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Stephen Williams (Bristol, West) (LD): I should like to have spoken at greater length in the earlier debate on smoking. None the less, I am delighted with the outcome. Clearly, my wise words were not needed.
Four or five years ago, we conducted a major survey in my constituency on health care services in Bristol. The most common spontaneous remarks expressed concern about standards of cleanliness in hospitals. In the verbal surveys about health care that we conducted on the doorstep, people often commented on that, and it is therefore right to raise the matter now. We also discussed it at length in Committee.
Proposed new paragraphs (e) to (j) in amendment No. 12 make sense. Proposed new paragraph (d) is also important because it is obvious that the infection control nurse needs to report directly to somebody, but I wonder whether we need to appoint a separate trust director for that role. As the hon. Member for Stafford (Mr. Kidney) pointed out, the medical or clinical director of most acute trusts is likely to hold such a responsibility alreadyfrom memory, that is the case in Bristolbut there may be some merit in making that publicly known.
Let me deal with amendments Nos. 35 and 37, which the hon. Member for Mid-Bedfordshire (Mrs. Dorries) tabled. I wonder on what evidence she based her remarks, because much of it appeared anecdotal. Is there such evidence in the public domain? Perhaps the
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Minister could comment on that. How widespread are the abuses of standards of cleanliness that the hon. Member for Mid-Bedfordshire described? Has she spoken to representatives of the Royal College of Nursing, Unison or any other representative bodies in the health service?
Mrs. Dorries: The hon. Gentleman knows full well that I have not spoken to representatives of the Royal College of Nursing because he asked me yesterday and I told him that I had not. I therefore have no idea why he is asking the question now.
Stephen Williams: I thank the hon. Lady for her answer, which I wanted to appear on the record. That is why I asked the question. I thank her for confirming what she told me last night, but I wondered whether she had spoken to the RCN in the intervening 24 hours. It is a shame that she has not.
Has the hon. Lady thought through the implications of her proposals? If nurses should take more care about laundering their uniforms, would it be better if that were done in the hospital? As I understand it, theatre staff are likely to have their uniforms laundered on hospital premises. Would that be a practical solution?
Mrs. Dorries: As the hon. Gentleman knows, we discussed the matter in Committee and the Minister rightly gave me the reasons why that could not be done. It would take too long and cost too much money among other reasons. Again, the hon. Gentleman knows that full well. I ask simply for guidelines for nursing staff on the safe and recommended method of laundering uniforms. As a former nurse, I probably know far more nurses than the hon. Gentleman and hold far more conversations about the subject.
Stephen Williams: I thank the hon. Lady and am pleased to have helped her to place on the record the reasoning behind the amendments. I do not necessarily disagree with her sentiments, but I wanted to clarify some of the reasoning.
Jane Kennedy: I apologise to the hon. Member for Westbury (Dr. Murrison) and others if they feel that the new draft code was placed in the Library unheralded. I cleared it for publication at the weekend and wrote to the hon. Member for South Cambridgeshire (Mr. Lansley) and all members of the Committee. However, the letters notifying them that the code was available were posted only yesterday at 4.15 pm. I apologise if they have not arrived and I hope that hon. Members will accept my apologies.
I ask hon. Members to be clear and careful with the figures that they use for deaths. It is easy for confusion in the mind of the public to lead to greater anxiety than necessary. I do not suggest that MRSA and health care-acquired infections are not a cause for concernthey are. However, I am worried about the figure of 5,000 deaths. The only figures on which we rely are those for 2003, which show that 955 death certificates mentioned MRSA. Of those, 321 identified MRSA as an underlying cause of death.
I agree that the issue causes huge confusion. That is why I was at pains to stress that we
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need to be clear about what we say and maintain a sense of perspective. However, I fear that the Minister fell into the common trap of confusing health care-acquired infections with MRSA. When I spoke briefly earlier, I saw a look of consternation on the Minister's face and I thought that she might be confusing the two. The figure of 5,000 that I cited related to the former, not the latter.
Jane Kennedy: I accept that. I probably did not hear exactly what the hon. Gentleman said and I thought at first that he had claimed that 5,000 deaths were caused by MRSA. I would be horrified if that were the case. The figure of 5,000 is often cited but it applies to an American study, which is quite old. It is extrapolated from data that are based on the United States. We are working hard to get the best information possible into the public domain.
I stress to the hon. Member for Mid-Bedfordshire (Mrs. Dorries) that we should not make such claims as deaths have doubled since 1997. I am resisting my natural inclination, which is to dive in with both feet and say, "Hang on a minute, let's go further back." However, I hope that she accepts that we began the collection of the data and the surveillance of MRSA and other infections.
Mr. Lansley: One moment the Minister enjoins us to be very precise, yet the next moment she blandly says, "We began the collecting of the data". That is not true. Nosocomial surveillance began under the previous Conservative Government. It was not carried out on a mandatory basis, but in a number of respects it was commenced under that Government.
Jane Kennedy: I accept what the hon. Gentleman is saying, but it was making the surveillance mandatory that led to increased reporting, because the information was required to be reported. That raised the reporting of the infection to a different level.
We need to remember that people who die with MRSA are often already seriously ill with another condition. It is therefore difficult to say with any certainty whether they would have recovered from their underlying condition if they had not acquired the infection. However, none of the brief discussion that we have just had should distract us from the seriousness of the issue.
I am grateful to my hon. Friend the Member for Stafford (Mr. Kidney) for taking the time to visit his local hospital. I am pleased to say that the "Clean your hands" campaign to which he referred has had a 100 per cent. sign-up in the NHS. It has been taken up very rapidly. My hon. Friend also described the board level buy-in at Stafford, which is essential if the whole organisation is to take on the change of culture necessary to reduce bacteraemia levels.
My hon. Friend also asked us to consider the relationship between hospitals and care homes, where more screening could perhaps usefully be developed. We accept that screening works, and we are trialling ways of determining how a patient should be managed, having used the screening to identify whether they have a health care-acquired infection. Those trials are taking place in
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three different trusts, one of which is being sponsored by the Department of Health. We shall get the results in September 2006, and they will enable us to learn a lot about how trusts should respond to screening, having applied it. A study carried out in Oxford showed that more than 90 per cent. of those diagnosed with an MRSA infection had had previous contact with the health care system and might have contracted the infection during their earlier treatment. All of this highlights the complex nature of the problem that we are grappling with.
I am grateful to the hon. Member for Westbury for his acknowledgement of the improvements in the code, and I accept that further improvements could probably be made. However, I want him and his hon. Friends to think carefully before pressing the amendments to a vote if they feel tempted to do so. As we discussed in Committee, amendments such as these would introduce inappropriate detail into the Bill, raising expectations and giving the impression that certain measures were more important than others. For example, hand hygiene and the decontamination of instruments are not mentioned in the amendments, but they are of equal importance. All aspects of infection control must be taken seriously and implemented if the fight against health care-associated infection is to be successful. However, I recognise that the amendments are the result of real concerns and I will try to allay those worries in the course of my speech.
Clause 13 inserts three new sections into the Health and Social Care Act 2003. Amendment No. 12 would add eight new paragraphs to section 47A. The first of these, proposed new paragraph (c), is aimed at ensuring that each trust has a director responsible for
While I understand the aim of trying to clarify lines of responsibility, this proposal could compromise the role of the director of infection prevention and control. The code of practicehon. Members might like to refer to pages 5 to 7 of the draftwill require an NHS body to establish appropriate management systems and the appointment of a director of infection prevention and control. As my hon. Friend the Member for Stafford pointed out, most hospitals now do that, and all health care providers will do so as a result of this code and the one that will follow it, which will allow regulation to the same standard that applies in the independent and voluntary sector.
I would like to point out that the draft code already gives the director of infection prevention and controlthat is a long title, but I cannot think of any way of shortening itresponsibility for the infection control team.
Proposed new paragraph (e) suggests that the code should specify the action that the trust director and board must take concerning ward closures when they receive an adverse report. I genuinely believe that that is too prescriptive. The code, as it is written, will require an NHS body to have criteria for advising closure and have arrangements in place for redirecting admissions. It is
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not that we think it unnecessary to bear these things in mind, but the amendment is too prescriptive in that sense.
The policy will be developed with input from the infection control team locally, so local policy will reflect local circumstance but while it is important for us to have a policy, we do not want to prescribe the content from the centre. I think it was the hon. Member for Windsor (Adam Afriyie) who said that we should resist the urge to be too prescriptive, and I commend his comments to his colleague. People on the ground should be allowed to make such decisions with the benefit of their local knowledge.
Paragraph (f) is intended to ensure that there is pre and post-discharge surveillance for patients undergoing surgical procedures. We agree that both kinds of surveillance are beneficial, and the code of practice will encourage NHS bodies to introduce them. However, we will not make them mandatory at this stage as there are significant technical barriers, with which I shall deal shortly. I direct Members to page 17 of the draft code on surveillance.
Paragraph (g) is linked to amendments that were tabled and discussed in Committee, and I have had a conversation with the hon. Members for Westbury and for South Cambridgeshire about the code. The paragraph implies that it should contain requirements relating to the number of infection control nurses. I do not want to include such requirements in a code dealing with infection prevention and control. I think that infection prevention and control should be everyone's business; it should not be left to a cohort of infection control nurses. Setting a ratio of specialist infection control staff to beds, rather than challenging the culture in the organisation, will encourage people to see the job as one to be performed by those people alone. Appropriate management and clinical governance systems are required, and that will be dealt with by the code of practice.
Paragraphs (h) and (i) suggest that there should be requirements relating to isolation facilities, and that standards relating to cleaning services should be defined. Pages 6 and 7 of the code deal with those suggestions. I can, I hope, reassure the House that the code will cover important matters of that kind. The draft code already requires NHS bodies to ensure that they have adequate isolation facilities to prevent the spread of infection. "Adequate" should not be interpreted as a dismissive term. It means what it says: it means enough to deal with the circumstances that might arise. The draft code also requires NHS bodies to have a cleaning plan giving details of the standards of cleanliness needed in each part of their premises. While I accept the strength of the arguments advanced in Committee and today, I feel that the code strikes the right balance, although we will keep it under constant review.
Paragraph (j) suggests that the code should require hospitals to record infection data by clinical department. We agree that analysis of surveillance by clinical department brings considerable benefit, and we now collect information on MRSA bloodstream infections by specialty in trusts. Enhanced surveillance allows us to do that. The code will encourage the NHS to undertake such analyses in the context of a range of organisms.
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We have been criticised for not proceeding with work on post-discharge surveillance. Let me explain the practical problems. Believe it or not, there is currently no agreed definition of wounds. There is a lack of computer access when it comes to visiting patients outside health care institutions, and not all health care providers have full access to patient records. That applies to, for instance, midwives visiting women who have had caesarean sections. Notwithstanding those problems, we are working with experts on plans to improve the position.
I hope that the hon. Gentleman accepts that we take the points that he and his hon. Friends have made seriously. We are working to make the code flexible and proportionate, and also to make it reflect the concerns that have been expressed. Although the amendment expresses reasonable anxieties, I consider it unnecessary and hope that the hon. Gentleman will accept my reassurances.
Amendments Nos. 35 and 37 would also include inappropriate detail about the code of practice in the Bill. Including their requirements in the code would present practical difficulties in relation to enforcement. We have been working hard with the Healthcare Commission to ensure that the code is enforceablean issue raised by the hon. Member for Westburyand we are concentrating on the outcomes that really matter.
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