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Alan Johnson:
The important change is that the PEAT scores were based then on one visit and the hospital was usually aware that the visit was going to be made. From this year, however, there will be a year-round appraisal that will not be based on the position on one
day in the year. Standards have to be maintained through the year, but I accept that this is not the only issue. I am setting out a whole series of measures that we are introducing to tackle the problem.
The House will be aware that we have also introduced a strong statutory regime to support our drive to tackle infections. The Health Act 2006 introduced a mandatory code of practice for the prevention and control of health care-associated infections. That came into force on 1 October 2006 and it requires NHS bodies to have management and clinical governance systems in place to deliver effective infection control. Compliance with the code is assessed by the Healthcare Commission, which is in the course of making 120 unannounced visits, mainly to acute trusts, to ensure compliance. We have also announced that from next year, health care-associated infection inspections by the Healthcare Commission will be undertaken annually by specialist teams.
We will continue to support the NHS to bring down infection rates. There is no single solution. In the past few months, we have introduced further measures to build on improvements already made. In July, we made an additional £50 million available to directors of nursing and a further £270 million will be made available by 2010-11 to support the drive to tackle infections. We are introducing MRSA screening for all patients—starting with elective patients—supported by £130 million of comprehensive spending review investment. We have published new guidance on uniforms, so that all staff workwear leaves the arm bare below the elbow to assist with hand washing, which is crucial in countering such infections.
To improve cleanliness and ensure that patients have confidence that their hospitals are safe, we have announced a deep clean of all hospitals, supported by strategic health authority funding of £57 million. This morning, I placed in the Library details of this funding for each area of the country.
Anne Main (St. Albans) (Con): I want to ask about high bed occupancy rates. The West Hertfordshire primary care trust was languishing around the weak category and was rated only 17 above the trust that experienced the dreadful deaths, yet we have a 95 per cent. bed occupancy rate. Will the Secretary of State address the problem of those rates, which seem to be linked to these infections?
Alan Johnson: There is actually no correlation between high bed occupancy rates and levels of MRSA, as the hon. Lady well knows. The Sherwood Forest Hospitals NHS Foundation Trust, for example, has a bed occupancy rate of 92 per cent., but it has cut the number of MRSA cases by well above the national average. As to the suggestion that we should set a national target for bed occupancy rates, I had thought that the Opposition were supposed to be against national targets. We have a bed occupancy rate of about 84 per cent. and we think that high levels of bed occupancy are wrong, but the real issue is how best to manage the beds, rather than providing simple statistics on bed occupancy.
Mr. Mark Lancaster (North-East Milton Keynes) (Con):
But there is a connection between high bed occupancy rates and the ability to perform a deep clean.
Milton Keynes hospital, which has an equally high rate, lacks any form of decanter area that would enable it to carry out a deep clean. What specific measures will the Secretary of State offer hospitals such as the one at Milton Keynes to enable them to carry out their deep cleans?
Alan Johnson: We are providing the funding to strategic health authorities and it is then a matter for them to oversee the process. Every trust has assured me that it will have completed its deep clean by the end of March. Many hospitals with high bed occupancy rates already have deep cleans. They usually find the capacity to carry them out around December or Christmas time. If Milton Keynes hospital has any specific problems, it should come and talk to us about them. Better still, it should talk to its SHA.
Dr. Andrew Murrison (Westbury) (Con): The Secretary of State is struggling for a good news story in all of this, so may I offer him one? It is the relatively low rate of health care-acquired infections in community hospitals. Does he not think it ironic that the Government are embarking on the biggest community hospital closure programme in the history of the NHS?
Alan Johnson: It is ironic that the hon. Gentleman should ask that question when he knows that we have put £750 million aside to build new community hospitals. We are actually presiding over a renaissance in community hospitals. All trusts will submit deep-clean plans to their primary care trusts. Strategic health authorities will take an overview of progress across their area, with trusts aiming to complete their deep cleans by March 2008.
Norman Lamb: Will the Secretary of State respond to a recent piece in The Lancet which cast considerable doubt over the value of hospital deep cleans? I can see that there are all sorts of good reasons for doing that, but the question is whether it will have a significant effect on the management of C. difficile and MRSA.
Alan Johnson: The article in The Lancet would have been fine if that was all we were suggesting we should do. I have already mentioned a number of initiatives—deep clean is one—and I will mention a series of other measures. Of course, deep clean on its own will not solve the problem, but it is highly symbolic in that it gives patients the confidence that that is happening in their hospitals at least once a year.
In addition to the measures I have mentioned, we are increasing the number of matrons to 5,000—to be in post by next spring. The hon. Member for South Cambridgeshire asked where that idea came from: one particular place it came from is his colleague, the right hon. Member for Maidstone and The Weald (Miss Widdecombe)—whom I notice is present. When we discussed the Healthcare Commission report on Maidstone and Tunbridge Wells, she was powerfully vociferous, as only she can be, on the need for more matrons in our hospitals. Sometimes, populist measures are right—and the public are absolutely right about the decline of matrons in the past. The right hon. Lady’s point is important, because the public do see matrons in a certain light. Ward sisters do a tremendous job as well, but they also welcome the creation of more matron places because they see that as important for the job that they do.
Angela Browning: Much as we would welcome modern matrons and more of them, the badge does not define the job. It is important that modern matrons have a managerial role of supervision on wards and that they do not just wear a badge and spend their time doing the paperwork in the back office.
Alan Johnson: I am told that they do just as the hon. Lady recommends in her brand-new community hospital in Tiverton, the construction of which she will no doubt congratulate us on. I agree with her point. Matrons will be able to set standards for cleaning and, where necessary, withhold payments and terminate cleaning contracts. Along with clinical directors, they will also report direct to trust boards at least quarterly on infection control and cleanliness.
We published new clinical guidance on isolating patients with health care-associated infection in September 2007. It outlined the importance of placing infected patients in single rooms. The Health and Social Care Bill, introduced to the House last week, will establish the care quality commission, a new health and adult social care regulator with tough powers to inspect, investigate and intervene where hospitals are failing to meet safety and quality requirements, including hygiene standards. The latest data on health care-associated infections were published earlier this month; they show that the actions we have taken are having an effect. The Health Protection Agency data show a drop of 10 per cent. in the number of MRSA cases, continuing the downward trend of the last 24 months.
Commenting on the MRSA data, the HPA’s infection expert Dr. Georgia Duckworth said that MRSA has
“started to come down and that’s brilliant news—two to three years ago professionals would have told you we couldn’t have done that”.
“This is a major achievement against the seemingly unstoppable rise in MRSA bloodstream infections throughout the 1990s”.
Mr. Graham Stuart (Beverley and Holderness) (Con): I have seen documentary evidence of a trust that wrote to clinicians saying that their foundation trust status would be threatened if the current MRSA rate were to continue, since which time they have massively cut the number of tests and have therefore shown a seeming improvement in MRSA infection rates. Will the Secretary of State comment on that?
Alan Johnson: We would need to see evidence of that. If the hon. Gentleman has it, he should let us see it. I would be perfectly willing to investigate that important allegation.
As the HPA’s infection expert said, a seemingly unstoppable rise in MRSA took place in the 1990s. The number of clostridium dificile cases in the 65 and over group has fallen to 13,660, which is a reduction of 7 per cent. compared with the same quarter last year and a 13 per cent. reduction on the previous quarter. Although I welcome this debate, it is important that we try not to play party politics with an issue as vital as patient safety. For that reason, I have declined to mention the rise of HCAIs under the previous Government. [Interruption.] Well, I did not dwell on it, and Conservative Members should not tempt me to do so, because an explosion in MRSA took place during the late 1980s and early 1990s.
The hon. Member for South Cambridgeshire makes reference to the outbreak that occurred at Maidstone and Tunbridge Wells NHS Trust. I agree completely with the points that he made about the failures of management and the disgraceful attempt by its chair to blame the public and then to blame the nursing staff alone. Some failures by the nursing staff did take place, but when one reads the report, as I know the hon. Gentleman has done, one learns of an abject failure in training and in prescribing antibiotics, and of a failure right through from the medical director to staff on the wards. That must come down to a failure in leadership.
The hon. Gentleman made a point about the trust’s leadership and the powers available to me. He is right that I could have used a section 66 power. However, all that leadership has now gone. As soon as the Stoke Mandeville report was published last July, the chair and chief executive went, but it was not as simple as that in the case of the Maidstone and Tunbridge Wells NHS Trust. However, as he said, its chair, its chief executive, its five non-executive directors and its medical director have gone, and the trust has a new management team.
Norman Lamb: The Secretary of State postponed or cancelled the package that had been agreed with that chief executive. Will he confirm that the cancellation will survive in law, and that the package will not be confirmed quietly after some time has passed?
Alan Johnson: The trust has confirmed that the proper procedures were not followed with that payment. The strategic health authority was not consulted and neither was the Treasury, so there is no legal basis for the payment. The suspension of the payment for 28 days gave time for that to be investigated properly. As I said during Health questions last week, we have written to every trust and chief executive in the country to make it clear that the public frown upon public money being squandered for unwarranted payments above the statutory minimum.
Greg Clark: The Secretary of State may not have been adequately briefed on the developments in the trust’s personnel. I understand that the medical director continues to be in place, and that at least some of the non-executive directors have agreed to go at the end of their term of office, but are still in place.
Alan Johnson: The hon. Gentleman is right; it is the director of nursing, who had a principal role in this, who has left. Three of the non-executive directors went immediately in November, and the other two are coming close to the end of their duty and will go at the end of this month. All non-executive directors will have gone by then.
I shall not reiterate everything that I said in the House at the time of the Maidstone and Tunbridge Wells report. The trust’s leadership has been completely changed. A new chair and chief executive have been appointed on an interim basis, and all the non-executive directors on the board have left or will be leaving very soon. I can tell the House that the overall situation on health care-associated infections has improved. C. difficile rates at Maidstone hospital have almost halved since 2006.
During a recent visit to the hospital, I announced £350,000 of additional funding to enable the trust to carry out a deep clean this winter as part of a comprehensive cleaning programme. Earlier this month, I gave the trust clearance formally to appoint the company that will build a new £228 million hospital in the trust area at Pembury. The new hospital will have 512 en suite bedrooms and be the first 100 per cent. single-room facility in England, enabling much better isolation of patients with infections.
The hon. Member for South Cambridgeshire referred in his contribution to the search and destroy programme in the Netherlands. The Dutch have always invested properly in health care, so they did not go through what we went through in the 1980s and 1990s. In the Netherlands, there is a much higher prevalence of single rooms for patients. All our new hospitals will be built with at least 50 per cent. single rooms and if we had the same rate of single occupancy as the Netherlands, we could adopt a search and destroy policy, too.
We are building the first 100 per cent. single-room facility in England, which will, as I said, enable much better isolation of patients.
Mike Penning (Hemel Hempstead) (Con): After 10 years in government.
Alan Johnson: Ten years in which we built 100 new hospitals across the country—the biggest hospital building programme in the history of the NHS— [ Interruption. ] The hon. Gentleman is rather touchy about these issues; he says we have closed hospitals. We have not closed hospitals—we have opened new hospitals. The hon. Gentleman may be sitting on the Opposition Front Bench, but he still cannot come to grips with the need for the NHS to move with the times and adapt to new medical circumstances.
The report on trauma, published this morning, showed yet again that we need to specialise and move away from the fixation on defending the district general hospital in all its former glory.
Mr. Lansley: I cannot believe that the Secretary of State seriously claims that a report that shows deficiencies in trauma care is simply an argument for specialisation and regional centres. The Conservatives have always argued for major trauma centres, but in addition to the availability of services in local accident and emergency departments. What the Secretary of State describes as a response to the report would strip away much of the emergency care in local A and E departments, which could be essential in the treatment of major trauma.
Alan Johnson:
Time and again, the hon. Gentleman and his party talk about a moratorium on reconfigurations. That was their policy. That is what they were saying in the summer. They got their statistics wrong. They got the hospitals wrong. They got the areas and the geography wrong. The one thing that was clear and consistent was—no change. They are fighting a political campaign based on the lowest common denominator: any change anywhere must be wrong. That is the view of the hon. Member for Hemel Hempstead (Mike Penning), as we know very well. I do not say that the report on trauma is solely about that issue, but it makes the point that we need clinicians who are dealing with such cases day in,
day out, not once every couple of weeks. All the medical evidence suggests that conclusion, which is why the entire medical profession supports the kind of reconfigurations that the Opposition oppose.
Miss Ann Widdecombe (Maidstone and The Weald) (Con): The Secretary of State has just said that the campaign against some reconfigurations is political and that the entire medical profession takes a different view, so could he explain why so many consultants in the Maidstone and Tunbridge Wells NHS Trust oppose the reconfiguration?
Alan Johnson: I am talking about trauma, stroke care, cardio-vascular care and cancer care, where there is a move towards more specialist centres to deal with those conditions, rather than trying to pretend that every district hospital can be all-singing and all-dancing—the Opposition view, which we completely oppose.
As I have explained, ours is not the only country grappling with such issues. The range of measures we have introduced is making a significant difference. Our recent announcements are designed to maintain momentum in supporting the NHS to provide safe, high quality care to every patient. As Lord Darzi’s interim report pointed out:
“Safety should be the first priority of every NHS organisation.”
There should be a collective accountability for preventing infections. We need to focus all minds on cleanliness, which must be integrated into the culture by every member of staff on every ward and in every location involved in health care provision. I pay tribute to those NHS staff who work so hard to ensure that that is the reality in hospitals up and down our country.
5.15 pm
Norman Lamb (North Norfolk) (LD): We would probably all agree that we should treat this subject with the utmost seriousness. The Secretary of State is right: there should not be party political point scoring over a matter that causes so many families distress and trauma.
It is important that we keep the issue in perspective. Every year, more people die from thrombosis in hospital than from hospital-acquired infections. Deaths from thrombosis are often avoidable if hospitals follow proper processes.
John Smith (Vale of Glamorgan) (Lab): The hon. Gentleman’s point is important. Would he stress, however, that he means hospital-acquired thrombosis, not just thrombosis?
Norman Lamb: Absolutely. I pay tribute to the hon. Gentleman’s work on the matter. The fact remains that more people die in hospital from thrombosis than from hospital-acquired infections. It is important that we keep a balance when we talk about the subject. None the less, some 300,000 cases of hospital-acquired infections occur every year, with some 5,000 deaths and an estimated cost to the NHS of about £1 billion, which could be spent on patient care and doing good things for patients. The NHS must take such infections very seriously.
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