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Madam Deputy Speaker: Order. Several Members are hoping to catch my eye and the time for debate is limited. If brief contributions are made, perhaps more Members will be successful.
6.20 pm
Shona McIsaac (Cleethorpes) (Lab): I was dismayed to hear the contribution of the hon. Member for East Worthing and Shoreham (Tim Loughton). He is oversimplifying what is a very complex issue and ignoring much of the associated science. The Conservatives talk about methicillin-resistant Staphylococcus aureus as if it were a single homogenous phenomenon, but it is not: 17 strains of MRSA have some resistance to penicillin treatment. Clones 15 and 16 have become much more dominant in recent years in the UK, which is why we have witnessed an increase in such cases in our hospitals. In fact, clone 16 accounts for about half of all cases of MRSA in the UK.
If Tory Front Benchers want to check that information, they should read the 25 February edition of The Daily Telegraph, in which Dr. Mark Enright of Bath university states:
"These clones appear to be highly transmissible compared to other MRSA clones, allowing them to easily spread from patient to patient . . . They are still quite uncommon in most other countries".
That point is pertinent to today's debate and to the comments of Tory Front Benchers. They say that we should use some of the best practice in other countries, which has had an effect on MRSA, but in many cases we are not dealing with the same strains, so the techniques used in those countries might not be appropriate here. We are dealing with the most resistant and most transmissible strains, particularly MRSA 16.
The genome for the MRSA 16 strain has recently been cracked and the toughness of that clone has become apparent: for example, it is very resistant to high temperature. There has been talk today of the need to wash nurses' uniforms and so on, but if we are to tackle this problem we need to bear it in mind that this strain can survive high temperatures.
Tory Front Benchers have also ignored the fact that Staphylococcus aureus is very common. Many of us carry it and, indeed, some 30 per cent. of the UK population are probably carrying it on their skin or in their noses and throats, so a third of those of us who enter the Division Lobby tonight will be carrying it. Some people also carry the resistant strains 15 and 16. We are dealing with something that is very common among the general public, but which will not have much of an effect on them. However, clone 16, which is causing most of the problems in the UK, does affect
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those with weakened immune systems and those who gather with many others in a single place—such as hospitals—because of its highly transmissible nature.
It has been argued that the problem has suddenly arisen because of cleaning contracts. Although that is an important subject, I am not convinced that that is where the blame lies. We need to consider why Staphylococcus aureus has become so resistant, and much of the explanation lies in its very nature. It mutates constantly. What was happening—we need to go back to the 1960s and 70s—is that antibiotics were prescribed when they were not, strictly speaking, necessary. The weakest strains died off and now we are seeing the prevalence of the resistant strains. That is why it is vital that everyone who is prescribed an antibiotic even now takes the full course. People may feel better after a few days, but if they do not complete the course, the resistant clones may become more dominant.
How do we tackle the problem? We need to reflect on the prescribing of antibiotics. Many primary care trusts and hospitals are considering that aspect and it is also vital to ensure cleanliness in hospitals, as the virus is likely to be transmitted through hand-to-hand contact.
Dr. Starkey: Does my hon. Friend accept that, although there is not enough evidence to demonstrate that the contracting out of cleaning services per se was directly associated with the increase in MRSA, there remains something to be said about the downward cost pressure, which reduced the amount of money being spent on cleaning—whether in-house or contracted out—and did partly contribute to falling standards within hospitals? Where the overall health budget was very constrained in the past, the additional cost pressures were even greater. Thankfully, under the present Government, it is no longer quite such a problem.
Shona McIsaac: My hon. Friend makes some very fair points. I was trying to emphasise that dealing with the problem of MRSA is not simply a matter of cleaning. Cleaning is one factor and good hand washing is important. We need to reduce skin-to-skin contact, which can transmit the virus.
My local trust has pioneered some of the important work that needs to be done. It is another reason why I feel that the Tories portrayed the problem in a way that is most unfair on hospital staff, particularly those working in the Northern Lincolnshire and Goole Hospitals NHS Trust. It has been one of the pilots for the clean your hands initiative. I mentioned on 2 February that the MRSA rate was on the decline. In the period from April 2001 to March 2003, there were 36 MRSA cases, 34 in the following year and then it went down to 28. Those 28 reports of MRSA equate to a rate of 0.09 per 1,000 bed days. It is clearly declining in my trust, which has also won national awards for cleanliness, so it is despicable for Conservative Members to go around portraying every hospital in the country as filthy. Excellent work is going on and I believe that the staff in my trust should be praised for their work in leading the national initiative through this programme.
2 Mar 2005 : Column 1059
6.29 pm
Mr. John Hayes (South Holland and The Deepings) (Con): It is right to view much of our debate as beyond, or one might say above, party politics. It is important to debate the issues in those terms, but I must tell the Minister that the suggestion that the problem has not worsened since 1980 does no favours to her, to the House or to the quality of our debate, because that is clearly not the case, as the statistics reveal. I shall deal with them in some detail in a few moments.
Dr. Starkey: Will the hon. Gentleman give way?
Mr. Hayes: I have only just started. All right, I will give way because I am such a nice chap.
Dr. Starkey: I am exceptionally grateful to the hon. Gentleman—and I stress that last word. My understanding of what my hon. Friend the Minister said was that the total rate of hospital-acquired infections was not worse. Everybody accepts, however, that the proportion of those infections that are caused by MRSA has increased.
Mr. Hayes: The hon. Lady makes an interesting point, and it perhaps reveals that if Ministers do not make themselves clear, it is likely to lead to a misunderstanding of what they mean. The Minister was clearly making a partisan point. I hoped to move on from that by making a speech that is largely non-partisan.
In that spirit, it is of course true to say that MRSA is more common now for a variety of reasons, not all of which are the result of public policy. The reasons include the ageing population, the survival of more sick people, and the likelihood of transmission in a more mobile population. But the fact that MRSA organisms are often associated with patients in hospital—because they are, implicitly, sick, usually weak and often old—means that we must face certain public policy imperatives. We need a holistic approach to the problem. I am tempted to add phrases such as "sustainable", "involving stakeholders" and "joined-up thinking", as well as other new Labour-speak, but I shall move on.
The holistic approach needed begins with an acceptance of some of the facts and figures. For that purpose, we should be clear about the National Audit Office report. As my right hon. Friend the Member for Haltemprice and Howden (David Davis) said, the report says that at least 5,000 patients a year die from MRSA; that such infections cost the NHS as much as £1 billion a year; and that at any one time at least 9 per cent. of patients have an infection acquired during their hospital stay. The effect of those infections varies, from relatively minor to death.
Mr. Mark Simmonds (Boston and Skegness) (Con): Is my hon. Friend aware that the NAO said in its latest report, published in 2004, that had the Government implemented the recommendations in its previous report in 2000, up to 750 lives a year could have been saved? Some of his constituents use the same hospital in Boston as many of mine—Pilgrim hospital—and the issue causes them immense worry and concern, but it is not an attack on the hard-working staff of the NHS in our area to say so.
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