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We introduced the motion today simply because we have raised infection control issues many times over the past three years, and we want action and need progress. The House needs an opportunity to learn why that action has not been taken, and why that progress has not been made. Our motion this afternoon is intended to provide precisely that opportunity. Let us consider where we are on the issue, and what has been done. In 2005-06, some 7,097 MRSAmethicillin-resistant Staphylococcus aureus bloodstream infections were reported. That was a reduction of 8 per cent. in relation to the 2003-04 baseline for the Governments target of halving the number of MRSA bloodstream infections by 2008. However, that should be put in context, because the number of deaths associated with MRSA has tripled since 1997. As we said back in 2004, halving MRSA rates would in fact do no more than bring them
back to the levels that pertained at the end of the 1990s. Of course, the bloodstream infections that are the subject of the Governments target do not include surgical site infections.
Since the Governments target was introduced, and even in recent months, more serious and more toxic forms of MRSA have appeared, including PVLI will not attempt to give its scientific namea dangerous form of MRSA in which a toxin that attacks leukocytes is emitted. It can lead to conditions such as necrotising fasciitis, which can lead to death in a matter of hourswithin 72 hours. Serious and highly toxic forms of MRSA are appearing in hospitals, but the particular form that I mentioned is generally associated with community-acquired MRSA.
Michael Fabricant (Lichfield) (Con): Was my hon. Friend as surprised as I was to learn of the move to tell nurses that, to try to avoid cross-infection with the more difficult forms of MRSA, they should no longer simply sterilise their hands using a sterilising wash, but should make it a regular practice to wash their hands? Was he as surprised as I was to hear that injunction, given that one might expect nurses to wash their hands as a matter of course?
Mr. Lansley: In my view, it has always been standard practice in hand hygiene both to use alcohol-based hand rubs and to wash ones hands in between patients. My hon. Friends interesting point brings me to the next issue. Interestingly, for reasons that I do not quite understand, the Government did not make any reference to Clostridium difficile in their amendment to our motion. One of the consequences of the Governments MRSA target has been a welcome increase in the availability and use of alcohol hand rubs in health care institutions, but that has not been effective in tackling the spread of Clostridium difficile, which requires washing with soap and water, too. One can see how it has come about that the Governments narrow targeting has contributed to the dangers, which have been increasing with Clostridium difficile. The Government have not responded to those dangers.
Mr. Lansley: I will give way to the hon. Lady in a moment, but first I wish to put the figures on the record. There are several times as many cases of Clostridium difficile as there are of MRSA. There were approximately 1,300 deaths in which C.difficile was an underlying cause in the last year for which figures were available. Some 2,247 deaths were associated with C.difficile, which is an increase from 975 in 1999, and is twice the number of deaths associated with MRSA. The Government, however, ignore that in their amendment.
Mr. David Heath (Somerton and Frome) (LD):
I agree that there has been a huge effort by staff and the Government to improve infection control. Without wishing to sound too much like an old soldier, 25 years ago, I worked in an operating theatre, and I am surprised by the laxity of procedures now. Some staff, for instance, wear jewellery while in uniform, do not
follow aseptic procedures, or wear scrubs outside theatre. A St. Thomass-trained sister would have scalped people for such surprising practices a few years ago, but the procedures that she enforced do not appear to be part of basic training today.
Mr. Lansley: I accept the point that the hon. Gentleman is making, and I shall come on to it later. It is addressed by the motion, which deals with the availability of facilities, particularly in hospitals, to support the adoption of a policy on uniforms. First, however, I promised the hon. Member for Milton Keynes, South-West (Dr. Starkey) that I would give way to her.
Dr. Starkey: The moment has passed, but I was seeking to emphasise the fact that a distinction must be made between the level of those increasingly drug-resistant infections in hospital and in the community at large. Hospitals operate against a rising base line, and the hon. Gentleman has ignored that key fact.
Mr. Lansley: It is interesting that the hon. Lady should say so, as I have been speaking for only seven minutes. I shall come on to talk about the technology that would allow us to distinguish between the rising incidence of infections in hospitals and their prevalence. I accept that, in many cases, infections are introduced to hospitals by admissions from the community, and were acquired in the community. New technologies make it possible to make that distinction more quickly, but that leads to the question whether a policy of screening all admissions should be introduced as a result. I shall come on to that in a minute, too.
Outbreaks of C.difficile are very serious. At Stoke Mandeville, for example, there were 330 cases, in 33 of which, it is believed, the infection led to death. There have been cases in Maidstone, Leicesterthe Secretary of State will know about thatand Nottingham. As with MRSA, we are dealing with more virulent strains of the infection such as the 027 strain. Other infections are a problem, too, such as GREglycopeptide-resistant enterococciAcinetobacter and multi-drug resistant TB. I do not dispute for a moment the fact that the Government face a challenging environment, given the prevalence of more toxic infections.
Mr. Paul Keetch (Hereford) (LD): The hon. Gentleman will recognise that that is not a new problem. Indeed, my mother died of MRSA in 1996 under the previous Government. [ Interruption. ] I am not seeking to blame anyone; I certainly would not do so for the death of my own parent. May I ask the hon. Gentleman whether he shares the Patients Associations concerns that there does not appear to be a national across-the-board view about infection control, and that there are variations at local level? We need more information, and people at Hereford county hospital, where my mother died 11 years ago, believe that there should be broader view at the top to make sure that there is a common set of practices to control infection.
I understand the point that the hon. Gentleman makes. He is right to point out that the number of deaths associated with MRSA, which was 49 in 1993, began to rise sharply in 1995 and 1996, as the trend line shows. I do not dispute that. The question is what we are doing now, as much larger
numbers of people are dying of causes associated with the infections. Should we specify how every hospital and every member of the NHS should work? Of course not, but we should ensure that the actions that would clearly help, and which are spelled out as necessary by the Health Protection Agency and in the Governments guidance to the NHS, are supported and pushed through by the Government where that has previously not been the case.
Mr. Burrowes: I commend my hon. Friend for not ignoring Clostridium difficile, which is ignored in the Governments amendment, as he pointed out. That is in marked contrast to the leaked memo, in which the Department of Health official states that Clostridium difficile is now
endemic throughout the health service.
Mr. Lansley: Indeed, it is a cop out. The Government must do one of two things. They must set a target and put in place the measures that will deliver it, or they should support the NHS in its local targets. The Government cannot have it both ways. They say, It is not our responsibility. The NHS hospitals must decide what to do, then they say they want to set a target and achieve it.
Although the numbers are coming down, we are not on course to hit that target and there is some doubt about whether it is in fact achievable.
If he did not pluck a target out of the air, will he tell the House where the evidence base is for his assertion that by 2008 the NHS should aim to halve the current rate of MRSA?
I am saying that that is where we will be without a shadow of a doubt. . . Where did I get that target? I got it on official advice[ Official Report, 30 November 2004; Vol. 428, c. 526.]
We never saw the evidence or the official advice. Now we see the official advice inside the Department. Officials do not believe that the target can be achieved. I think they are wrong about that. It can be achieved. They never believed that it would be achieved, and they did not give the Secretary of State the advice on the basis of which he plucked his target out of the air. That is just one more example of the right hon. Gentleman in his progress around Whitehall, with his Cabinet colleagues following in their dustcarts.
Andy Burnham: Now that the hon. Gentleman has seen the advice that was put to Ministers, what does he think is the right responseto redouble efforts or, as he appeared to conclude yesterday, to scrap the target?
Mr. Lansley: It is important to redouble efforts. It is absurd that Ministers say, The target is marvellous. We will not achieve it, but the target is marvellous. The target has probably contributed to a lack of attention to Clostridium difficile and a 17 per cent. increase in the infection, which has killed twice as many people as has MRSA. Ministers think that the sum total of their objective is a target for MRSA bloodstream infections, rather than to deliver proper infection control across the NHS. They would rather hit the MRSA target, or pretend that they will, than deliver the actions that are necessary. Redoubling our efforts, if the Minister asks
Let me give the Minister another example. Back in 2004 my right hon. and learned Friend the Member for Folkestone and Hythe (Mr. Howard), then Leader of the Opposition, and I challenged the Prime Minister and the Secretary of State on the finding in the National Audit Office report that managers were putting targets ahead of infection control advice. The Prime Minister told us that that would not happen, that patient safety would come first and that managers would never do such a thing. Yet the Healthcare Commission report into the Clostridium difficile outbreaks at Stoke Mandeville stated:
Other managerial imperatives were given greater priority than the control of infection... The director of infection prevention and control had not persuaded the board to give sufficient priority to the control of infection in general and to the control of C. difficile in particular.
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. This was a significant failing.
Charles Hendry (Wealden) (Con): I have a letter from the director of nursing and patient services at Maidstone and Tunbridge Wells NHS Trust to a constituent whose mother contracted C. difficile in Maidstone and subsequently died. It states:
given its age and design is I am afraid totally unsuited to the management of infection and the support of barrier nursing for patients with infectious diseases... The Ward sister... is relatively
new... I will ask that her manager ensures, as part of her personal development plan this year that infection control is a key part of her development.
Mr. Lansley: Yes. Unfortunately, one of the serious outbreaks took place at Maidstone. We have not received the results of further investigations into some of the outbreaks and it is wrong to assume that the failings at Stoke Mandeville occurred elsewhere. However, I would be surprised if similar failings had not arisen in other places. The Government should have done something about it at the time.
The Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham) asked what actions we would take and mentioned redoubling efforts. Let us consider bed occupancy rates. In 2000, the Government promised the National Audit Office that those rates would go down, but they have gone up. Professor Barry Cookson of the Health Protection Agency rightly said:
What all the evidence shows is that we have to get bed occupancy rates to 85 per cent. but the Government has clearly got its waiting list targets and has signed up to them.
What has happened? We have 9,000 fewer beds than we had 21 months ago. Five per cent. of the NHS hospital sectors bed capacity has disappeared in that time. That is not a consequence of the increasing average length of stay or higher day case rates, but a result of budget cuts.
Anne Main (St. Albans) (Con): Unfortunately, my health authority and trusts have the same problem. Dr. Martin Woolaway, the director of public health for my authority, stated in a report to the NAO about preventing infections:
Preventing infections continues to be adversely affected by high bed occupancy, the movement of patients and the lack of beds to allow separation of elective and trauma patients.
Mr. Lansley: That is disgraceful. Last year, 40 per cent. of nurses reported that they did not have sufficient time to clean beds thoroughly between patients. That is central to proper infection control.
What about undertaking wider surveillance and inspection instead of the Governments narrow targets? The Minister asked what he should have done in response to the memorandum from the director of health protection. He should have said that the Government would redouble their efforts, not only in relation to MRSA bloodstream infections but a wider range of infections. He should have agreed to disseminate that data and ensured that people could act on the information.
What about cleaning? The Minister is apparently interested in that and believes that the problem will be solved by in-house cleaning. Why, two years after the publication in 2004 of the model cleaning contract, which was trumpeted as a way of ensuring high standards of cleaning, could Norman Rose of the Business Services Association say that
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