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House of Commons

Tuesday 2 November 2004

The House met at half-past Eleven o'clock


[Mr. Speaker in the Chair]

Oral Answers to Questions


The Secretary of State was asked—

Hospital-acquired Infections

1. Ann Winterton (Congleton) (Con): If he will make a statement on the (a) incidence and (b) cost to the NHS of hospital-acquired infection in the last period for which figures are available. [194999]

The Secretary of State for Health (Dr. John Reid): Because we were the first Government to introduce mandatory surveillance of the incidence of hospital-acquired infections, previous data are not as robust as we would wish. However, previous surveys and estimates indicate that the proportion of patients who acquire an infection in hospital is around 9 per cent., which is largely unchanged from a survey conducted 24 years ago in 1980. The rates of infection in most other European countries range between 6 and 10 per cent. The best available estimate is that hospital-acquired infections cost the NHS £1 billion a year.

Ann Winterton: Hospital-acquired infection is currently a massive problem in this country, and the Government's solution is to reintroduce the matron. Will the Secretary of State confirm that matrons will be taken from experienced nursing staff, will be properly trained and will therefore have the authority and professional standing to close wards for thorough cleaning, to recruit additional infection-control nursing staff and to train others in infection control? Does he agree that if those safeguards are not introduced, the matron's charter will be yet another piece of meaningless spin, which will be costly for patients?

Dr. Reid: I regret the hon. Lady's choice of last sentence. I accept that hospital-acquired infections are a major challenge for the NHS and for all of us. I do not regard the matter as a party-political issue, which is why I invited the Conservative spokesman, who has accepted the invitation, to discuss the matter and share ideas and proposals. I confirm that we will examine all proposals.

It is not true that we have been involved in spin. We are the first Government to collect the data, which are admittedly limited—it is difficult to obtain some data for
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international as well as domestic reasons. However, we are passing power to front-line staff and the chief nursing officer has been put in charge. We want to make sure that nurses and matrons are in control of not only hygiene, but hospital cleaning, and that they are involved in writing up contracts. Hospital-acquired infections are a long-standing, complex issue, and I hope that all hon. Members share my determination to tackle them.

Joan Ruddock (Lewisham, Deptford) (Lab): Last week, I visited three wards in Lewisham hospital, each of which contained two patients with methicillin-resistant Staphylococcus aureus. Those patients had entered the hospital with the condition. Has my right hon. Friend any advice on community action to try to reduce the incidence of that condition and, in particular, for nursing homes, where far too many elderly people may unfortunately be subject to that infection?

Dr. Reid: My hon. Friend is right. Staphylococci are present outside hospitals, and methicillin-resistant Staphylococcus is, of course, the most difficult Staphylococci to tackle. MRSA is dangerous in hospitals because the people there are, by definition, ill, weak and, in many cases, elderly, and it is so dangerous for vulnerable patients. We will examine all ways in which to tackle MRSA, and those areas of hospitals where people are vulnerable, critical or elderly are key.

There are many reasons why it is difficult to overcome MRSA. We must tackle issues such as shortages of trained staff, old buildings with single rooms, high capacity, an emphasis on cost rather than cleaning and the bacteria's immunity. New hospitals, more staff, single rooms and hospital design are important, as well as hygiene training, infection-control nurses on the ground and control by front-line staff. All those measures are available, along with scientific research. We are tackling all those issues, and I hope that all hon. Members who have any ideas about how to put those measures into practice—in some ways, MRSA is the biggest challenge that we face in our hospitals—will join us. I welcome all ideas from all quarters.

Sir Michael Spicer (West Worcestershire) (Con): Why has the incidence of MRSA increased so quickly in recent years?

Dr. Reid: We estimate that the rate has risen by about 5 per cent. over the past couple of years, so the increase is about 2.5 per cent. a year. [Interruption.] We have collected data on bloodstream bacteria MRSA only for the past couple of years. The data are limited, but we have never collected them before.

As far as we can see, the incidence of MRSA is rising, and it is a major problem for us, but I issue two pleas to hon. Members to put this in proportion. First, it is not rising at 100 per cent. per annum, as some newspapers are suggesting. Secondly, the overall rate of hospital-acquired infections, which is estimated to be about 9 per cent., is roughly the same as 25 years ago, and probably 50 years ago, although we do not have the empirical data to verify that. There is no internationally-classifiable coding for deaths caused specifically by bacteria-led MRSA. Another reason why our data collection is less adequate than I would
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like is that MRSA is normally a contributory factor and is often not cited on death certificates. We want to see improvements in that respect, as well.

Mr. Andrew Lansley (South Cambridgeshire) (Con): Last August, hospital cleanliness scores were published. This year they have not been published. Why not?

Dr. Reid: That matter has been passed to the Healthcare Commission and the scores will feature as part of the star ratings.

Mr. Lansley: More talk from the Secretary of State, but no action. Perhaps he would like to admit that the reason is that last year the hospital cleanliness scores suggested that no hospital in the whole national health service had an unacceptable level of cleanliness. That did not accord at all with patient experience and illustrated the fact that the system is discredited, as the Healthcare Commission subsequently found.

Let me try the Secretary of State with another one. Last December, the chief medical officer said that there should be a rapid review process to consider new products and processes, 50 of which have been presented to the Department. A meeting took place on 24 August. On 11 August, the Minister in the other place said that reports on just six would be published by mid-October, but that has not happened—why not?

Dr. Reid: Since the hon. Gentleman said at the time that we were not independent when assessing hospital cleanliness and suggested today that the reports are discredited—I do not accept that, but it is his view— I should have thought that he would welcome the fact that we have asked the independent Healthcare Commission to estimate cleanliness in hospitals. It seems that if we do it, it is wrong, and if we ask an independent body to do it, it is wrong. That is a sign of bias rather than objectivity on the hon. Gentleman's part; he is so much better when he puts party politics aside.

On his other question, let me say in my normal balanced fashion that I would have liked the study of these materials and treatments against MRSA to have started more quickly than it did. He is right about that. The organisation has met only once and is meeting again this month. The list of six that it has considered is scheduled to be published, and that will happen very soon. It is running a couple of weeks late, but I hope that it will not be much more than that.

Mr. Lansley: I am afraid that, as we have demonstrated many times in this House, the Government's response is one of a lack of urgency and delay. The data from the patient environment action teams are not being published. When we asked why not, we were told that it was because they were awaiting ministerial approval. That has nothing to do with the independence of the Healthcare Commission.

Let me return to the point at which the Secretary of State started—that we need more data. More than four years ago, the National Audit Office said that the mandatory scheme should be extended to include all parts of the voluntary surveillance scheme that predated it and should be done on the basis of clinical specialty;
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but Ministers said no. Where is the National Audit Office's recommended national infection control manual, on which the Department started work in 2001? Even the matron's charter, which was mentioned by my hon. Friend the Member for Congleton (Ann Winterton), said that people would be able to refer to a model cleaning contract, yet that does not exist. Why are the Government all talk and no action? Why cannot people see the action that needs to be taken to deliver cleaner hospitals and a safe environment for patients?

Dr. Reid: Over the past few years the Government have been acting to deal with some of the very issues that the hon. Gentleman raises. He says that we are not putting out data. In fact, in July we issued data on bloodstream MRSA infections. I have to say, again in a balanced spirit, that an objective observer would recognise that during the 20 years in which they were in power the previous Government refused to publish any data. We are the first Government to have mandatory surveillance, the first Government to collect and publish the data, and the first Government to ensure that hospitals are judged on their cleanliness.

Earlier, we discussed the potential contributory causes of MRSA. On old hospitals, we have the biggest building programme in history. On lack of staff, we have brought in 100,000 more doctors and nurses. On the immunity of the bug, within a month we are bringing the best international minds to this country to tackle the problem. We are putting nurses back in charge. We have just issued the matron's charter, and the chief nursing officer is taking this over. On cleanliness, above all, I am the Secretary of State who said—

Mr. Speaker: Order. Perhaps I can make an appeal to the Front Benches. It is now quarter to the hour, and we are still on Question 1. I need sharper answers and sharper questions. Perhaps Paul Burstow can help us.

Mr. Paul Burstow (Sutton and Cheam) (LD): Thank you for that instruction, Mr. Speaker. The Secretary of State says that this Government are the first to do anything about MRSA. Surely that does not absolve them, however, if they are not doing enough to tackle the problem and there is still more to do. I certainly want to take him up on his offer of a meeting to discuss that issue. In July, he published a report promising cleaner, safer hospitals and action to deal with that. I have asked questions about that report, because it came just two days before a very critical report by the National Audit Office about the Government's performance in relation to hospital infections. The answer that the Minister gave me was that the report was a hastily cobbled together report on work in progress and contained nothing about new policies. Is that the case—

Mr. Speaker: Order. It would be helpful if the Secretary of State could provide a sharp reply. At this rate, we shall only get four questions into the hour.

Dr. Reid: The answer to the first part of the hon. Gentleman's question is yes; the answer to the last part is no. The answer to the middle part is that I look forward to seeing him at the meeting.
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