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Clause 13

Code of practice relating to health care associated infections

Dr. Andrew Murrison (Westbury) (Con): I beg to move amendment No. 12, in page 9, line 18, at end insert—

'(c)   require the nomination in each NHS Trust of a Trust Director responsible for cleanliness and health care associated infection control ("the Trust Director");

(d)   provide for the senior infection control nurse to report directly to the Trust Director;

(e)   indicate action to be taken by the Trust Director and Trust Board in respect of ward closures on receipt of an adverse report from the senior infection control nurse;

(f)   require pre- and post-discharge surveillance for a person undergoing a surgical procedure;

(g)   contain requirements relating to infection control nurses;

(h)   contain requirements relating to isolation facilities;

(i)   define standards relating to cleaning services;

(j)   require hospital infection data to be recorded by clinical department.'.

Mr. Deputy Speaker: With this it will be convenient to discuss the following amendments:

No. 35, in page 9, line 18, at end insert—

'(   )   require all medical staff who have direct contact with patients not to travel to and from work in work uniform.'.

No. 37, in page 9, line 18, at end insert—

'(   )   define standards relating to the home laundering of staff uniforms.'.

Dr. Murrison: I think that the Minister was expecting me to hold forth on the previous group of amendments and I am sorry, especially after our experience in Committee, to disappoint her on this occasion, but it is Valentine's day, after all.
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This is an important group of amendments. We discussed health care-acquired infections, particularly MRSA, at some length in Committee, though we were disappointed that the time available did not allow us to explore as fully as we would have liked all the clauses following those related to the ban on smoking. Nevertheless, we covered a great deal of ground.

The Minister is, I expect, acutely aware of the toll that health care-acquired infections take in the United Kingdom. We reckon that about 5,000 people are killed every year and the statisticians tell us that that is more than the number killed on our roads, so it is a substantial problem. In addition, there are the people whose recovery is impeded as a result of health care-acquired infections but who, fortunately, do recover. The cost to the national health service is enormous. Some estimate that it is around £1 billion a year, so this is a big issue, and it is appropriate that Ministers should take the opportunity to try to improve matters in the course of the Health Bill.

Mr. Philip Hollobone (Kettering) (Con): I congratulate my hon. Friend on the words that he has just uttered. Is there not a third category of people who need hospital treatment—I am thinking of elderly people in particular—but who are very worried about the reports that they read about MRSA and other hospital-acquired infections? Such people may not pick up any infections, but the stress and strain they undergo as they await their hospital appointment is often intolerable.

Dr. Murrison: My hon. Friend is correct. Like me, he will have had constituency experience of the worry involved. People who face the possibility of going to hospital often volunteer the fact that they are worried about it. As I pointed out in Committee, I usually go to some lengths to put the matter in some sort of perspective. Although it is a substantial problem—I hope that the figures that I have given underscore that—the chances of somebody succumbing to such an infection are small. It is important for those of us who try to be responsible to try to reassure people wherever we can.

The figures speak for themselves, however, and in public health terms, 5,000 deaths a year are significant, so Ministers need to address the problem as a matter of urgency. The way in which they have chosen to do that is to introduce a code. In Committee, we were not particularly happy with the draft code, of which we were heavily critical. I am more than happy to tell the Minister that the version that has been provided more recently—very recently, I have to say; it was placed in the Library unheralded and unannounced yesterday, where we found it—is an improvement, and I am grateful for it. When we met a little while ago, the Minister said that she would let hon. Members have the revised copy as soon as possible, and she has at least given us sight of it before this debate. We must be thankful for that, although it would have been nice to have had the opportunity to examine it more closely and at a more leisurely rate.

Last week, we saw some updated figures for MRSA bacteraemia, of which the Minister will be well aware. The raw data for the six-month reference periods since 2001 run at 3,616, 3,584, 3,749 and 3,525. The figure for
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April to September 2005 is 3,580. The best interpretation of those figures is that there has been little or no change during that period; the level seems to have been pretty well flat-lining. The overall rate per thousand bed days is not entirely clear from the data, only in so far as it is specific for individual trusts. The overall rate for the health service is a little opaque. On the basis of eye-balling the results from trusts, I suspect that the overall rate per thousand bed days would probably give a worse impression of our success or otherwise with MRSA than the raw data that I have just quoted. Sadly, my statistical skills are not quite what they were, so I struggled with the figures presented to me by the Health Protection Agency, but I believe that that is a fair reflection.

The disparity between trusts that is apparent from the Health Protection Agency data is grounds for alarm but also hope, because it suggests that health care-acquired infection, and MRSA in particular, can be controlled. For example, the fact that Cambridgeshire and Yorkshire can do so well against the record in Somerset and London suggests that infection rates will be reduced by the adoption of best practice. Presumably, that is why the Minister has introduced the code, which is the burden of part 2, and it is also certainly the reason for our insistence that the code should be robust.

The question is whether the code is robust. In the short period that we have had to examine it, we have formed the view that while it is better than the draft version, it is not quite as robust as we might have liked. On comparing amendment No. 12 and what we have said in Committee with what has transpired, we have found bits that we would commend and that improve the original draft, on which we congratulate the Minister, although we are disappointed by some elements.

7.45 pm

We were pleased to note that one or two of the elements in amendment No. 12 have been reflected. Notably, there are improved lines of accountability, but we note that there is no categorical mention of a board member with specific responsibility for health care-acquired infection control. Perhaps the Minister will clarify that point, as we felt that it was important to nominate at board level somebody with specific responsibility for the matter, perhaps among other duties, and to whom those who carried out hospital policy on health care-acquired infection were responsible. That board-level responsibility is not entirely clear, although we accept that some of the changes in the revised code would improve the prominence of health care-acquired infections at such a level.

We have also noted that the code now refers to pre-admission screening, which we said in Committee was important, as the Minister will remember. Indeed, there is also some reference to post-discharge surveillance in certain circumstances. I imagine that that has been informed by the University College hospital work in the area, which I am happy to say has found its way into the revised draft code.
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Other good things have appeared, such as a strong reference to occupational health in hospitals. I freely admit to my interest in the matter, as before I was elected I was a locum consultant occupational physician at the Gloucestershire Royal hospital, so I have a particular interest in occupational health. I am convinced that the health service has traditionally not done particularly well on occupational health, and I am pleased that it has a relatively high prominence in the revised code.

I struggled to find much reference to dealing with locum casual and agency staff in the health service. It relies heavily on such personnel, so it is important that any occupational health service captures them adequately. My experience as a locum is that people often simply come and go, and that occupational health and any control mechanisms do not touch them at all. It is important that we deal specifically with such staff. As I said in Committee—I was perhaps rather too graphic—we do not want any Typhoid Marys wandering around the health service, potentially spreading infection through bad practice or whatever. That is an omission from the code, and perhaps the Minister could reflect on it in her remarks.

We remain concerned about the lack of clear standards relating to a model cleaning contract, a point that we raised in Committee. Despite the strengthening of lines of accountability that I have mentioned, we are concerned about the fact that managers are still not clearly and indisputably in charge of everything that happens at ward level. I know that the Minister will regard that as a constant Opposition refrain, but we believe in it strongly. Our experience suggests that we need proper control of what goes on at ward level, and we believe that cleanliness and hospital-acquired infections are all rolled up with the lack of control that sometimes exists in our national health service.

We regret very much the lack of reporting of health care-acquired infections at departmental level. The Minister will remember that we spent some time on these matters, and that I described my personal experience of them. As I recall, we had a slightly light-hearted debate about the cleanliness of doctors' hospital clothing—their white coats, neckties and so on. My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries) spoke at some length about nurses' uniforms. Departments are ultimately responsible for health care-acquired infections. The national health service is labour-intensive: it relies on its people. At the end of the day, it is people who are responsible for all the good things that happen in our NHS and, sadly, for those areas in which things are done less well.

Unless we focus on individuals at a level lower than that envisaged by the code, we may miss a trick in identifying less good practice that potentially causes or contributes to a health care-acquired infection, which is why we have insisted that any data should be collected at the lowest possible level, although having read the revised draft code, it does not seem that that point has been adequately taken on board. When we get data, I hope that the report is conducted at a fine level rather than at a macro level, where I suspect that lessons will be lost. I would be delighted if the Minister were to say how she intends to improve that element of the draft code.

We will watch the Healthcare Commission closely, because, having read the code, it seems that it must do a great deal of interpretation. It will, of course, be
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responsible for benchmarking one trust against another and I hope that it will apply consistent standards across the health service. The working of the code will depend on how the Healthcare Commission decides to use it.

As I have said, some trusts are doing well on health care-acquired infection and some are doing less well. The logical extension of the observation that some trusts are doing well but that others are doing less well is that the Healthcare Commission will act against those that are not doing well. It is reasonable to assume that some trusts are doing less well because they do not comply with good practice, much of which is laid out in the code. The matter is, of course, complicated, and some trusts do less well because of the nature of their work, but it is still reasonable to assume that those trusts that are doing less well are to some extent not applying the best practice laid out in the code. I hope that the Healthcare Commission examines that matter and, where it is necessary to do so, implements the necessary measures to make sure that those institutions improve. We will monitor the situation to make sure that that happens.

Finally, this area is clearly a matter of great concern for a large number of our constituents. It is a pity that the issue has been an also-ran in comparison with the main business of the day, smoking, but that should not disguise the fact that it is important for a large number of our constituents. The Government have chosen to put their store by the code, and, of course, I wish it well and hope that it works. However, I have set out our serious concerns, which I hope the Minister will bear in mind when she comes to revise the document—as we understand it, the code is a live document that will be revised periodically.

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