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Ms Hewitt:
The hon. Gentleman raises an important point. Many hospitals have introduced protected hours for visiting and controls on numbers, and several NHS
foundation trusts engage their members in decisions on such restrictions. However, I must say that, once again, the hon. Gentleman is asking the Government to decide. Does he want us to set a target for the number of visitors that there should be at any one time, or where they should sit?
Let me say a little more about targets. We set the target of halving the MRSA rate, and I am sure that if we had not set that target the rate would have been going up rather than down and that we would have a much bigger problem than we already have. However, we always said that the target would be challenging—my right hon. Friend the Member for Airdrie and Shotts (John Reid) said that at the time. There is no point in setting easy targets. We need to set challenging targets in order to ensure that everybody makes the greatest possible effort to deal with a problem that affects the NHS as a whole.
The Opposition are against targets. They have been busy telling the press that they will get rid of all the NHS targets. The hon. Member for South Cambridgeshire has confirmed that they want to get rid of targets—in other words, he has confirmed that he does not believe that the Government should focus on the top priority issues for patients and the NHS by setting a target for reducing the MRSA rate.
Charles Hendry: Does the Secretary of State believe that the Government should have a view on what constitutes good practice? In answering questions on issues such as nurses’ uniforms and visiting hours, she said that she did not have a view. Does she have a view on whether it is right for people no longer to wear masks in operating theatres, because people have frequently been told that they cannot be afforded and that there is no money for them? Does she believe that masks being worn in such circumstances constitute good practice?
Ms Hewitt: I will shortly come on to the action that we have been taking, and supporting the NHS to take, to get the infection rates down, but the hon. Gentleman might find it useful and interesting to look at “Saving Lives: Our Healthier Nation”, one of the pieces of useful guidance and support that we have been giving to the NHS to ensure that action follows the setting of targets.
The Conservatives need to deal with this issue. If they really believe that targets should go, do they think that the NHS should be trying to halve MRSA rates by 2008, or not? Do they want waiting times to fall? Do they want cancer patients—people urgently referred by their GP because they might have cancer—to be got through their appointment with their specialist and their diagnostic tests, and to be started on their treatment, within 62 days? That is the target that we have set, and which has helped to transform cancer care in the past 15 months alone. Do they believe that that target should be maintained and achieved, or do they not mind what the MRSA rates and the cancer waiting times are? In other words, are the Conservatives prepared to set national standards for the NHS and to ensure that they will be followed through, or will they give up, as they did when they had their disastrous years in government?
Mr. Lansley: The Secretary of State has strayed into saying that if there are no targets there are no standards, but of course there are standards. We have been very clear about standards. Our point about targets can be seen in respect of MRSA; they have focused so narrowly on one measure of MRSA infection that other forms of MRSA infection—C. difficile, Acinetobacter and Panton-Valentine leukocidin or PVL—are not being addressed with the comprehensive action that is required.
The Secretary of State talks about all the actions that she is taking and the documents that are being published. Let me ask her a question about the matron’s charter of October 2004. It has a lovely chart that shows how matrons will have the authority to withhold payment. Have matrons actually exercised such a power to withhold payment on any occasion since October 2004?
Ms Hewitt: Almost every time I visit an NHS hospital I meet matrons who every day act to improve patient care and uphold the highest standards that all of us want. The House and the public now know that the Conservatives would scrap the targets that are helping to reduce infection rates.
Let me deal with C. difficile—
Andrew Rosindell (Romford) (Con): Will the Secretary of State give way?
Ms Hewitt: No; I want to make a little more progress before I give way again.
It is perfectly true that the national target that we set in 2004 related to MRSA and not to C. difficile, which is also an increasing problem in hospitals not only in Britain, but in almost every developed country in the world. I make two points about that. First, because the MRSA target has focused the attention of every hospital—from the board right down to every ward—on better infection control, it is helping to deal not only with MRSA but with C. difficile and other infections. Secondly, we are seeing very different rates of C. difficile in different hospitals, particularly in respect of the latest, most difficult, strain. That is why, in the operating framework that we set for 2007-08, in which we confirmed that infection control was one of the NHS’s top four priorities for the coming year, we also said that we expected every acute hospital, with its local primary care trust, to set a challenging target for bringing down its C. difficile rates, where that was needed.
Ms Hewitt: Local targets, because there is such local variation in the incidence of C. difficile, which is not something that one can say about MRSA.
Norman Lamb (North Norfolk) (LD): I am very grateful to the Secretary of State for giving way. Is she really saying that it is appropriate to have a national target for MRSA, despite considerable variation around the country, but local targets for C. difficile because of massive variation? That simply does not make sense.
Ms Hewitt:
That is precisely what I am saying. We set a national target for MRSA because that was a nationwide problem. Although some trusts had very
low rates, in most hospitals we expected—rightly—to see very significant reductions in MRSA infections. As I said earlier, and as has been confirmed in many conversations with the experts—the NHS front-line staff—it was because we set that target and focused on MRSA specifically and infection control generally that the infection rate started to come down. However, given that some hospitals are really struggling with outbreaks of the most recent and difficult strain of C. difficile, but others have it well under control, rather than trying to set a national target it makes much more sense to say to the service, as we have done, “Let us have challenging local targets agreed between the hospital and the PCT, but reported nationally not only to ourselves, but to the Healthcare Commission and, most important of all, to the patients themselves.”
Ms Hewitt: The hon. Gentleman is being very persistent; I give way.
Andrew Rosindell: I thank the Secretary of State. She will recall, because we have corresponded on the matter, that C. difficile has been a serious problem in Oldchurch hospital, in my constituency. As she is also aware, we now have the new Romford hospital. The death of my late constituent, Mr. Patrick Martin, in 2005 caused a great deal of anguish, but a public inquiry has not been called. Will the Secretary of State please reassure my constituents that although there has not been a proper inquiry and investigation into that incident, the same problem will not be transferred from Oldchurch hospital to the new Romford hospital? Surely it is time that we had a full public inquiry into Mr. Martin’s sad and tragic death.
Ms Hewitt: The hon. Gentleman has indeed written to me about the tragic death of Mr. Martin, and I should obviously like to extend my condolences to Mr. Martin’s family. Although it is never possible to eradicate MRSA completely, given the complexities of modern medicine, every avoidable death from MRSA—or any other hospital-inquired infection—is one death too many. That is why, as part of the clinical governance arrangements in the NHS that we have been strengthening since we were elected, it is essential that every hospital learns the lessons from any one of these preventable deaths—and, indeed, from every incident of MRSA or outbreak of C. difficile, even if it does not lead to a death. I am glad that the hon. Gentleman mentioned the new Romford hospital, which is one of more than 80 new hospitals that, under our Government, have been built or are in the process of being built for NHS staff and patients.
I want to stress that even with 12 million people admitted to hospital every year, and such tragic cases as the one to which the hon. Gentleman has just referred, the risk of MRSA bloodstream infection remains very low, with fewer than two cases for every 10,000 hospital bed days. However, we also know that we can and must do more with all such infections. That is why in 2005 the chief nursing officer launched the national programme “Saving Lives”, which was based on the best available information, guidance and practice from the UK and internationally. The programme was designed to focus the efforts of every
hospital on a small number of high impact clinical interventions, and it has done so. All the evidence shows that if a hospital implements those measures consistently, it will reduce the rate of all those serious infections.
Let me quote Peter Wilson, the consultant microbiologist at University College London Hospitals Foundation Trust:
“Even though UCLH had high levels of MRSA bacteraemia in 2001, we have been successful in reducing them substantially by being focussed on the task and gaining the full support of the chief executive.”
He says that the trust has introduced
“wound surveillance and rapid MRSA screening in addition to increased use of hand gel and hand hygiene education.”
“Any hospitals using similar strategies should be able to achieve the MRSA target. Antibiotic control has also ensured low levels of C difficile.”
Mr. Heath: The Secretary of State is probably entirely right to say that proper interventions and protocols can reduce bacteraemia in the hospital environment, although part of the equation is having the capacity to isolate cases, which comes back to the bed occupancy issue that my hon. Friend the Member for Sutton and Cheam (Mr. Burstow) raised earlier. However, can anything be done to reduce the proportion of the resident population of Staphylococcus aureus that is methicillin resistant? Is there any public health measure that has been shown to be effective in achieving that?
Ms Hewitt: The hon. Gentleman makes an extremely important point. Hospitals have found, as a result of the monitoring that we have asked them to do, that MRSA is present in some 20 per cent. of patients admitted from nursing homes and 7 to 8 per cent. of patients admitted as emergency cases. At this point, the most useful action, and one that we strongly recommend to the NHS, is to screen high risk patients, especially elderly people, those coming in for orthopaedic surgery—emergency cases as well as elective—and patients coming in from nursing homes. That is precisely the guidance that the chief medical officer and chief nursing officer issued last year to supplement the guidance that we had already issued in “Saving Lives”.
Mr. Lansley: I am surprised by those remarks because I have read “Saving Lives” on the summary of best practice in screening for MRSA, and I quoted from that document in my earlier remarks the conclusion that the best way to deal with it was universal screening of all admissions. The Secretary of State is now saying that her recommendation is different from what her own document said.
Ms Hewitt: The guidance that we issued last year on screening recommends strongly to trusts that they focus their efforts on those most at risk —[ Interruption. ] Well, I will send the hon. Gentleman a copy of the document because I have just been looking at it. It sets out in great detail the different groups of patients most at risk of MRSA and other infections —[ Interruption. ]
Mr. Deputy Speaker (Sir Michael Lord): Order. The hon. Member for South Cambridgeshire (Mr. Lansley) may not like the answer that he is getting to his question, but he must listen to it without continually intervening from a sedentary position.
Ms Hewitt: I am grateful to you, Mr. Deputy Speaker.
We have issued that further guidance and we expect it and other guidance to be implemented. However, a critical element in the action needed to ensure that targets are taken seriously and achieved is our investment in improvement teams. Those teams work directly with the acute hospital trusts that are finding it most difficult to get infection rates down. In the past year, they have worked with more than 50 trusts, and that is exactly the same approach that we adopted in our work to improve accident and emergency services. Our aim then was to get rid of the appallingly long waits on trolleys in corridors that people had to suffer, and to cut waiting times. For example, when the teams began work, people were waiting for hip replacement operations for 18 months or even two years.
That is an example of how we set a target, focus attention on it and then send in improvement teams to work with those hospitals that are struggling the most, but we have done more than that. The hon. Member for South Cambridgeshire spoke rather scornfully about the Health Act 2006, but I think that it represents a hugely important step forward, as it gives us the power to introduce a statutory code of practice as part of our campaign to save the lives of more NHS patients.
The 2006 Act came into effect last October and it requires every NHS trust to have proper systems in place to deliver effective infection control. The Healthcare Commission will assess compliance with the code of practice, as part of the checks on the quality of health care that it makes on behalf of all patients. Already, 41 trusts have carried out self-assessment exercises and declared that they were not doing enough to control infections. The Healthcare Commission is following up each of them to ensure that effective remedial action has been taken.
If the Healthcare Commission finds that a trust has not taken effective remedial action to deal with infection control problems, it will be able to issue statutory improvement notices that require the trust to remedy the failure within a specified period. I assure the House that it will have no hesitation in doing so.
Justine Greening (Putney) (Con): I thank the Secretary of State for giving way—[ Interruption.] I am delighted that her Front-Bench colleagues have woken up enough to hear my intervention. The right hon. Lady talked about quality control, but is not what she said at odds with the Local Government and Public Involvement in Health Bill that we debated yesterday? Under that Bill, the public and patient involvement forums are to be turned into local involvement networks. The forums’ ability to hold trusts accountable for their performance in respect of hospital-acquired infections is a very important element in ensuring that targets are met, but do not the new proposals simply water that down?
Ms Hewitt:
The hon. Lady is absolutely wrong. The system is not being watered down, as the success of the patient and public forums provides the basis for the much stronger system being put in place with the local involvement networks. We have been able to make an enormous difference to the quite shocking standards of hospital hygiene that we found when we were elected
10 years ago, precisely because of the work of patient environmental assessment action teams that go into hospitals and make unannounced inspections on behalf of patients and the public.
Although all of our work—with “Saving Lives”, the new screening guidance, the new code of practice, stronger powers for the Healthcare Commission and with the improvement teams—was having an effect, we remained unsatisfied. Infection rates for MRSA were falling, but not fast enough, so last month we announced a further allocation of £50 million in capital funding—[ Interruption.] The hon. Member for South Cambridgeshire should listen, as he was asking for more capital funding. That £50 million in capital funding was made available to enable hospital trusts to buy equipment and carry out work so that they could further improve hygiene and reduce the risk of infection.
I can announce that, as of today, £45 million of that £50 million fund has already been released to trusts. They are using the money to build more single rooms for isolation treatment, to install more hand-washing basins and to modernise bathrooms, and to put in safe storage containers for dirty linen where they are needed. Trusts are also using the money to acquire new equipment for the heavy duty, deep steam cleaning of infected rooms and wards, and they are buying new wipe clean computer keyboards for theatres and new equipment for microbiology laboratories. Further investment in the national health service, made possible by the record investment that our Government are making in the NHS—investment that the Conservatives voted against—[ Interruption.] They do not like to hear that, but they will hear it. That investment would be put at risk every year by the Conservatives’ new economic policy; they would cut funding for the NHS and other public services to pay for tax cuts.
We know that getting infections under control has to be a top priority for the NHS, which is exactly what we said in the NHS operating framework for the next financial year. Cut infection rates, cut waiting times further, reduce health inequalities and achieve financial health—the top four priorities for the NHS for 2007-08. Those are all targets that the Conservatives would scrap. All those achievements would be put at risk by their health and economic policies.
I commend the amendment to the House.
4.46 pm
Norman Lamb (North Norfolk) (LD): The debate has clearly been inspired by the leaking of the now infamous Department of Health memorandum, which painted a disturbing picture of the trends in health care-acquired infections. In the aftermath of the leak of that document, the headline focus was on the MRSA target, but as the hon. Member for South Cambridgeshire (Mr. Lansley) rightly said, the previous Secretary of State made an absolute commitment not merely to move towards that target but to meet it. It is right, therefore, that the Government should be held to account on their progress in achieving that absolute commitment.
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