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“are more likely to catch it from yourself.”
That is the absolute truth. Many people who are admitted to hospital, particularly for a surgical intervention, may well have the MRSA bug or any one of 16 or so other infections. Once those infections are introduced into the bloodstream, bacteraemia arise. We need to tackle the problem, and the Government are taking it seriously. We cannot pretend that it is only the Government’s responsibility and ignore the excellent initiatives by trusts up and down the country. Many of those initiatives are the result of the mandatory requirement for trusts to report MRSA, which is a significant driver that empowers not just trust board members—in an excellent initiative, many boards now have a member with specific responsibility for reducing infection—but all the staff who work in our fantastic NHS.
The most important improvement that has allowed us to make headway in tackling all those health care-acquired infections is the provision for nurses to take a leadership role. To many of us who spend time in our local hospital—recently, I have had to do so more often than I would wish, as my parents have been unwell and have undergone surgical procedures, as did my son the week before last, although he was on a different ward—it is obvious whether those initiatives are taken seriously and a leadership role is adopted by the ward manager. When I go on to a ward and see at every bedside a gel dispenser and, at the entrance to the ward, huge signs explaining that it is important to take precautions to prevent those infections from being taken on to the ward and transmitted to vulnerable people, I know that that the problem is being addressed.
My knowledge derives not just from recent experience as a ward visitor but from my experience as a nurse on an isolation unit before coming to the House. I become increasingly angry when I listen to debates in which people say, “It is all the Government’s fault, because they have not done anything about it.” May I gently remind Opposition Members that, having worked on an acute isolation unit throughout the 90s, those beds were increasingly filled by people who became MRSA-positive during their stay in hospital? There was no requirement to count the number of individuals who became infected, but we lost many people, because they were very poorly in the first place, and thus succumbed to infection. However, there was no drive to deal with that matter, and no interventions that allowed us to ensure that those patients did not become infected. It was almost as though we were supposed to tackle the infection in the isolation unit, but by then it was far too late, of course. That is not where the work is valuable. It must be done at a much earlier stage. That is why I am firmly convinced that the problem is a collective one, and that we must work with health care professionals.
I found the Opposition motion very mealy-mouthed about health care staff, particularly those in our hospitals. The motion states how strongly the House
supports them, and then goes on to criticise them for their practices and the work that they are doing. I shall outline some of the work that I have been doing in conjunction with nurses, and the work that has been going on with the trade unions and the Royal College of Nursing to promote good practice among staff, and to spread good practice among all staff, not just nursing staff. It is important that each care giver in a ward setting be included in training programmes. That is exactly what is happening.
It is obvious that if nurses are delivering 80 per cent. of the care, they will take a leading role in how we tackle these matters, as they are doing. Last year the Royal College of Nursing launched a good campaign in conjunction with the Government, called the “Wipe it out” campaign. It gave excellent advice to staff in hospitals—for example, on how to tackle MRSA, how to deal with uniform issues, and how to deal with the indwelling devices that are inserted in some patients, such as a urinary catheter or a nasal gastric tube. That work has led to the empowering of front-line staff to try and think of new ways of tackling infections.
I have read articles that would make Florence Nightingale turn in her grave. She, of course, was very much aware of infection. More people died of the infection that they acquired at the hospital at Scutari than died of their wounds, but that was before antibiotics. None the less, the problem existed for them.
There is no doubt that we could take punitive measures. We could tell trusts that we do not want them to admit certain patients, or not to allow their relatives to visit them in hospital if we are not sure of their personal habits. We could say that we do not want children to visit during their parents’ or grandparents’ stay in hospital, even though contact with their families makes patients’ stay in hospital much nicer. I have little doubt that we could reduce the amount of infection that is brought into hospitals, but we do not do that because we know the psychological effect that that would have. So we have to think differently about the impact of the people who visit.
I recently watched a family who had come to visit their grandfather in hospital. The little six-year-old girl said that she wanted to go to the toilet, and toddled off alone to the visitors toilet. She was gone for some time, then returned. It was a surgical ward and the grandfather had undergone surgery. I have no idea whether the little one had managed to do all that she needed to do and wash her hands. It is clear that many of us have a responsibility within that setting.
I have no hesitation in saying that we should give good and sound advice to families who visit, and many hospitals do. Excellent advice is also offered to those who come in for surgery. My son recently underwent arthroscopy and was told that it might be a good idea to use an anti-bacterial wash for a week before he went in, thus reducing the risk of self-infection. That was sensible. He received excellent, timely care and had a fantastic discharge. I hope that all patients can have a similar experience.
There are many ways in which front-line staff and visitors can collaborate. I have no hesitation in telling people who go to hospital, either as patients or visitors, that they should challenge staff if they feel that the
practices that they have seen are not good enough. We should be able to say, “This is our NHS and we want some reassurance that hand washing is going on.” I suspect that that happens nine times out of 10 and that people have a good experience. However, we must take a collective interest in care delivery.
When I was nursing and increasing numbers of MRSA cases came to our ward, we were relieved of wearing our caps because, we were told, they might introduce infection. Frankly, reorganising the deckchairs on the Titanic comes to mind. Yet the public debate is often handled in that way. It does not concentrate on the issues that we need to discuss.
There should be collaboration with, for example, community nurses on the way in which we hand over people, who may have been vulnerable at home for some time, to the acute setting for surgical procedure or medical admission. We should ensure that the person being admitted is as clean and clear of infection on the skin as possible, and not a carrier of the conditions that we are discussing. That must also apply to the private sector. We find that elderly, poorly people are often admitted to an acute setting as emergency cases, and the issue of health care-acquired infections has not been tackled. Repeated admissions also cause enormous difficulty. We do not do justice to those on the ground who try to make serious headway in tackling the problems.
I am interested in the focus on uniform policy. The advice not only from the Department but from the RCN “Wipe it out” campaign is clear about not wearing a uniform in a public place. I get so angry if I see anyone in a uniform toddling around ASDA and thinking that it is all right to push a trolley. Not long ago, I tackled someone who turned out to have come from a private nursing home. She was wearing a short uniform and some trousers. I was worried about her walking around a public place in uniform. It is time to outlaw wearing uniforms outside work and ensure that proper facilities are available.
Most hospitals have reasonable changing facilities. They must have either good laundry facilities or enough uniforms to ensure that laundry can be done at home but that a clean uniform is worn each day. None of that is rocket science but it shows how seriously a trust is taking cleanliness and how it disseminates that practice among the staff.
There has been a huge improvement in our local trust, and our local hospital—which is now run by the local doctors in the PCT—in that they now have evening cleaning teams who ensure that the place is clean and tidy and that the public toilets are cleaned. There is also a telephone number that is always staffed so that people can call to report any toilets that are not as clean as they should be. All this contributes immensely to ensuring that our hospitals are as clean as they should be.
Norman Lamb: I am interested to listen to the hon. Lady’s speech, which is obviously based on experience. I mentioned earlier the proposal by the Royal College of Nursing for 24-hour cleaning teams who would be available at the instruction of the nurses to clean whatever areas needed cleaning. What does the hon. Lady think of that proposal?
Laura Moffatt: We have to think about the local setting. Some wards will not require that service, but others certainly would benefit from that particular boost. That is why I am interested in the local credit card system that the managers have in some wards. Some places have decided to spend their money on that system to ensure that they have access to a gold-plated cleaning service. Such services should be available at the behest of the ward manager, if she chooses to use them. We have heard how complicated the link between cleanliness and MRSA can be, but the use of such services would be an illustration that a particular ward was taking the issue seriously.
I have little doubt that much is being done throughout the NHS to tackle this matter. The numbers of those infected, particularly with bacteraemias, is beginning to reverse, thank goodness. Those who are infected are also showing an improvement, despite the increased activity. We need to highlight that point, because much has been said today about the reduction in beds and the resulting increased activity, but the reality is that headway has been made.
We can trust our hospital staff to deal with this matter, but we must work in partnership with them. As a passing shot, I have to say—as a former member of the nursing profession—that the medical profession is not exactly blameless in all this, to say the least. I hope, however, that the days of hard-pressed senior house officers and registrars walking from bed to bed in their grubby white coats are over. In our local trust, I have noticed that they are now using greens from the theatre, which are changed daily. It is a much better practice to wear a fresh outfit every day.
Many of our medical schools—especially in Sussex, I am delighted to say—now offer a new module covering the reduction of hospital-acquired infection as part of the training for undergraduate doctors, which is a big step forward. I should like to see them go a step further and to deliver those classes to their nursing colleagues as well, so that doctors and nurses can discuss ways of tackling these issues together.
Mr. Heath: My experience of theatre work is that it is very much a shared endeavour, and that the surgical team, the anaesthetist, the operating department’s assistants and the theatre nursing staff all understand that they have a shared responsibility for asepsis. I am not sure that that is always the case on the wards, however, and the points that the hon. Lady has made on that are very valid.
Laura Moffatt: I thank the hon. Gentleman for his intervention, but I firmly believe that that situation is changing. When a leadership role is taken by the ward manager, everybody understands, throughout the setting, how important cleanliness is. However, it is also about training. In the protected hour, when patients have a quiet time—there are few enough of those on our wards, which are busy, care-giving settings—the ward manager recently held a training session, often interrupted by calls from patients, to talk to the cleaner about the different cleaning agents that need to be used to tackle all the infections that we face.
I am not in the least depressed about the rate at which we are tackling such infections, as a tough target has been set. When the previous Secretary of State announced
it, most of us knew that it would be tough. Without it, however, we had nothing to aim for. We had to ensure that everyone knew that the House was serious about tackling such infections. I firmly believe that progress is being made. I shall be watching carefully the hand-washing techniques of fellow Members of Parliament; although I will only be able to do so in the ladies’ facilities of the House of Commons, it would be helpful if the chaps watched each other as well.
5.31 pm
Miss Ann Widdecombe (Maidstone and The Weald) (Con): I was exceedingly disappointed by the Secretary of State’s response to the motion. I consider that the NHS today has a tremendous problem. It does not much matter whether it is lesser, greater or co-extensive with the problem that might have been prevailing before 1997. The fact is that there is a problem, and it must be tackled.
The Secretary of State’s speech, however, was entirely defensive, and consisted of little more than comparative statistics. That attitude even prevailed when the hon. Member for North Norfolk (Norman Lamb) gave an interesting example of practice in the Netherlands, which was of considerable significance to the debate. The Secretary of State’s immediate response was not, “That is very interesting. I will have that looked at”, or, “Oh yes, that has already been considered and we do it in some of our hospitals.” It was, “Ah, but the Netherlands has a 7 per cent. infection rate, and we have an 8 per cent. infection rate, so it doesn’t really matter.” When we raised the issue of uniform policy, we did not get an answer; our point was merely characterised as the central plank of Opposition policy to deal with MRSA and C. difficile, instead of being treated on its merits, not as the solution but as a contribution to the solution of the problem in front of us.
In many ways, I was reluctant to participate in this debate, because no Member of the House ever wants to do anything other than praise their local hospital. When they have to do the opposite, they tend to feel cheated and a bit unhappy. But I cannot today pretend that all is well in Maidstone hospital, which has MRSA and, much more worryingly, C. difficile. I believe that various factors are contributing to the hospital not being able to control that problem as soon as should be possible.
I often think that we treat foot and mouth disease far more seriously than we treat C. difficile. If foot and mouth disease breaks out, whole areas are isolated, troughs are set up, people disinfect themselves down to their boots, and great care is taken to ensure that nothing can come out of the zone into any other.
Mr. Crispin Blunt (Reigate) (Con): Quite right too.
Miss Widdecombe: As my hon. Friend says from a sedentary position, that is quite right too. I was not trying to deplore the measures that we take over foot and mouth; I merely wanted to translate them into the measures that we take with C. difficile and MRSA, and to suggest that we could be a little more focused.
Certain things could be done, which are only being done patchily in the NHS, that should be standard practice. One of those is screening. The hon. Member for North Norfolk was absolutely right: screening is important.
I have a tale of three hospitals. They are my own hospital, Maidstone, to which I am utterly devoted and for which I shall always fight but which, on this occasion, is causing me anxiety; the Royal London hospital in Whitechapel, London, to which my mother was recently admitted as a trauma case; and King Edward VII’s hospital, a private-sector hospital also in London, to which she was transferred when the trauma had been stabilised. I watched the way in which those hospitals operated.
When my mother went into King Edward VII’s hospital, the reaction was immediate. A swab for MRSA had to be taken straight away. It was not a case of whether MRSA had been present in the Royal London. There could be no argument: she was coming into the hospital, and therefore needed a swab. For the 48 hours that elapsed before the swab proved negative, she was barrier-nursed. Everyone wore aprons and gloves and underwent a disinfecting procedure before daring to leave the ward, even if they went out merely to fetch a pen or some hospital gadget. If they walked out of the ward, full disinfecting procedures took place as if it were a foot and mouth area. That is effective screening. When the negativity of the swab had been established, the barrier nursing ended and ordinary nursing was substituted.
In the Royal London the floor was so clean that you could see your face in it, and the nursing on the Helen Raphael ward was exemplary. I should add that it was an old-style Nightingale ward. The nurses sat at a desk at the end: they could see every single patient, and every single patient could see every single nurse. Everyone knew what everyone else was doing. The ward did not have those wretched little rooms behind the desk into which nurses often disappear, and from which they emerge very quickly when people come to look at the wards. It was a very disciplined, busy set-up. I think that discipline and nursing standards are crucial.
The hon. Member for Crawley (Laura Moffatt) referred to “ward managers”, but it is the ward sister who should be responsible for discipline on the wards. In Maidstone hospital, old people’s drips are running out and not being replaced. Food is being put in front of old people and taken away again without any attempt being made to ensure that they eat it. Pills are being found in the dressing-gown pockets of patients because they have simply been handed over rather than being administered with supervision. There is some extremely sloppy nursing, and it is therefore not surprising that there is also infection.
One patient sent me a video showing the amount of dirt in some of the wards. Before any Member puts his or her hand up and mentions contract cleaning, I should say that one example of that dirt consisted of a bowl of blood that had sat on a window sill for nearly 24 hours. It was not a contract cleaner’s job to pick that up; it was, crucially, a nurse’s job. It was the ward sister’s job to notice that it had not been picked up, and her job to ask “Why is that drip not being filled?” or “Why is that patient not being fed?”
One of my constituents telephoned his brother to say that he was in Maidstone hospital with C. difficile, sitting in his own diarrhoea, and that he wished he was
dead. Can anyone believe that when that is the standard of nursing, it has nothing to do with the spread of infection?
Screening is important, discipline is important, standards of nursing are important, and the ward sister’s role is important. She is not a commissioner of blankets and bandages; she should be exercising discipline on the wards. The role of visitors is also crucial. The hon. Member for Crawley told the story of the seven-year-old girl who went off to the loo. Was she not challenged, either going or coming back? Did no one ask “Have you washed your hands?”, or say “You will make sure that you wash your hands, won’t you?” Was she challenged by any of the nurses, by the ward sister or by any passing bearer of tea and coffee?
Laura Moffatt: As a nurse, I am probably much harder on, and less tolerant of poor nursing care than most others. In fact, I can get very angry about it, but does the right hon. Lady agree that, thankfully, due to the extra nurses working in the NHS, poor nurses are still a minority? From her speech, the House would think that a majority of care was being delivered in that poor way.
Miss Widdecombe: That standard of nursing is far too common across the NHS. I accept that it is not apparent in every ward. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley), in his excellent introductory speech, pointed out that we can have two adjacent wards, one with no problem and one with a problem, and two completely different sets of practices. That is why I mention the ward sister. The ward sister and individual discipline on wards are utterly crucial.
If it were simply Maidstone, I would say that something has gone badly wrong at that hospital, which clearly it has, but I get letters from all over the country from people who have similar experiences to tell about their local hospitals. While I would not dream of saying that it is so everywhere, it is certainly so in a greater number of places than it ought to be. Screening, hygiene, discipline, challenging of visitors, proper disinfection processes—those are not rocket science. They all make a tremendous difference to whether infection grows, or is contained and eventually reduced.
No one blames the Government for the fact that C.difficile exists. It is not their fault. It is not the NHS's fault. It is not any individual hospital's fault when it suddenly occurs, but the reaction to it is the responsibility of Government, the NHS and the individual wards, and that reaction is not all that it should be. It should be standard practice that a swab be taken from every admission to the NHS. I know that it is boring but it should be done once a person is admitted to the wards. Full-barrier nursing should be provided until the swab has been shown to be negative. Care in isolation should be provided if the swab is positive. However difficult that may be, and it would be, I do not deny it, that should be standard practice—it should already be standard practice.
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