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4. Proceedings on consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
6. Standing Order No. 83B (Programming committees) shall not apply to proceedings on consideration and Third Reading.
7. Any other proceedings on the Bill (including any proceedings on consideration of Lords Amendments or on any further messages from the Lords) may be programmed. [Mr. Heppell.]
That, for the purposes of any Act resulting from the Pensions Bill, it is expedient to authorise
(1) the payment out of money provided by Parliament of
(a) any expenditure incurred by the Secretary of State by virtue of the Act, and
(b) any increase attributable to the Act in the sums payable under any other Act out of money so provided, and
(2) the payment into the Consolidated Fund of any increase attributable to the Act in the sums payable into that Fund under any other Act. [Mr. Heppell.]
That the Excise Duties (Surcharges or Rebates) (Hydrocarbon Oils etc.) (Revocation) Order 2006 (S.I., 2006, No. 3235) dated 6th December 2006, a copy of which was laid before this House on 6th December, be approved. [Mr. Heppell.]
That the draft Excepted Vehicles (Amendment of Schedule 1 to the Hydrocarbon Oils Duties Act 1979) Order 2006, which was laid before this House on 6th December, be approved. [Mr. Heppell.]
That an Humble Address be presented to Her Majesty, praying that Her Majesty will, with effect in each case from 19th January 2007, reappoint James Samuel Younger to be the chairman of the Electoral Commission for the period ending on 31st December 2008, and further reappoint Pamela Joan Gordon to be an Electoral Commissioner for the period ending on 30th June 2007. [Mr. Heppell.]
That the Merchant Shipping (Inland Waterway and Limited Coastal Operations) (Boatmasters Qualifications and Hours of Work) Regulations 2006 (S.I., 2006, No. 3223), dated 7th December, be referred to a Delegated Legislation Committee. [ Mr. Heppell. ]
The Petition of residents of Werrington, Peterborough, and others,
Declares the Petitioners' desire for a more visible Police presence in the Werrington Centre, Peterborough, to reduce the level of violence, intimidation and vandalism, which Peterborough's otherwise extremely capable and dedicated officers are struggling to prevent due to the minimal resources available to them.
The Petitioners therefore request that the House of Commons urge the Secretary of State for the Home Department to use his powers to provide a more visible Police presence in the aforesaid location, thus helping to make it a safer and more pleasant place to shop and work.
And the Petitioners remain, etc.
Richard Younger-Ross (Teignbridge) (LD): I wish to present a petition from constituents who are concerned about cuts in service at our local hospitals, and particularly the cuts in the opening hours of the minor injuries units at Ashburton and Bovey Tracey hospitals.
The Petition of County Councillor Sally Morgan, residents and users of rural Community Hospitals and Minor Injury Units in the Teignbridge and South Dartmoor area
Declares that they are deeply concerned for the future of the Minor Injury Units at Bovey Tracey and Ashburton Hospitals.
The Petitioners therefore request that the House of Commons and her Majesty's Government consider the pledge laid out in the Government white paper Our Health, Our Care, Our Say that
community facilities should not be lost in response to short-term budgetary pressures...
And ensure that rural health services are resourced fairly, allowing the Minor Injury Units to remain open for the future.
And the Petitioners remain, etc.
Mr. David Burrowes (Enfield, Southgate) (Con): It is a pleasure to have secured, for the first time, a debate on clostridium difficile. The subject is important, and merits not merely a short Adjournment debate but a longer debate, perhaps in Government time. Clostridium difficile infection is recognised by the Health Protection Agency as the most important cause of hospital-acquired diarrhoea. The purpose of this debate is to challenge the Government on whether C. difficileas I shall refer to it from now onis given the importance that it deserves in action as well as words.
endemic throughout the health service, with virtually all trusts reporting cases.
The official statistics paint only a partial picture. In 2005 there were 51,690 reports of C. difficile among people aged 65 and over; in 2004 an estimated 1,300 deaths were attributed to it. There are clearly at least seven times more cases of C. difficile than of MRSAmethicillin-resistant Staphylococcus aureusand at least four times more deaths from C. difficile than from MRSA. But is C. difficile receiving the attention that it deserves? Many would describe it as the Cinderella of hospital-acquired infections, but it deserves to be at the centre of everyones attention, given its prevalence and the risks of fatality.
The purpose of the debate is also to highlight the tireless efforts of my constituent Graziella Kontkowski, who, with her brother Markboth are here in the House tonightset up a website and forum, www.cdiff-support.co.uk. There are literally thousands of hits per day from the many people who wish to receive support and advice, and to give their stories. That highlights the profound concern about C. difficile throughout the country.
My constituent was motivated by her and her familys experience with her grandmother, who sadly and tragically died on 26 September 2005 as a result of contracting C. difficile at North Middlesex hospital. Graziella tells me that half the ward became infected with the deadly bacteria, all due to lack of hygiene. Measures were not taken to prevent the spread of the bug, and patients and their relatives were not given information about the severity of C. difficile. Graziellas efforts to get to the truth and to secure improvements at North Middlesex university hospital and the other local hospital, Chase Farm, spurred her to set up the website and to help others in a similar situation to that of her family.
C. difficile is an appalling infection, attacking particularly the elderly on prescribed antibiotics. The symptoms of severe diarrhoea, stomach cramps and fever, often followed by dehydration, take their toll on the vulnerable. Loss of pride and self-esteem is great, and extremely sad for relatives as they watch the deterioration happen before their eyes. That is particularly aggravated by the lack of information
about what is happening. That is why the C. difficile support group was set up, and that is also why the Government must take urgent action.
Many sad cases could be recounted, such as those of elderly patients who have fought successfully for years against cancer only suddenly to be struck down by C. difficile, and to die in a matter of weeks. Such tragic circumstances were highlighted in the outbreaks of C. difficile at Stoke Mandeville hospital that ended in 2005 and that led to at least 33 deaths. A Healthcare Commission report challenged the Government approach, not just to isolated incidents of infection control, but to the whole policy on health care.
The achievement of the Governments targets was seen as more important than the management of the clinical risk inherent in the outbreaks of C. difficile.
operational problems arose out of the need to juggle a number of must do objectives, including the control of finance, the reconfiguration of services, and meeting targets for waiting times.
The juggling of those targets and reconfigurations is a reality across the country. In the Enfield area, Chase Farm hospital is facing the prospect of cuts to its accident and emergency services and doctor-led maternity services, and North Middlesex university hospital is debt-ridden. The risk is that as they juggle their priorities, they will drop the ball of infection control, particularly in respect of the care of the most vulnerablethe elderly. That is the Governments responsibility. As Graziella has said:
The government has set hospital trusts targets, in the process of trying to achieve these targets patient care has been compromised and standards have dropped drastically now making hospitals a dangerous place to be in. People are no longer afraid of going in to have treatment but what infections they might catch. Does the Minister not feel that is unacceptable?
The key question is: have lessons been learned? However, perhaps that could be prefaced by another question: do the Government know the extent of the problem, so that they can tackle properly the C. difficile problem? There is evidence of under-reporting; there is mandatory surveillance only of over-65s, so there is no obligation to report on under-65s.
Let me refer the Minister to three examples on the C. difficile support website this week. There is an example of poor hygiene not from someone older than 65, but from a 23-year-old young man. He said that he suffered from ill health; he had suffered from Crohns disease. He entered hospital and thought he
was in a clean environment ... I was suffering intense diarrhoea and reported it to the doctors and nurses that were looking after me. They told me it was nothing to worry about. A day or so later, when going to the toilet, I noticed excrement on the floor leading up to the toilets themselves. When I went into the toilet, there was...fecal matter all round the bowl and over the floor. I said to the staff about this, but it wasnt cleared up for a good few hours after I reported it. The following day I was feeling a lot worse. Nausea and severe stomach cramps along with dizzy spells made me realise that there was something seriously wrong.
I tried telling the doctors about my concerns, but I felt as though they just guffawed at it ...The diarrhoea and vomiting had severely disrupted the electrolytes...in my blood, putting my heart under intense strain. My heart stopped and I had to be resuscitated.
The doctors concluded that this was all due to an infection with a highly virulent strain of C.Diff.
The ward I was on was closed as another 13 patients were affected by the bug.
I was diagnosed with C.diff following a course of antibiotics that I took for an infected scar after a laparoscopy operation. I had a really dodgy tummy, then was admitted to hospital with life-threatening temperature, low blood pressure and high pulse. 24 hours later I was diagnosed with C.diff ... They got my temperature back up, and sent me home. Waiting at home for me was my Mumshe had just finished chemotherapy and was still susceptible to illnessso should they have sent me home? They kept me on a general ward
whilst in hospital, and made no effort to stop the infection spreading to other patients.
Brought my dad home from hospital yesterday ... Just looking through the copy of the discharge notes sent to the GP:
Mr. X has been well throughout his stay.
I cant believe there is no mention of catching C.diff, treatment given etc. The GP now has no idea that my dad has this bacterium.
There are reports of patients being discharged from hospital before they are fit and ready to go home. This debate was also prompted by my experience over Christmas when visiting various residential homes. Sadly, I saw time and again residents who had recently been discharged from hospital who were malnourished and dehydrated; indeed, some were infected by the bug. Does the Minister therefore agree that all health care professionals, including those working in long-term care facilities, need to be made aware of the emergence of a stronger strain of C. difficile? Why are basic hygiene and the soap and water scrubbing that are so essential in tackling C. difficile not commonplace in hospitals?
Staff have to go back to the rather old-fashioned method of soap and water and that is a rather difficult message to get through.
Have the Government taken heed of the recent outbreak at Nottinghams Queens Medical Centre and joined in the good practice of setting up isolation wards away from short-stay surgical wards? Why, contrary to advice from the chief medical officer, is there inadequate control over the prescribing of high-risk broad-spectrum antibiotics to over-65s? Why do we not in this instanceperhaps uniquelylearn a lesson from Europe and industrially launder nurses uniforms, instead of continuing with our unique British practice of laundering uniforms at home?
Will the Government, who are so intent on a target culturenational targets, combined targets and now local targetsagree with the memo from their own Department, which said that this is basically a cop-out? Will the Minister condemn trusts that, according to the memo, simply see C. difficile as an unavoidable fact of hospital life? What will be done to tackle the lack of information for patients and relatives once patients are infected? What precautions are communicated to discharged patients when they go home, in order to stop C. difficile spreading in the community, as it can do? It is not just a hospital problemit is out there in the community. Will the Minister therefore agree that C. difficile is indeed endemic and needs to be tackled as an urgent priority, rather than by simply trying to handle targets better?
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