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23 Jan 2007 : Column 1335
6.30 pm

Dr. Andrew Murrison (Westbury) (Con): It is extraordinary, is it not, that of all debates, this one on health issues is the one with just one Labour Back Bencher turning up to make a contribution. The Secretary of State was at pains to explain that this issue was her No. 1 priority, but it does not seem like that to me—and I have to tell Government Front Benchers that it will not seem like that to people watching today’s debate or reading accounts of it. I hope that the Minister of State, Department of Health, the hon. Member for Leigh (Andy Burnham), will explain in his winding-up speech how it is that just one Labour Back Bencher has spoken on such an important issue.

One in 10 in-patients will acquire an infection in UK hospitals. In 2004, there were 1,300 deaths resulting from C. difficile alone, as a result of which people worry about going to hospital. Anyone doubting that needed only to attend, as I did, a recent meeting convened by the MRSA and C. diff support group in Portcullis House. A range of harrowing tales was told by members of that group about their experiences and their concerns about this important group of infections. I recommend that the Minister listen very carefully indeed to those accounts and experiences.

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) and my hon. Friends the Members for Hemel Hempstead (Mike Penning) and for Mid-Bedfordshire (Mrs. Dorries) did some comparing and contrasting between our attitude towards health care-acquired infection and foot and mouth, between command and control in the NHS and military hospitals in Iraq, and between hospitals of which they had first-hand experience. All three supported discipline in the NHS and I suspect that my right hon. Friend the Member for Maidstone and The Weald would endorse the Royal College of Nursing wipe-it-out 10-point plan on MRSA, which clearly states:

I am sure that she would agree with all that.

The cost to the NHS of health care-acquired infections is more than £1 billion annually. That approximates to the NHS deficit, which today—no, tomorrow, as it has been delayed—prompts the Wiltshire primary care trust to announce the closure of community hospitals in my constituency. When set in that sort of context, one realises the enormity of the problem faced by the NHS right now—and the scope for remedial action and what that might mean at ground level. It would certainly mean a great deal to my constituents as they face the closure of their community hospitals.

Indeed, the true cost may be even greater, as we have very little idea of the amount of wound infections that stop short of bacteraemia. Estimates suggest that the true incidence of MRSA is in fact 10 times the official figures. MRSA grabs the headlines, but the real menace right now appears to be Clostridium difficile, which has proved refractory to most of the initiatives that Ministers have launched on health care-acquired infections.

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At the centre of the Government’s efforts is the “Clean your hands” campaign, but the Healthcare Commission does not think much of it. It pointed out that compliance was poor last year and revealed that more than a third of trusts were not providing the basics necessary for hygiene—hot water, paper towels and alcohol rubs. It said that 50 per cent. of staff had no training in hygiene in the preceding year. Little wonder that we are not making much progress.

In health care there is only one thing worse than a target—and that is a target that is not being met. It is now clear that the November 2004 MRSA target will not be met. The famous leaked memo tells us that very clearly, but more revealingly still, that memo is largely given over to how an inconvenient truth might be dished up and presented to the public, whom I imagine Ministers consider to be gullible. Rather than present options for remedial action, it agonises over how fudging the target might be seen as a “cop-out” or, with remarkable frankness and extraordinary understatement, open to the “accusation of fiddling”. This is a memo not from a “good day to bury bad news”-style subordinate, but from no less a person than Liz Woodeson who, as director of health protection, is at the very heart of the Government’s strategy for public health.

The memo speaks volumes about two things: the Government’s failure to address MRSA and their obsession with spin over substance. So ineffectual have Ministers been that the Prime Minister’s Delivery Unit has, we understand, stepped in and we await its report on what can be done, in the words of the Department of Health, to “galvanise action”. Surely it is not too much to expect our record on hospital-acquired infections to approximate more closely to those of northern rather than eastern Europe.

We learn that the Minister of State has been on a back-to-the-shop-floor initiative—a bit like Gerry Robinson. His quest is to find a solution to what the Prime Minister has characterised as the “dirty corridors” of the NHS. I hope he gained as much from his experience as I did from my experience as a member of the ancillary staff of a hospital in our national health service some years go, but I fear that he may have seen a great deal but learned very little. We hear that he wants trusts to do away with cleaning contractors. I wonder whether that is evidence-based medicine or an innovation in the lexicography of the NHS called “anecdote-based medicine”. When the Healthcare Commission does its annual health checks, will it be expected to press for the latest whimsy of Ministers rather than standards grounded in the evidence?

If the Minister can produce a body of evidence to support the contention that hospitals with contracted-out cleaning are worse than those with in-house cleaning, we would be more than happy to support him—but I do not think he can, so I am afraid we will not. What the Minister has not thought through is the fact that the big contracting-out that the Government introduced cannot simply be undone. Of course cleaning is contracted out in independent sector treatment centres and PFI projects—that is the whole point—but it is not clear how the Minister, if keen on bringing hospital cleaning in house, will govern these particular institutions and change their practice. If he is so keen on contracting out on a grand scale, why is he recanting when it comes to individual hospital trusts?

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Mr. Walker: Are we not in danger of over-complicating the issue? If Tesco had a store that was routinely filthy, it would fire the manager and hire a new manager who could ensure that the store was clean. Surely if a hospital trust is routinely filthy, we should fire the chief executive and hire one who can ensure that the hospital is clean and safe for the patients under his or her duty of care.

Dr. Murrison: My hon. Friend makes a very good point, which demonstrates the importance we attach to this issue. His remark underscores how important it is for us. It is a pity that Government Members do not think it at all important, as evidenced by the fact that only one of their Back Benchers managed to turn up to make a contribution.

What account has the Minister taken of the hospital-acquired infection record of non-NHS hospitals, and are there any lessons to be learned from it? I make no particular judgment, but the record in some non-NHS hospitals is clearly better than in some NHS hospitals, so it would be foolish not to study it carefully and learn whatever lessons are to be learned. I would be interested to hear whether the Minister has reflected on the difference between the two and on what might be done to improve the record in the NHS as a result.

I am quite convinced that what is actually important is that ward staff must be comfortable with the management tools to direct cleaning staff, that cleaning staff should feel that they are a full and valued part of the health care team and that senior nurses should have access to them 24/7. We often go around hospitals, and it seems to us that cleaning staff are not seen as full and active parts of the health care team—well, they are, and they must feel that they are—and I am very sorry that the Secretary of State’s amendment eschews our mention of health care staff. That is a pity, and I hope that it is an oversight. Mention of ancillary staff is long overdue, and I hope that, in reparation, the Minister might mention their contribution to cleanliness in hospitals. [ Interruption. ] If the hon. Member for Livingston (Mr. Devine) would like me to give way, I should be more than happy to hear his remarks.

My hon. Friend the Member for Leominster (Bill Wiggin) is right to be concerned about innovation and the fact that it has been introduced far too slowly. The rapid review panel is apparently not rapid, according to a frustrated innovator, called Air Science, which has contacted a number of right hon. and hon. Members. It says that

The main block appears to be the rapid reaction panel’s level 2 assessment, which involves the ability to gain support for the translational research and development which enable small companies of the sort that Air Science evidently is to front up the innovation that the health service needs to tackle health care-acquired infection. A level 2 innovation is promising, but crucially, has not yet been proven in an NHS hospital setting. Most companies struggle to afford the means to provide such proof and they need help with it. Air Science concludes by saying:

23 Jan 2007 : Column 1338

The onward march of Clostridium difficile has underscored the need for restraint and discernment in the prescribing of antibiotics. Four times as many people die in the UK from that health care-acquired infection as from MRSA, and conventional cleaning and hand washing will not necessarily help that much—a different approach is needed. What is the Minister doing to ensure best practice in universally applying the lessons available from best performance in the NHS and to ensure that they are learned by outriders? It seems that he is doing precious little, judging by the absence of a reference to Clostridum difficile from the Government amendment.

The hon. Member for North Norfolk (Norman Lamb) made a very valuable contribution. He rightly talked about antibiotics. He should also have talked about—we might have done as well—instrumentation that introduces infection, such as intravenous cannulation and other things, as that has been the subject of much debate recently and of comment by Professor Hajo Grundmann of the National Institute of Public Health in the Netherlands. It is very important that we consider minimising such interventions in our fight against health care-acquired infections.

The Secretary of State for Health mounted a robust defence of the national MRSA target set in 2004, saying that, in its absence, less progress would have been made. Will the Minister say when he will set up a comparable target for Clostridium difficile, because that is the natural extension of what the Secretary of State said? The Secretary of State’s defence of local targets was based on a false assertion that it is a local problem—well, it clearly is not, as is made very clear by the comment from her own Department that it is endemic.

The hon. Member for Crawley (Laura Moffatt) and my hon. Friend the Member for Shrewsbury and Atcham (Daniel Kawczynski) rightly talked about staff. The Government amendment removes any mention of staff from our motion, which is a pity, and I hope the Minister will explain that. From the Royal College of Nursing 2005 “Working Well” survey, we learned that the number of nurses with access to changing facilities dropped from 61 per cent. in 2000 to 50 per cent. in 2005, and that only 39 per cent. of nurses have access to showering facilities at work. Just 35 per cent. of hospital-based NHS nurses said that their employer provides a uniform laundering service. Is that any way to treat a profession that is doing its utmost to reduce health care-acquired infections? What message does it give to those who are entering the profession about the significance attached by management to basic standards of hygiene?

6.44 pm

The Minister of State, Department of Health (Andy Burnham): I welcome today’s debate, because it deals with an issue to which this ministerial team attaches the highest possible priority: patient safety and public confidence in our national health service. It gives us an opportunity to say very clearly on the record that MRSA infection is falling in our NHS, despite what others might seek to claim. However, there is absolutely no complacency whatsoever among Labour Members, and I will set out some of the measures that the Government are taking.

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While sitting through this debate, I have heard more bar-room garbage emanate from Opposition Members than perhaps I have ever heard before. Yesterday, they pledged to abolish targets and end top-down Government action in the NHS. [Hon. Members: “Hear, hear.”] The call was to keep politicians out of health care and the NHS—a big, principled call. Today, they bring us to the House to demand no less than six-monthly reports on Government action to tackle health care-acquired infections. Yesterday, they committed themselves to scrapping our MRSA target. Today, they put before us what seems like a target for the number of washing machines in NHS trusts.

Bill Wiggin: I do not think that the Opposition should take any lessons from the Minister or the Government about keeping politicians out of the health service, when only one Labour Back Bencher can be bothered to make a speech.

Andy Burnham: The hon. Gentleman will hear me robustly defend the role of politicians in the crucial issue of public confidence, and he will get his answer. After hearing the utter the confusion among Opposition Members, those who work in the NHS are entitled to ask what the Opposition are proposing. Are they saying, “Trust the professionals”, or are they suggesting that how many times they should wash their uniforms and where they should wear them should be subject to mandatory guidelines? That is the message that has come from Opposition Members all afternoon. I have sat here and I have heard it. They do not trust the professionals at all to do any of those things, and that rings out from those on the Opposition Benches.

Several hon. Members rose—

Andy Burnham: I will not give way.

We have seen in all its painful unravelling that Tory health policy is confused, contradictory and dangerous.

Mike Penning: Feeble!

Andy Burnham: The hon. Gentleman should listen, because we have a policy to tackle MRSA. It begins with a clear national target that, today, the shadow Secretary of State said that he would scrap. We have put £50 million into the NHS in the past few months to enable hospital trusts—including his trust, about which an announcement will be made next week—to make improvements.

Mike Penning: Will the Minister give way?

Andy Burnham: No, I will not give way.

The Government have introduced a legal code that places statutory responsibilities on NHS trusts to tackle hospital-acquired infection. That is our policy. We know that we have got a good package. What is Conservative party’s policy? We have heard today that it is to scrap the target, install a few washing machines and hope for the best. I am afraid that that is simply not good enough. All the momentum that we have established in tackling MRSA would be lost in the Tory NHS, and Lansley’s La-la land, where Ministers have no role and everything happens by magic. What a wonderful place it must be. [ Interruption. ]

Madam Deputy Speaker (Sylvia Heal): Order.

23 Jan 2007 : Column 1340

Andy Burnham: I shall deal with the points that have been raised in today’s debate. The hon. Member for North Norfolk (Norman Lamb) made an excellent contribution. I did not agree with every word that he said, but he made some very valid points. He asked about the advice to Ministers in the memo. I think that he said that it used the phrase “MRSA would never be beaten.” The memo does not say that; it says that achieving the target will be challenging and that some in the Department question whether it can be achieved.

Let me, in all honesty, give the hon. Gentleman my best answer, and this is what I believe. Yes, it is a challenging target. It was challenging to the NHS when it was set, but that was the point of the target. Its purpose is to cut infection, not to generate comfortable or pleasing headlines for the Government. I would rather we had a real go at meeting that target and changing the culture right across our national health service, even it we miss it by 5, 10 or 15 per cent., because we would thereby deliver a major reduction in infection in the national health service and we would improve patient safety. I reject the approach that the hon. Gentleman advocated of scrapping the target entirely.

Norman Lamb: The Minister insists that he is going to stick with the MRSA target, but what about C. difficile? Although MRSA levels have come down, C. difficile levels are increasing at a disturbing rate.

Andy Burnham: The hon. Gentleman raises a fair and important point. People have spoken about the memo and Liz Woodeson, and now that the memo is in the public domain, it is right to comment on it. As a result of that memo, we did two things in the Department. We made £50 million available this financial year to the national health service. That equates to £300,000 per trust. The trusts can use that money to make practical improvements to their estate, such as more isolation facilities or washroom facilities—if that is what they choose. It is up to the NHS trust concerned to put those measures in place. That is specifically linked to C. difficile and the challenge that we face in relation to that. At the same time, we have asked every PCT, as part of the model contract, to negotiate with its main providers a target for cutting C. difficile. We believe that that is the right approach: to keep our headline national target on MRSA, but to put in place action to cut C. difficile.

Adam Afriyie (Windsor) (Con): Will the Minister give way?

Andy Burnham: No, I would like to make some progress. The people who took part in the debate raised many points and I would like to answer them.

The hon. Member for North Norfolk rightly raised the question of antibiotics. The guidance that the chief medical officer and chief nursing officer have issued to the national health service makes the same point that he made about a safe prescribing policy for broad-spectrum antibiotics. The code of practice that I have already referred to requires there to be an antibiotic prescribing policy in place. I could go through more measures, but I wanted to give him an answer. There is action in hand to tackle the important point that he raised.

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