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It worries meI think Florence Nightingale would have had a bit of a fitthat now one has to remind medical staff to wash their hands. It should be absolutely second nature. They should wash them more often. Most of us have observed medical staff moving from bed to bed, coming and going from wards and,
not always, perhaps not even for the majority of time but quite enough of the time, forgetting to wash their hands. That is not rocket science either. Therefore, if common sense were applied instead of statistics, we could make a serious difference, at not particularly great cost, possibly at rather a lot of inconvenience, but it would be worth it.
I have had elderly patients die in Maidstone hospital who probably need not have died, whose relatives cannot forget what they saw. I have had recounted specific descriptions, including an occasion when a patient, and it was observed, rang a bell in the middle of the night for 15 minutes and was not answered because all the nurses on the ward were at coffee break at once. Rocket science? Discipline and the ward sister.
Mike Penning (Hemel Hempstead) (Con): It is a privilege to follow my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe), who spoke so much common sense. We have had an interesting debate, and I do not want to dwell on statistics and bore Members by talking about numbers. However, I desperately want to look at one area. In common with many Members, constituents of mine have died from MRSAmethicillin-resistant Staphylococcus aureusand C. difficile in local hospitals, but I want to talk about the many patients who have not died, but who have suffered what they almost feel is a worse outcome, that of losing their legs.
Let me give the example of a constituent I met shortly after the last general election. The gentleman had been involved in a serious car crash and he had extensive neck, head and shoulder injuries, but he had no problems at all with his legs. He had steel plates inserted in theatre and was in intensive care for a considerable period. When he went on to the wards to recover, he was tested for MRSA; he was found to have it and subsequently lost both of his legs. That highlights the daily effects of having that kind of infection in our hospitals. Like my right hon. Friend, I do not blame the Government for the existence of such infectionsI do not think that anybody would dream of doing sobut what is important is how we react to this situation.
I have a question for the Ministerhave any modelling or other studies been done on the effects of contract cleaning and in-house cleaning? As the Minister knows, I am a trade unionist, and the point contained in my question is often thrown up by Unison and other such bodies representing their workers. Their representatives say, The problems arise because we have contract cleaning. I am a member of the Health Committee, and in that capacity I have visited hospitals using contract cleaners that are immaculately clean and hospitals cleaned in-house that are also immaculate; but, frankly, in my area of Hertfordshire there are also filthy hospitals that are cleaned by contract cleaners and filthy hospitals that are cleaned by in-house cleaners. It must be the job of the Secretary of State and her Department to set standards so that the whole country is on a level playing field. Like many Members, I was disappointed to hear this afternoon the Secretary of State yet again avoid responsibility.
Mrs. Dorries: In my dayI hate saying that, as I use that phrase so many times in talking about this subjectwe had ward sisters and staff nurses, and we used to go into kitchens, check under the beds and check the headboards and bedside cabinets and tables, and if we were unhappy we would get the cleaners straight back in to clean again, because our word was law. That is not the case nowadays. The ward sister is not even allowed to speak to a cleaner and, besides, many hospitals do not even wet-mop any longer. Therefore, the management of the staff is what is important.
Mike Penning: My hon. Friend is a former nurse and she brings a whole education to this House in terms of understanding what goes on in hospitals. My mother was a nurse for 40 years. Florence Nightingale might be turning in her grave, but my mother turns incessantly because of nurses and doctors who do not do things such as wash their hands. I will come on to cleanliness and the mopping situation shortly.
I want now to discuss an issue that my right hon. Friend referred todiscipline. I recently visited my hospital and I was introduced to a modern matron. I asked that modern matron what she did and she replied, I manage. I inquired whether she managed a ward and she said, No, no; I manage lists and things. That shows why the Governments target culture is so wrong and why targets should be abolished. Instead, standards should be set throughout the NHS for what is right and what is wrongwhat is good practice and what is bad practice.
Let me give the Minister a prime example of good practice across the board combined with discipline that is working very well. If the Minister were as lucky as I am, he would have had the pleasure of visiting the field ambulance unit in al-Amara in Iraq. It is made up of regulars from the Royal Army Medical Corps and other services, but also of Territorial Army members of our armed forces, of whom we should be very proud for augmenting our forces. Most of those TA members are doctors, nurses and technicians who have come from the NHS. They work in the NHS in everyday life, but they are currently in Iraq serving our armed forces.
The Minister can correct me if I am wrong, but in the three years that that field ambulance unit has been in place, there has been not a single case of MRSA among our armed forces there, nor among those of the local population who were treated there when they needed acute care. Why is that? Part of the explanation is clearly that the bed occupancy rate is very low. Patients are not being rushed into a bed within minutessometimes, it literally is minutesof its being vacated. Also, cleanliness is the responsibility of the ward sister and of the nurses in that field hospital. Those same nurses also work for our NHS in this country. I have met them and they want to provide the best possible care; they want to put a rocket up cleaners who are not doing their job, but they are not allowed to. However, when they are working in the military, they naturally have the backing of rank and of the armed forces. As we have heard so many times today, keeping our wards clean daily is not rocket science.
Many years agoit must have been 1972, given that I joined the Army in 1974I volunteered to work on Saturdays on the geriatric unit, as it was called in those
days, that my mother worked on in the Rochford hospital in Essex. I saw nearly every Saturday what we would now call spring cleaningthe hospital called it Saturday cleaningwhere nurses and cleaners worked together and blitzed the ward. Patients who could leave their beds did so, and everything was cleaned until it was spotless. I cannot remember the last time I saw a nurse do that sort of cleaning. That is not because they do not want toby the way, if it is, they should do it anywaybut because of the pressures in the NHS today and the different nursing methodologies, which simply involve passing the drugs around, for example. It is not that our NHS does not care. Far be it from anyone in this House to say that people join the NHS for any reason other than to serve their communities; they certainly do not do it for the money. They do it because they care, but bit by bit, the view that the patient must come first and bureaucracy second is somehow being knocked out of them.
Miss Widdecombe: Has my hon. Friend observed, as I have, that on going into NHS hospitals nowadays, one sees armies of people with clipboards? That is the culture that is depressing real effort and enthusiasm.
Mike Penning: I could not agree more with my right hon. Friend. In my armed forces days, those who walked around with a clipboard were usually left alone because they were not doing anything. We do not want people with clipboards; what we need is for wards and beds to be cleaned efficiently, so that we can get to grips not only with MRSA, but with C. difficile and other infections. Given the information in the Governments leaked documents, there is no doubt that through targeting just MRSA, efforts to deal with other dangerous and critical infections have unintentionally fallen by the wayside. I do not think that the Department said, Well let C. difficile explode out of all proportion,, but it took its eye off the ball by going down the avenue of targets. As the experience of my local hospital structure shows, if one thing is targeted, something else gets forgotten because the system simply does not have the capacity to cope.
I shall not dwell on what I saw in my hospital the Friday before last, when I visited a friend who has since sadly died, but I will point out that I saw a ward full to bursting and a mixed-sex ward. That, in the 21st century, is degrading, and the Government promised that it would not happen. No more than 20 ft from the ward that I visited was another ward that was empty not because it was infected, but because there is no money to staff and run it. Frankly, the south-east gets a particularly bum deal when it comes to NHS funding. The Secretary of State knows, because I go on and on about it, that this is an issue in my general hospital, which is about to be closed. I will defend that hospital and its nurses to the hilt. We have to have the capacity that allows cleaning to take place in the short period during which beds can be cleaned properly, for example.
My hon. Friend the Member for Mid-Bedfordshire (Mrs. Dorries), who probably has much more experience in nursing than all the Government Front Benchers put together, raised the very important issue
of wet-mopping, which we used to call grind it into the ground mopping. I do not know whether anybody has noticed this, but wards tend to be rectangularthey have corners. However, the cleaning process involves the use of circular electric mops that cannot get into the corners. Bit by bit, the dirt and muck gets thrown into the corners, and unless someone is willing to get on their hands and knees, the dirt will not be cleaned out. When wet-mopping was done, that was not a problem because mops can get into the corners. Of course, even with wet-mopping people could be complacent and not use hot water or the right chemicals, but at least it was possible to see what was going on; now, often it is not.
Has there been any indication of the cost to the NHS of litigation arising from cases of hospital-acquired infections? The Minister said that the Government recently invested £50 million to help deal with hospital-acquired infections, £45 million of which will be used immediately. I should be interested to know whether any of that has gone to West Hertfordshire Hospitals NHS Trust. I should be very surprised if it has, but perhaps he could write to me and let me know. The cases where those who have acquired these infections have gone down the litigation route must be costing the NHS an absolute fortune. In the long run, it must be cheaper, and morally and ethically preferable, to clean the wards properly rather than paying lawyers a fortune.
Anne Main: My hon. Friends constituents and my constituents often use the same facilities; indeed, many of my constituents go to the Hemel Hempstead hospital. On management of rates of infection, I am sure that he shares my concern at the following report, which said:
Mandatory staff training is included for staff at induction, but all staff groups are not always covered and training of doctors remains a challenge as does infection control standards in relation to outside contractors.
I agree with my hon. Friend that cleaning implements may be contributing to the problem, but so are training and a failure to keep track of those in an outside capacity who come into hospitals, as he said earlier.
Mike Penning: My hon. Friends knowledge of health provision issues in south-west Hertfordshire is well known, and she raises an important issue. As the hon. Member for Crawley (Laura Moffatt) also said, we should not simply concentrate on what the nurses should be doing; we must also consider the other hospital professionals, especially the doctors and consultants, who have their own problems. In my experience of sisters running wards, if a consultant turned up with a dirty coat, for example, they would grab him by the ear and sort him in out in 20 seconds flat.
My hon. Friend the Member for Enfield, Southgate (Mr. Burrowes) had an Adjournment debate recently in which he raised the issue of C. difficile, which is a frightening infection. It cannot simply be treated at the bedside with gel; unless it is attacked at its core, treatment will make no difference. In fact, it thrives in such environments. We need to appreciate the levels of hygiene and the standards that will have to be applied across the NHS in dealing with that issue. If the
Minister does not have the powers to enforce the cleaning standards that he is looking for, I am sure that my Front-Bench colleagues will help him to obtain them.
The country is sick and tired of an extremely well paid Secretary of State saying to this House and in TV broadcasts around the country, Its nothing to do with me. The buck stops with the Secretary of State. Yet again, we have heard at the Dispatch Box today that
At the end of the day, the Secretary of State is responsible for health care in this country. That is what she is paid an awful lot of money for, and many people are disappointed with the level of treatment that we are getting.
Bill Wiggin (Leominster) (Con): I am delighted to have the opportunity to speak in this debate because Hereford hospital, which serves many of my constituents, has had a good recordthough not perfectin recent years with hospital infections. In 2004 it had the lowest rate of MRSA detected in hospitals. Between April and September 2005 there were 13 cases of MRSA, and I am pleased to report that between March and October 2006 only 12 cases were diagnosed in Hereford hospital, and 10 of those had had the infection before being admitted. Hereford hospital also does quite well in controlling Clostridium difficile, with an infection rate of 1.12 per 1,000 bed days for patients aged 65 and over. In the March to October 2006 period, there was only one case reported.
I know that the Hereford Hospitals NHS Trusts chairman, Cessa Moore, and the new chief executive, Martin Woodford, have wisely given infection control a high priority. The hospital has a dedicated infection team that promotes cleanliness and personal hygiene. It also regularly updates its education programme. I am confident that the efforts of the hard-working staff and the hospitals management are keeping superbug outbreaks low. On the Healthcare Commissions core standards assessment form, the hospital is compliant with requirement C4a, which requires that
Healthcare organisations keep patients, staff and visitors safe by having systems to ensure that the risk of healthcare acquired infection to patients is reduced, with particular emphasis on high standards of hygiene and cleanliness, achieving year on year reductions in MRSA.
Despite the hospitals good record, the excellent work of the staff and praise from its users, the Government have decided to tie its hands behind its back and starve it of resources. Earlier this month, the Secretary of State refused its application for foundation status. The primary care trust budget was also top-sliced to prop up PCTs with financial failings elsewhere in the vast area covered by the strategic health authority. With those actions, the Government have undermined our efforts to manage the dangers posed by superbugs and are letting down NHS staff and patients. While I have every
confidence in the abilities of staff and the management team in Hereford, I have little confidence in the Governments support for them. Labour has made a mess of governing the NHS, and superbugs may well end up as another unwanted part of the Prime Ministers legacy.
Bill Wiggin: It was clear from my opening comments that I gave the figures as accurately and as helpfully to the Government as I could. I am sorry that the Minister was not paying attention. It is difficult to make progress in such debates when although we try to be positive about what is happening, requests for foundation status are turned down. How can the Minister possibly try to score political points when he has gone out of his way to sabotage the one thing that my hospital wanted most? If he wishes to intervene again, I shall be happy to listen to any more ridiculous attempts to whitewash this Governments disgraceful legacy on the NHS.
Fears have been heightened because this month both MRSA and C. difficile have featured in the news. In Nottingham 30 deaths have been linked to C. difficile since November, and in the last couple of days it was reported that specialist teams will be brought in to fight MRSA in two hospitals in the west midlandsthe Princess Royal in Telford and the Royal Shrewsbury. Because of the fears and concerns about the reporting of superbugs, last month, the Hereford hospital patient and public involvement in health forum took it upon itself to monitor the situation on the ground and carry out regular cleanliness visits.
Dr. Pugh: The hon. Gentleman mentions heightening fears, but during the 2005 election the right hon. and learned Member for Folkestone and Hythe (Mr. Howard) wrote to my constituents suggesting that the MRSA rate was 10 times higher than it actually was, and the local hospital demanded an apology. Would he care to comment on that as an example of how fears can be heightened unnecessarily by the political process?
Bill Wiggin: I was expecting that sort of intervention from Labour Members. People are fearful because they do not know what is going on. When we try to draw attention to what is happening, we are told that our figures are wrong. In my experience, it is hard to discover the correct figures. Tremendous pressure has been put on NHS staff to produce figures that suit the Government, especially around election time. I suggest that the hon. Gentleman checks more carefully before accusing my right hon. Friends of misleading his constituents.
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