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In the light of its findings earlier this year, the Healthcare Commission knew that there were significant failings in the management of the trust—but it was not until the publication of the report that the chairman and the chief executive resigned. More recently, non-executive directors and the former director of nursing have resigned.
No one who saw the commission’s report when it was presented to the Department of Health in May could have come to any conclusion other than that the failings in the trust’s management and leadership were so great that they needed to be replaced.
The Secretary of State says that he was not asked to replace the management by the Healthcare Commission, so he did not do so. He hides behind the commission. He has instituted an independent leadership review, even though it will not serve any purpose, because the leadership has failed and its members are disappearing. One of them took a large severance payment, which the Secretary of State claims that he can stop—I doubt that he can—and the leadership is not in place in Maidstone and Tunbridge Wells to follow up the report and demonstrate to the public’s satisfaction that there is new leadership in place. It will take far too long for that leadership to be put in place, but it should have been put in place in May, when the findings were first presented to the Department.
Greg Clark (Tunbridge Wells) (Con): Does my hon. Friend share my concern that the new chief executive appointed to turn the trust has a part-time appointment, and is responsible, too, for the Ashford and St. Peter’s Hospitals NHS Trust? Is that the level of commitment that he would expect to turn around the problems in our trust?
Mr. Lansley: My hon. Friend makes an important point. If the Secretary of State had taken the action clearly indicated in the report and used his powers under section 66 to remove or suspend the board and put new leadership in place, my hon. Friend and his constituents would know that that leadership would be permanent and would take the necessary action. However, the Secretary of State did not do that. He hides behind the Healthcare Commission, but that is not its responsibility. It should investigate problems and report on them. It is the responsibility of the strategic health authority in the first instance, the NHS chief executive in the second instance, and Ministers in the third instance to exercise the power of performance management and, if necessary, to intervene. They have the powers under NHS legislation, but they did not use it.
The Minister of State, the hon. Member for Exeter (Mr. Bradshaw) is always telling me that a consequence of our policy would be a lack of accountability to Parliament. Ninety patients died— [ Interruption. ] Indeed, since September 2006, there have been further deaths associated with C. difficile at the Maidstone and Tunbridge Wells NHS Trust this year. Who has come to the House to be held accountable for that? If Ministers are genuinely accountable, they should have used the powers that they claim are so important and done something about the problem. If they are not prepared to use them in those circumstances, in what circumstances would they use them?
Part of the report entitled “Developments since the investigation was announced” describes “musical chairs” among senior executives. There were further outbreaks of C. difficile in January in the Kent and Sussex hospital; in April at Maidstone and Tunbridge Wells; and in May and June there were 45 new cases of C. difficile at Maidstone, and nine deaths. I am not arguing that the
failings disclosed up to September 2006 have continued to anything like the same extent, but it is perfectly clear from the report that things that should have been done have not been done. The policies were not shown on the departmental intranet. Earlier this year, the Healthcare Commission said that it was still observing patients with diarrhoea on open wards, and it saw patients with MRSA being barrier-nursed on such wards.
What was done to ensure that the new management at the Maidstone and Tunbridge Wells NHS Trust was in place at the right time? The Secretary of State did not take the action that he should have taken. He should be accountable to the House for that simple fact.
Mr. David Burrowes (Enfield, Southgate) (Con): Is not the Government’s response to C. difficile complacent? When the subject was considered in January, the Government failed to mention C. difficile in their amendment to an Opposition motion. Are not they simply responding to the Healthcare Commission rather than the pleading of people such as my constituent Graziella Kontkowski and the C. difficile support group?
Mr. Lansley: I recall the occasion that my hon. Friend mentions, and also his Adjournment debate on the subject. The Government said nothing about C. difficile and, when we challenged them about what they would do, it was obvious that they had targeted MRSA and that C. difficile rates had risen because of lack of action on, for example, hand washing. They said that they did not believe that it was right to have a national target; a central target was wrong. They claimed that the targets had to be local because there was such local variation in C. difficile. Ten months later, the Secretary of State came to the House to say that central targets were essential. The Government have no comprehensive strategy and cannot even manage, in the space of a year, to maintain a consistent policy. The Conservative party has a strategy and a policy, which we would be prepared to pursue.
“healthcare-associated infections (HCAIs) are a worldwide problem”.
Indeed, they are. However, a Europe-wide survey shows that places such as Denmark and the Netherlands have succeeded with MRSA where we have failed. Even the French and the Slovenians have moved substantially in the right direction, whereas, according to the European Antimicrobial Resistance Surveillance Survey, we are moving in the wrong direction.
The Government had a policy of “bare below the elbows”. That is good, but their document states that
“it seems unlikely that uniforms are a significant source of cross-infection.”
They have a deep clean policy, but a press release that the Department published in September claimed that trusts were, in any case, conducting a deep clean on a ward-by-ward basis. Although the Prime Minister announced the policy, we found that no follow-up or evaluation was intended, and that it is only now that the Department is trying to put in place some structure for deep cleaning.
Yet in 2000 the NHS plan pledged
“a nation-wide clean-up campaign throughout the NHS starting immediately”.
The right hon. Member for Darlington (Mr. Milburn) said in 2001:
“This extra money will help get the basics right. It will drive forward the biggest clean-up campaign there has ever been in NHS hospitals.”
The right hon. Member for Airdrie and Shotts (John Reid) said in 2004, when he was Secretary of State:
No stone is being left unturned in the battle against the superbug. We are improving cleaning standards, rolling out cleanyourhands and making sure infection control is a fully staffed priority for every NHS trust”.
He said that approximately two months before the outbreak at Maidstone and Tunbridge Wells began, in circumstances in which nursing staff were not capable of delivering that priority.
We are told that there are to be 3,000 extra matrons. What is the evidence base for that decision? How long was it in gestation? Where is the consultation document for the Royal College of Nursing to consider its appropriateness? Why a matron for every two wards—why not a matron for every three or four wards? Where did that policy originate? Is it a case of what The Lancet described as
“Politicians...pandering to populism about hospital cleanliness”
and not listening to the evidence?
The Government claim that they want targets, but 45 per cent. of trusts said that they had difficulty reconciling the targets for accident and emergency attendance with those for hospital-acquired infection. The amendment is too little, too late. The Government say that targets are essential, yet they get in the way of NHS staff doing what they need to do. We need a strategic approach, the resources to help NHS staff achieve the goal and time for change. I commend the motion to the House.
4.44 pm
The Secretary of State for Health (Alan Johnson): I beg to move, To leave out from “House” to the end of the Question, and to add instead thereof:
“recognises that healthcare-associated infections (HCAIs) are a worldwide problem; acknowledges that the recent Comprehensive Spending Review settlement for the NHS includes £270 million to tackle HCAI; welcomes the initiatives the NHS is taking to manage infection control, including a new “bare below the elbows” dress code, new clinical guidance to increase the use of isolation for infected patients published in September, every hospital to undertake a deep clean as part of a wider drive for a culture of cleanliness, matrons and clinical directors to report directly to trust boards on infection control and cleanliness, annual infection control inspections of all acute trusts using teams of specialist inspectors, and MRSA screening for all elective admissions next year; further welcomes the introduction of legislation for a new health and adult social care regulator with tough powers to inspect, investigate and intervene in hospitals that do not meet rigorous standards for cleanliness and a new legal requirement on chief executives to report all MRSA bacteraemias and clostridium difficile infections to the Health Protection Agency; believes that centrally determined targets for tackling HCAIs are the most effective way of ensuring infection levels are reduced in every hospital; notes that as a consequence MRSA bloodstream infection numbers are falling; and welcomes the Better Care for All PSA Delivery Agreement, which sets two new targets for the period 2010-11 to keep MRSA bloodstream infections below half the numbers of 2003-04, and to deliver a 30 per cent. reduction in clostridium difficile infections from the numbers in 2007-08.”
This is an important debate. Patients have a right to clean and safe treatment wherever they are treated in the NHS. Safety in health care, an essential element of every medical procedure, must be our priority. We have put in place a wide-ranging series of measures to tackle infections and improve cleanliness.
Health care-associated infections are acquired as a consequence of treatment for a medical condition. The problem is not new, nor is it unique to the UK. HCAIs affect every health service in the world, and prevalence in the UK is similar to that in other developed countries. For example, the rate of HCAIs is 9 per cent. in England, while rates vary between 6 and 10 per cent. in France and between 5 and 10 per cent. in the United States. The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned Holland, which has enjoyed good success in tackling MRSA, but its rate of health care-associated infections is 7 per cent., which is very close to the rate in the UK.
The two major health care-associated infections in the UK are MRSA and clostridium difficile. MRSA is a bacterial infection that is resistant to commonly used antibiotics. It can infect surgical wounds and ulcers and, more seriously, can cause bloodstream infections. Clostridium difficile is a bacterium that naturally lives in the gut. Again, it particularly affects the elderly. When antibiotics kill off normal, healthy bacteria, the consequences can be severe, so antibiotic prescribing policies are even more important in controlling the disease.
Norman Lamb (North Norfolk) (LD): The Secretary of State has rightly described the two main hospital acquired infections, but there have been recent newspapers reports about pseudomonas and the suggestion of a 41 per cent. increase over the past four years. Although levels are still low, reporting is currently not mandatory. Is the Secretary of State concerned about that increase and does he think that there needs to be a change to mandatory reporting?
Alan Johnson: Pseudomonas is a growing concern. We need to consider closely whether there needs to be mandatory reporting. Pseudomonas particularly affects people with burns and those who are very ill with specific diseases. It is a growing problem that we need to ensure receives adequate attention.
The risk of getting MRSA or C. difficile is low. Last year, there were just under 56,000 C. difficile infections and 7,000 MRSA bloodstream infections in our hospitals. That is still too many, but it has to be seen in the context of a health service that deals with 1 million people every 36 hours. The Government have introduced a range of measures to improve cleanliness and tackle infections. In 2001, we became the first country in the world to introduce mandatory surveillance of MRSA. We built on that in 2004, with the introduction of C. difficile surveillance for those aged 65 and over, the most vulnerable group of patients. In 2005, we enhanced the surveillance system for MRSA and earlier this year we extended C. difficile surveillance to every patient over two years of age.
Mr. Hoyle: My right hon. Friend may not be aware, but a company in my constituency called Carrington’s has developed a fabric that kills MRSA. That could be a major battle winner against MRSA, so will he investigate whether it can be introduced further, into trusts other than those where it has already been trialled?
Alan Johnson: That may well be one of the 21 different new techniques and technologies that are being examined and trialled in some hospitals, to see whether the claims that the manufacturers make are borne out in practice.
We have the most comprehensive surveillance system in the world for health care-associated infections. The European Union is using our approach to C. difficile monitoring as its model, as it develops a pan-European approach to monitoring C. difficile. We have introduced a wide range of guidance and best practice procedures to support managers and clinicians to best meet the challenges of HCAIs. That includes the publication in 2003 of “Winning Ways”, which provides a clear direction for the NHS on action to reduce the high levels of MRSA and C. difficile. In 2005, we launched the saving lives programme, a key initiative that all trusts have signed up to, in order to implement best practice to reduce infection rates. The programme was relaunched earlier this year to include best practice on antimicrobial prescribing and C. difficile high impact interventions. The clean your hands campaign, run by the National Patient Safety Agency, is now in its third year. All acute trusts are signed up to the campaign and the National Patient Safety Agency is now piloting an extension of the programme to other health and social care settings.
We have set up improvement teams in the Department of Health that are providing tailored support on MRSA and C. difficile. This summer, we doubled the number of these teams and, by the end of this month, they will have worked with 146 trusts. The work of the improvement teams has had a real impact on MRSA bloodstream infections in the trusts that they have helped.
We continue to set challenging targets to ensure that this issue remains a priority. Trusts are already working towards the nationwide target to halve the number of MRSA bloodstream infections by April 2008, and the latest data show that good progress is being made. Trusts will also be required to reduce the number of C. difficile infections by 30 per cent. as part of our new better care for all public service agreement.
Alongside this drive to reduce the rate of infections, there is a concerted effort to improve the cleanliness of our hospitals. High standards of cleanliness and hygiene are not just an important part of the drive to lower infections but a core part of what patients are entitled to expect from the NHS, day in and day out. In 2000, we introduced patient environment action teams, which assess annually every in-patient health care facility in England. The inspection covers hospital cleanliness, the quality of the environment, food and the issues of privacy and dignity. Thanks to the hard work of NHS staff, and to the priority that we have placed on this issue, hospital cleanliness has improved year on year since annual inspections first began more than seven years ago.
Mr. Ken Purchase (Wolverhampton, North-East) (Lab/Co-op): In that context, does my right hon. Friend recognise the important work that has been carried out at the New Cross hospital in my constituency, which has moved from below average to the top of the league table? He presented an award to the hospital for that work this week. Will he congratulate the staff on the tremendous work that they have done in very difficult circumstances?
Alan Johnson: I wish that my hon. Friend had been at the Health Service Journal awards on Monday evening, in his penguin suit, when I presented the Secretary of State’s award to Wolverhampton for its excellent work in this area. I congratulate him and, through him, his local trust on the work that it has done.
Greg Clark: Is the Secretary of State aware that the Royal College of Nursing has published 10 minimum standards for infection control, one of which is the adequate provision of changing facilities for staff in every hospital? Does he endorse that minimum standard and, if so, what is he doing to ensure that the Kent and Sussex hospital, which lacks those basic changing facilities, can have them?
Alan Johnson: That is an important aspect of this issue. This is not something that we believe that we should drive centrally, however, although there are other issues over which we should have central control. It is up to the local trusts, including the trust of which the Kent and Sussex hospital is a part, to ensure that there are proper changing facilities. I shall say more about that trust later, because I know that the hon. Gentleman has taken a keen interest in these matters on behalf of his constituents, who were so appallingly affected by the Maidstone and Tunbridge Wells report.
Adam Afriyie (Windsor) (Con): I wonder whether the Secretary of State could enlighten us. The Conservative motion states that
“this House supports NHS staff in their efforts to minimise healthcare-associated infections”.
The Government’s amendment to the motion, however, proposes that we leave out that recognition of support for NHS staff. Why is that?
Alan Johnson: I do not need to put it in amendments; I tell NHS staff week in and week out what a fabulous job they are doing. I know that the hon. Gentleman has been paying close attention to my words, and he will already have heard me say what a tremendous job the staff are doing.
It is thanks to NHS staff that we have seen cleanliness improving year on year since the annual inspections began seven years ago. At that time, about one third of hospitals were rated as poor. Now, only a handful fall into the lowest categories of poor or unacceptable. We raised the bar for PEAT scores in 2007, and I am pleased that the NHS has risen to the challenge. Even with this higher standard, figures published today by the National Patient Safety Agency show that in 2007, 98 per cent. of hospitals were rated excellent, good or acceptable, up from 95 per cent. in 2006.
Mr. Lansley: But will the right hon. Gentleman acknowledge that the PEAT scores only get us so far, as throughout the period of the C. difficile outbreak, the scores for the Maidstone and Tunbridge Wells NHS Ttrust were acceptable?
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