a low-status job. They are not involved in a team, and there is limited work satisfaction. They do not feel that they are striving towards a goal and achieving things for patients in the way that other people in the hospital are. That means that those who take up the job are often people who have been unable to find employment elsewhere; as soon as they do, they leave. Work satisfaction and morale are extremely low. That is why the system does not work.

I entirely share the view that if cleaners are rotated from ward to ward, they will not derive any satisfaction from their work. However, the issue on which we are
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touching is whether we can deliver a quality-managed, rewarding role in a subcontracted environment. There are other models—for example, in IT provision and other fields of medicine—in which highly motivated employees operate in a contract framework that allows them to be part of a team. In those models, the contractor is measured not just on whether enough warm bodies turn up every day to clean the floor, but on whether outcomes are delivered, whether there is job satisfaction, and whether the labour turnover is sufficiently low for people to spend enough time in the job learning how to do it.

Mr. Russell Brown : My hon. Friend the Member for Strathkelvin and Bearsden (Mr. Lyons) said that he did not want the subject to become a political issue, but sometimes we cross the battleline on these matters. He commented on the status of the job and the high turnover. I fully appreciate that there will be different situations as regards cleaning operators in different parts of the country, but there are many dedicated cleaning staff. I can only highlight my own locality, where there are people who have worked in the service for 15, 20 or 25 years, and who are dedicated to doing a job that is seen by some people as very mundane—almost as a case of putting in the time in return for money. There will be turnover, but many members of staff—the vast majority, I think—are genuinely dedicated.

Mr. Norman : We are in danger of violently agreeing. It is not my intention to be critical of the cleaning staff that we have; quite the contrary. The way forward is to create a workplace environment in which there can be more of the type of staff to which the hon. Gentleman referred: those who are dedicated because they have great satisfaction in coming to work, and because they feel that they are part of the team and are treated as playing a serious, important role in the battle against MRSA. The issue that we are touching on is whether that can be delivered under a subcontracted arrangement. I am not one to take a dogmatic stance on that; it is an open question. All I would say is that it is not impossible, in my experience, to deliver high-quality performance and to involve motivated employees though subcontractors. It is possible, but it can be difficult.

I will move on quickly, because I am aware that I am using a lot of time. It is important to tackle MRSA holistically, right the way through the hospital management system. That includes not just doctors and cleaners, but the nursing environment. One thing that gives me great concern is that sisters no longer feel that they have control of the ward environment, for some of the reasons that we described. They no longer, for instance, control the access for doctors and consultants as they used to; they no longer feel that they have sufficient control of the cleaning environment. They find themselves tied down with far more paperwork and back-office activities and therefore do not have the capacity to play a commanding front-line role for as much of their time as they would like.

When attacking a problem like this in any organisation, it is central to establish the supremacy of the first line manager, who, in the case that we are discussing, would be the sister. The sister must have
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control of everybody who comes in and out of the ward, and of the disciplines that are applied. That has to be clearly established in the hospital culture.

It is important, too, that we start to think again about the training of some of the nurses. We have moved a lot of nursing training into the classroom and out of the ward environment. There have been steps to try to create a higher status for the nursing profession and for nurses to take up some of the roles previously undertaken by doctors. All those are understandable measures. However, we should never allow the idea that nurses are too important to do the cleaning, which is starting to appear in some parts of NHS hospitals, to become widespread.

At the end of the day, the nurse should be responsible for the whole of patient care, and that includes every aspect of the environment and cleaning. It does not mean that qualified nurses should delegate such activities to unqualified nurses. From anecdotal evidence, it seems that that happens in far too many hospitals today: if cleaning needs to be done or a patient needs cleaning, we look around for an unqualified nurse. Let us remember that we have substantially increased the number of unqualified nurses during the past six or seven years. I think that they make up something like 27 per cent. of the total number, although that figure may have changed.

I urge the Minister to think rapidly about another point touched on by the hon. Member for Strathkelvin and Bearsden: the design of, and access to, washing facilities in hospitals. We are building substantial numbers of new hospitals, and the development of MRSA has important implications for design. One of the reasons why there is not effective hand cleaning today, even in very modern hospitals, is because it is difficult to do. First, the hand-cleaning facilities are out of sight. Secondly, they are 50 or 100 yd away at the other end of the ward. If doctors are moving from patient to patient and visitors come into the ward and there are no visible hand-cleaning facilities, the chances of their missing out on hygiene and hand cleanliness are much greater. It is critical that we should think again about design. If hygiene and hand cleanliness are to be part of the continuous discipline of the ward environment, hand-cleaning, washing and bathroom facilities need to be substantially improved.

The last thing that I want to touch on, although it has not cropped up to date, is bed occupancy levels. If, as we seek to do in the NHS, we run very high bed occupancy levels—for good reasons, for the most part, such as our effort to reduce waiting lists and maintain throughput—the MRSA environment becomes much more difficult to control. Patients are moved from ward to ward to maximise utilisation, and there is a risk of spreading infection as a result. There is not enough time to screen patients as they come into critical wards. When wards ought to be closed down or when extreme cleaning measures ought to be taken, the stress on management to deliver targets—dreaded word—and to accept patients is in conflict with its capacity to take the measures necessary to deal with what appears to be the invisible problem of MRSA, which is unmeasured and lurking behind the scenes.
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I do not believe that there need be a direct conflict between bed occupancy levels and the control of MRSA; it is not as simple as saying that occupancy levels should move down from 85 per cent. to 80 per cent. However, I believe that we should again vest control of the ward environment in the sister and in the chief executive of the hospital. It needs to be absolutely clear that the NHS trust, the chief executive, the line management and the sister are responsible for making such clinical judgments. That is why we have to be extremely careful about the type of pressures that we are putting on chief executives and trusts with a target-based performance regime; I have discussed that before with the Secretary of State and others. There is a balance to be struck, and I am not convinced that we have got it right.

Mr. Deputy Speaker : Order. I have no control over the time that Members take, but I can say to them that the purpose of these debates is for the Member initiating them to get a full response from the Minister. If hon. Members are brief, I will have time to call them before I start the wind-ups, but if they are not brief we will have to go straight into the wind-ups.

10.15 am

Dr. Phyllis Starkey (Milton Keynes, South-West) (Lab): I will be very brief. I want to make two general points followed by a specific one about an issue that has not been raised.

My first point is that, to a certain extent, the problem of MRSA will get worse regardless of what we do about it. The rise of drug and antibiotic-resistant bacteria is an inexorable fact of life. It is a fact that bacteria are incredibly successful at evolving, and the more we use drugs and antibiotics the more they will evolve resistance to them. We have to try to slow down the rate at which that drug and antibiotic resistance occurs. The clinical guidelines on the way that drugs and antibiotics are used are important and should be adhered to, because sensible use of drugs and antibiotics can slow down the development of resistance and extend their useful life. That is the issue that I was trying to raise earlier. It is a matter of everybody adhering to clinical guidelines, but it is also a matter of educating the public to understand that antibiotics can have a very limited life if we use them irresponsibly.

Secondly, I commend the hon. Member for Tunbridge Wells (Mr. Norman) for his remarks about management. In hospitals, a lot of people are collected together who are, by definition, ill. They therefore have limited resistance to infections to which the healthy population would be resistant. That means that hygiene is of prime importance and, to protect patients, there must be clear management structures that maintain a proper hygienic environment within hospitals.

My third point arises out of a specific issue that could affect the hospital in Milton Keynes, and it is that the media must act responsibly. I understand that ITV was planning to broadcast a programme about MRSA on Monday evening in which publicity would be given to MRSA cases in a number of hospitals, including the one in Milton Keynes. The hospital management there drew
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to ITV's attention the fact that the information on which the programme was based was unfounded: an allegation, for which there was no proof, that there had been a case of MRSA in the Milton Keynes hospital. Moreover, ITV had apparently asked a private firm to go round the hospitals testing their public spaces for the presence of MRSA, and the test that that firm had used was not one of the approved tests; apparently, it cannot distinguish between MRSA and MRSE. Do not ask me to say now, off the top of my head, what the E stands for; suffice it to say that MRSE is a different infection which, although serious, is not as bad as MRSA.

I am pleased that ITV did not go ahead with the programme. I have no idea whether it intends to show it on another date, but I hope that the postponement is evidence that it has acted responsibly, and that when it was drawn to its attention that the information on which its programme was based was inaccurate, it chose to withdraw it. I hope that that is a proper interpretation of its behaviour. If it is, I wish to place on record my appreciation for that part of the media acting responsibly. If my interpretation of ITV's behaviour is wrong, my commendation will be withdrawn. I simply wanted to get that example into the public domain. It shows that the issue is serious and needs to be publicly debated. However, it is incredibly important that the debate is well informed, based on solid facts and does not confuse the public still further.

Sue Doughty (Guildford) (LD): The Evening Standard was responsible for similar infiltration, in which a journalist posed as a porter and took swabs in my local hospital—the Royal Surrey County. We did not have the opportunity to check the facts before they went into print. I subsequently asked the Health Protection Agency to look into the claims in the Evening Standard that the hospital was rife with MRSA—that it was on every surface. As of this morning—even now—the agency has not received the MRSA isolates to try to reproduce those tests. This case involves a laboratory, Chemsol, which has done a lot of the testing in hospitals that the Evening Standard has highlighted as being riddled with MRSA. We need accuracy in this matter, because people worry when they go into hospital. We want to know where MRSA is—not where it is not. That is an outstanding problem.

Dr. Starkey : I absolutely concur with that. Responsible media reports are very useful, but the media must not confuse the public about an important issue, many aspects of which have been responsibly explored in this debate.

Mr. Deputy Speaker : Before I call the hon. Member for Weston-super-Mare (Brian Cotter), I ask him to be brief, because we want to get to the wind-ups.

10.22 am

Brian Cotter (Weston-super-Mare) (LD): Thank you, Mr. Deputy Speaker. I also thank the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) for raising what is always said to be an important debate in this Chamber in terms of trying to achieve clarity. People have worries about the matter and the problem must be addressed, so I thank him for his constructive and informed comments.
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The hon. Gentleman referred to the National Audit Office and the figure of 5,000 patients a year. It has said since the report that patchy progress has been made since 2000 in tackling this issue. I took part in a debate in January, after it was announced that Weston general hospital had come out as one of the worst in the country for MRSA cases. In fact, there are complications relating to how figures were arrived at—in Weston in particular—but I have a concern about the matter.

We have a new chief executive of the Weston hospital, and in recent times I have been encouraged by how he has tackled the issue. As many of us are, I am encouraged by the way that various initiatives have been taken to do with the cleaning of hands by doctors and nurses. I hope, and am assured, that they are encouraged to clean their hands after every single contact with patients and others; I am assured that that is happening in Weston.

In Weston, I attended the initial meeting of the patients' environment forum, which is bringing medical staff, patients, housekeepers, cleaners—everybody—round a table together. I was glad to see them sitting round the table talking about the problem and trying to make a combined effort. I have referred to the fact that Weston has had some particularly bad statistics. It also has a population whose age is higher than average. Given that, it is imperative that action is taken to improve standards of cleanliness.

It has sometimes been claimed that problems arise from residential and care homes. According to Mark Gritten, the chief executive of Weston hospital, between April 2003 and April 2004, 15 out of 32 cases of MRSA at the hospital involved people who had been admitted with that condition. According to a recent Government report, more than a third of care homes failed to have strict infection control. Although I know that the majority of homes in Weston are of a high standard, what action is the Minister taking—given that the Government identified this as an issue—to try to get care homes cleaned more satisfactorily?

I want to make a point to the Minister on behalf of Weston general hospital and the trust, which I have made before, but which I feel constrained to make again. We have some real statistics that show that my area is underfunded as against other parts of the country to the tune of £10 million. I shall return to that issue; I hope it will be addressed, because it is having an impact in other respects too. Recently, under the new chief executive, the hospital voted an extra £50,000 to be spent on cleaning services, which is good. But if we had more money, we could spend a little more on what needs to be done, as many people have identified, in terms of cleaning and general issues.

To quote a local source from the hospital—the chief executive—we have a problem, because with underfunding, particularly in Weston, it is difficult to

is making screening and keeping people to one side very difficult. Perhaps the Minister will reconsider Weston's funding in this respect, because it is having an impact in all sorts of ways.

I welcome the debate but draw my remarks to a conclusion, as we all want to hear what the Minister has to say.
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10.27 am

Mrs. Patsy Calton (Cheadle) (LD): I, too, congratulate the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) on securing this important debate. I associate myself with his remarks about it being a tragedy for patients, their relatives and staff when an MRSA case comes to light and, unfortunately, leads sometimes to the patient's death.

The hon. Gentleman made some good points about how important everyone in the hospital is—not just the medical staff, but the non-medical staff—and the importance of their working together. I shall return to that in a minute. Although there is perhaps no direct link between the observed cleanliness of a ward and the MRSA cases that occur in it, patients' perceptions are important. Patients who believe that they are going to get better seem to do so more often. When a patient goes into a ward that is untidy and dirty, with dust on surfaces and dirt on the floor, it is likely that that will affect their perception of their getting better. It is important, for patients' perceptions apart from anything else, that the ward is demonstrably clean.

We have not dwelt a great deal on statistics, possibly because, as my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) highlighted, one problem is that they are not massively available on this front—the recording has not been as effective as it might have been. We know that the death toll from hospital-acquired infections is about 5,000 a year, but the National Audit Office estimates that there may be as many as an additional 15,000 cases per year where hospital-acquired infections are a contributory cause of death. However, they are not properly recorded, so we do not know.

The NAO estimates the cost of hospital-acquired infections to be £1 billion per year, so anything we can do to reduce that amount means that there is quite a prize to be won, not just in terms of patients getting better more quickly, but in terms of the health service saving the money that it has to spend on those infected patients.

Some 9 per cent. of patients have a hospital-acquired infection, which is a horrendous statistic. I make no party political point on that because it has been the case for a number of years, and it requires investigation. Although it is common to quote that it is less of a problem in other countries, statistically, it is not much different there, and any difference could be accounted for by variations in accounting methods. It is not helpful to bandy about the idea that this is a British disease.

Dr. Murrison : I must correct the hon. Lady. Although rates of hospital-acquired infection are more or less uniform across Europe, the chances of catching MRSA certainly are not. There is a 40 times greater chance of getting MRSA in the UK than in Holland, for example.

Mrs. Calton : I am well aware that, where MRSA is concerned, there are variations within hospitals, across the country and in different countries. We do not know enough about that, or about why there are such variations across different countries, within our country and within wards. However, I was talking about hospital-acquired infections generally, and MRSA is part of that wider spectrum.
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The Public Health Laboratory Service said in 1999 that patients stayed in hospital 2.9 times longer if they had a hospital-acquired infection: they stayed an average of 14 days, at a cost of £3,000 per patient. That cost will be higher now. A person with a hospital-acquired infection is seven times more likely to die in hospital than someone without one. Those are important facts and estimates on which we need more information, and more collecting of information.

My hon. Friend the Member for Sutton and Cheam asked some time ago, in a parliamentary question, about MRSA research studies that were then still to report. I shall be interested to obtain any information that the Minister can give us on the studies that should have reported by now. For example, it was reported on 6 October 2003 that the study entitled "Faster Testing for MRSA: Models to Estimate the Cost-effectiveness of Faster Testing of Cases Admitted for Hip and Knee Replacement" would report by November 2004. It would be useful if the Minister gave us an update on some of the information that she gave earlier.

I agree with many of the points made by the hon. Member for Tunbridge Wells (Mr. Norman), but I take exception to his view that cleaning is necessarily a low-status job and I want to dissociate myself and my party—

Mr. Norman : I just want to clarify that my point was not that cleaning is necessarily a low-status job, but that it should not be. Cleaning is as much a specialist and critical part of the control of the ward environment as any other role there. In fact, I specifically said that we must get to a stage at which we take cleaners and their contribution as seriously as we do that of consultants, nurses and the chief executive of the hospital.

Mrs. Calton : I thank the hon. Gentleman for that clarification. I hope therefore that he will not again use the term "enough warm bodies". That is a somewhat derogatory remark to make about anyone working in the health service.

The hon. Gentleman is absolutely right, though, to say that this problem is a matter for everyone working in the health service, and for patients as well. My hon. Friend the Member for Weston-super-Mare (Brian Cotter) made the point that he was pleased to see at his hospital medical and non-medical staff, patients and visitors all working together via a patients forum to try to reach a solution. He is right about that, and I am pleased to say that my hospital, Stepping Hill, is similarly taking notice of patients forum responses.

I support the points made by the hon. Member for Milton Keynes, South-West (Dr. Starkey), who asked for greater responsibility from the media. Some reporting of MRSA that has taken place will undoubtedly create fear in the minds of quite a few patients and leave them afraid to go to hospital. I have even felt that it is best to stay away if it is possible at times. The prospect of going into hospital when the headlines are screaming MRSA is a concern in the minds of patients who are immune-depressed. Those headlines are often based on faulty science or a woeful lack of information. The matter must be publicly debated, and I support the debates in this House, but scaremongering is not useful.
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We need more information about the impact of cleaning methods in hospitals. Since we know that hands are the most important vector of infection and of MRSA in particular, anything that they touch must be clean. We know that dust can carry infection. We have concerns about cleaning contracts, the wages paid to cleaners and the contracts associated with private finance initiative and public private partnership methods of building new hospitals. All those must be looked at—we must ask whether they produce more hand contact with infection. Unfortunately, I think that in some cases they do. I visited a hospital recently where the beds seemed to be very close to each other, and that concerned me greatly, particularly as they were in a renal unit.

The issue of more than 85 per cent. occupancy must be examined as well. Is 85 per cent. the optimum point beyond which we can go no further? It would be useful to know what research has been done on that.

We know that hand washing is the most important activity for cutting cross-infection. In my constituency, bedside-mounted and staff-carried alcohol gel dispensers are being installed at Stepping Hill hospital, which already has a low incidence of infection. That is not a gimmick; it is useful. Views from the patients forum have been sent to the clinicians and a week-long awareness raising campaign is forthcoming.

I do not think that anyone has mentioned that elective surgery patients can be separated from trauma patients. That seems to be producing good results in many hospitals. We need more single rooms in order to isolate people, and that seems to be a deficiency in some hospitals. In the South Manchester University Hospitals NHS Trust, which is also used by my constituents, an integrated care pathway for MRSA has reduced cross-infection. We should examine all good practice to see whether it can be spread throughout the country.

The Royal College of Pathologists is concerned at the lack of training in microbiology in medical schools and training establishments. I would be grateful to the Minister if she addressed that issue.

10.38 am

Dr. Andrew Murrison (Westbury) (Con): I congratulate the hon. Member for Strathkelvin and Bearsden (Mr. Lyons) on bringing this debate to Westminster Hall. It is an important issue. Before the party conference recess, we debated the similar issue of hospital-acquired infections during an Opposition-day debate. There is a great deal of commonality between MRSA and hospital-acquired infections; indeed, the one cannot really be considered without the other.

I recall on 8 September when we debated hospital-acquired infections that the Minister was keen to draw attention to the fact that this is a non-partisan issue. We celebrated that during the debate, but the Secretary of State subsequently abandoned the refreshing attempts at consensus and claimed that MRSA rates increased substantially while the Leader of the Opposition was a member of the Cabinet over a decade ago. The Secretary of State neglected to point out that rates of MRSA infection have doubled since 1997. I mention that only to get the partisan part of the debate off my chest. In the spirit of this debate and of Westminster Hall, I will resist
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the temptation to score points during the rest of my remarks, which I will keep brief given that the Minister has many points to answer.

We must get away from the blame culture—we have touched on that at some length today—but equally we must be clear about what the evidence suggests. In the context of contract cleaning, it is important to state for the record that there is little evidence that there is a correlation between contracting out of cleaning and the incidence of MRSA. There may be some good common-sense reasons—my hon. Friend the Member for Tunbridge Wells (Mr. Norman) touched on some—for supposing that contracted-out cleaning might not be as good as in-house cleaning, but we need at least to acknowledge the evidence that exists. I am afraid that this area, more than any other, is susceptible to political manipulation, and we must avoid that.

I echo the points made by hon. Members about the importance of the cleaning staff. I know that, as a politician, it is always extremely easy to say that kind of thing, but it is genuinely the case. I speak from some experience. My first job as an NHS employee was as a hospital porter some 25 years ago, so I understand the importance of ancillary staff in the national health service. I hope that, as we try to work out how to deal with this problem in the NHS, Ministers will give further thought to how ancillary staff can be made to feel a better part of the hospital team. At the moment, ancillary staff sometimes do not feel that way.

I hope that the Minister will recall a constituent of mine called Mrs. Burton, whose story I raised during the Opposition-day debate on 8 September. Mrs. Burton trained to be a nurse many years ago and unfortunately recently had occasion to be admitted to hospital as a patient. When she came out, she wrote me a very good letter in which she laid out 20 points covering things that she thought might be improved in the NHS, particularly in relation to the management of wards, to address the problem of hospital-acquired infection and MRSA. It was a very considered letter. I did send it to the Minister and I would be grateful if, when she replies, she said when I will receive a reply to those points. We are facing a real problem in the NHS in respect of MRSA and the Minister ought to be grateful for any help that she can get at this juncture. Mrs. Burton's remarks were valuable in that respect.

Although many of the points raised by my constituent might seem not particularly trendy or a little old-fashioned, many of those who are involved in the sector feel that we might need to look at old-fashioned notions of cleanliness and asepsis. I was interested to see an editorial in the British Medical Journal last month that essentially said exactly that. It was authored by a professor of infection control from the Netherlands, a country that has a very low rate of MRSA—although I should say, in response to the remarks by the hon. Member for Cheadle (Mrs. Calton), that it has a hospital-acquired infection rate that pretty well mirrors our own. We need to be a little careful about confusing one with the other.

The professor concerned stated that we must have some

By that, I think that he meant that sometimes in this area it is difficult to get material that is high up the evidence hierarchy to persuade us to act in one way or another to
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tackle the range of conditions, but we must apply what appears to be common sense. In that respect, the remarks by my hon. Friend the Member for Tunbridge Wells were particularly valuable. Sometimes, there will not be strong evidence for acting in one way or another and we must apply what appears to be common sense in management terms.

The Leader of the Opposition called MRSA "the British disease". I think that he probably meant that it was an NHS disease, because the instances of MRSA are a lot higher in the NHS. In private hospitals, it is less of a problem, or less of a declared problem—perhaps there is a subtle difference between the two.

Dr. Starkey : Does the hon. Gentleman accept that he is not comparing like with like? NHS hospitals have a much higher percentage of chronically ill patients than private hospitals and one needs to take into account the susceptibility of the patients to the infection as well as the prevalence of the infection.

Dr. Murrison : The hon. Lady is absolutely right. I am not being judgmental; I am just stating a fact. We must compare like with like. It might be useful to compare orthopaedic cases in the private sector and in the NHS. The same applies to other case mixes. We need to learn why that is. Given that throughput in the private sector is comparable with that in the NHS, we cannot blame the fact that the NHS sees more patients. We must learn about the problem wherever we can.

We must also compare large hospitals with small hospitals. It seems that MRSA is far less of a problem in community hospitals than in larger ones. Above all, we must consider why we seem to be doing so badly in resolving the problem of MRSA in this country compared with other European countries.

The National Audit Office said that the cost to the NHS is £1 billion, but the true cost is far higher in terms of patient suffering and problems for staff. It should be no surprise to any of us here that it is a real problem for staff morale. Trust in NHS staff has taken a major hit. We all receive letters about MRSA and the question of trust has arisen in my mailbag. We are at a sorry pass when the Government exhort patients to ask nursing staff if they have washed their hands. I am unhappy about that because washing hands should be part of the culture of the NHS and I welcome measures to introduce basic hygiene into the clinical curricula.

I said on 8 September—it is worth repeating in the context of MRSA—that during my medical training no attention at all was paid to hand washing or hygiene of any sort. It was perhaps dismissed as being not sufficiently academic to be introduced into a medical curriculum. It jolly well is and I hope that the Minister will do everything she can to ensure that hygiene is an integral part of the curriculum for everyone who trains for a post in the NHS.

I shall rattle through the remainder of my speech briefly. There is some unfinished business from 8 September to which the Minister may now be in a position to respond. First, my right hon. Friend the Member for North-West Hampshire (Sir George Young) asked about the rapid review of innovative
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products and the Minister of State, Department of Health, the right hon. Member for Barrow and Furness (Mr. Hutton), said that his Department was considering six of them. I wrote to clarify which ones and to ask for a progress report, but I have received none. Perhaps the Minister can help me with that.

Secondly, I asked how many times senior nursing staff have been able to exercise the powers that Ministers have apparently given them to withhold payment to contractors and departments that have not cleaned to a satisfactory standard. Again, I have received no answer. Finally, the Government's then recently announced target of a tub of hand cleanser for every bed by April 2005 implied that it was good enough to wait nine months, but I asked whether that could be speeded up. Again, I would be grateful if the Minister gave a progress report on that.

I have said enough. The Minister has many points to respond to and I would be grateful if she did so.

10.48 am

The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson) : I congratulate my hon. Friend the Member for Strathkelvin and Bearsden (Mr. Lyons) on securing this debate on an important subject and I welcome him back from the summer recess. It is a pleasure to see him looking so well.

Hospital-acquired infections, including MRSA, are a financial burden on the NHS, but, more importantly, as a number of hon. Members have said, they affect patients by causing illness, pain, anxiety, longer stays in hospital and sometimes death. We are therefore facing up to the challenges that they present. Such infections are a problem not only for the NHS, but for health services everywhere, as a number of hon. Members noted. In the United States, Australasia and most European countries, including ours, the percentage of patients who experience a hospital-acquired infection ranges between 4 per cent. and 10 per cent. That proportion is remarkably consistent.

Unfortunately, as a number of hon. Members commented, not all hospital-acquired infections are preventable. Many factors contribute to the problem. As my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey) said, more susceptible patients, such as those with severe and chronic diseases, are being treated than ever before. At the same time, advances in treatment that improve patient survival rates, such as chemotherapy, can leave patients much more vulnerable to infections. However, although there is no simple solution to this complex and multi-faceted problem, it is generally accepted that up to 30 per cent. of cases of infection could be avoided with the better application of existing knowledge and good practice.

MRSA has become a greater problem in the UK for a number of interrelated reasons, including the simple fact that the strains responsible for most of the infections in the UK are particularly well adapted to spreading between patients. Although the causes of MRSA are many and complex, we believe that the risk of contracting MRSA and other health care-associated infections can be reduced by simple and effective infection-control measures. We know that more needs to be done but, as the NAO report acknowledges, our work has moved infection control up the NHS agenda, so that it is now a top priority.
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I shall deal briefly with the political aspects. Like the hon. Member for Westbury (Dr. Murrison), I am delighted about the tone in which this debate and the previous debate in the House have been conducted. The problem will not be solved by party political rhetoric, and I am deeply grateful to hon. Members for generally resisting the political. However, perhaps they will forgive me if in response to the hon. Gentleman's comments, I say simply that if his leader will not listen to the rest of us, he should listen to his hon. Friend the Member for Tunbridge Wells (Mr. Norman) and recognise that we have published data on hospital-acquired infection rates and there is no doubt that the imperative under the Conservative Government to take the cheapest competitive tender did not help the situation in the early days, or that the lack of investment has not helped the health service.

Dr. Murrison : Will the Minister give way?

Miss Johnson : I have got very little time, but I will give way once to the hon. Gentleman on this point.

Dr. Murrison : I am very grateful to the Minister for giving way. There may be some truth in what she says, but the number of MRSA cases continues to climb; it went up by 4 per cent. last year, which is a significant increase. It is therefore a bit disingenuous of her to blame Conservative regimes for the problem.

Miss Johnson : I was only making the point that we either have done or are doing a lot of the things that have been suggested and that the genesis of the problem lies much further back in time. In that genesis we see issues such as getting the cheapest cleaning rather than seeking to achieve value for money and maintaining standards.

I was interested in the remarks of my hon. Friend the Member for Milton Keynes, South-West about the responsibility of the media. It is important that all of us, including the media, conduct the debate in the best possible way. Otherwise, as a number of hon. Members said, we will increase patients' anxiety about going into hospital. The hon. Member for Cheadle (Mrs. Calton) pointed out how sad it would be if that were to happen, because the vast majority of patients are far better off receiving their treatment than worrying about infection rates.

Turning to the scale of the problem, our best data on MRSA are drawn from surveillance of bloodstream infections, which have shown a slight, but not dramatic, increase—about 5 per cent.—in the past three years. I have with me a list, extracted from the published data, which shows that infection rates are currently falling in a number of trusts. We want to continue that success and build on it so that every trust is in that category, which is why there is now a target for all trusts to reduce infection rates. That can only help. In addition all the actions suggested in the documents "Winning Ways" and "Towards cleaner hospitals and lower rates of infection" are now being pursued. That will begin to have an impact.

It has been suggested that collecting data from every ward might be advantageous. I counsel against that because of the different patient mixes in wards and the different issues and ward environments. In addition, it
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might lead to great anxiety on the part of patients in some areas, and perhaps to over-reassurance for staff and patients in others.

I am not going to go through the situations in other countries, because that subject was substantially aired in the previous debate in the House. However, a couple of Members have mentioned the built environment and PFI schemes. I agree with the hon. Member for Tunbridge Wells in that respect—indeed, I agree largely with a lot of what he said. Getting the built environment right is crucial. Since 1997, our guidance on major hospital redevelopments has aimed for a minimum of 50 per cent. of bedrooms to be single bedrooms. As the plans progress, we should be better placed to achieve the same low infection levels as in the best examples abroad, which might partly be due to building structures, although I agree that there are other issues such as where basins and hand cleaning provisions are located. All indications are that investment in buildings will bring about a big change. Single-bedroom provision in the major PFI projects is running at 35 per cent. to 40 per cent.—sometimes even 50 per cent. Change is taking place.

In July, we announced a new year-on-year MRSA reduction target to show the priority that we give the problem. Having a target also ensures that the issue is given priority in the NHS. I must briefly address the question whether targets in some way militate against solving the problem. A number of trusts that have falling rates of MRSA have hit all their targets. There is no straightforward correlation, and I counsel hon. Members against stating any such correlation: the figures show that no such correlation has been proved. Targets have improved access to treatment and shortened waiting times. We are confident that the new target will help in improving infection control.

As Members have said, hand hygiene is very important. In September, we launched the first ever national hand hygiene campaign. I agree that just having a campaign is not sufficient, but we are taking a phased approach. Good preparation is important to the introduction of such measures. The National Patient Safety Agency is driving that forward.

The provision of alcohol rubs has been mentioned. That is being rolled out over the next year, but that is not to say that we are not trying to bring it forward. Some Members have already highlighted the fact that such provision already exists in a number of places; it depends on the circumstances, on what provision there was before, and on how quickly people have been able to institute it. At the end of the day, such provision may not be possible for every single bed. For example, it is not always feasible in children's wards. However, handrubs will be required at all staff-patient contact points and a number of hospitals are driving that forward in the most positive way.

Many hon. Members asked about cleanliness and the role of ward sisters and matrons. We have already said clearly, and I reiterate, that it is important that matrons and ward sisters are in control. They should have sufficient control over cleaning staff to make sure that they are able to maintain and have oversight of the wards. Under the new "Agenda for Change" pay system, the minimum wage in the NHS will be the national minimum wage plus 84p. That will help to make sure that cleaners are paid more than the
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minimum rate for other cleaning jobs. I agree strongly with hon. Members, particularly my hon. Friends, who made points about the significance of including cleaners in the ward team. Increasingly, all such people will be under the control of matrons and hospital staff, with the flexibility to deal with issues if they arise. Better, renewed contracts will strengthen provision.

Concerns have been voiced about the training of microbiologists. The inspector of microbiology and infection control is discussing the training curriculum with the royal colleges to improve course content on infection control. That is the right avenue to take.

We have made sure that all the right measures are in place to start to tackle the problem. I agree that the problem is one of culture and that it needs to be tackled in the most fundamental way by hospitals, but they have the incentives and resources to do so and are able to give it priority.

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