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The right hon. Lady makes a good point, which I shall deal with. In 1982, 170,520 ancillary staff were employed in the NHS in England. By 1996, the number was down to 66,7608,000 jobs a year or more than 20 a day were lost in the cleaning and ancillary service. Let us remember the process. Compulsory competitive tendering was allegedly a test of efficiency. In reality, health service workers who had worked in the NHS for five, 10, 15 or 20 years were
sacked and asked to bid for their jobs back. At the same time they were told that £2.40 or £2.30 an hour was far too much.
Mr. Lansley: The Government claim, rightly, that there have been 250,000 extra staff in the NHS, of whom 107,000 have been administrators. How many have been cleaners? Does the hon. Gentleman understand that on wards at Maidstone at the time that the infections were occurring there was access to cleaning for two hours a day twice a day. That is all that was available.
Mr. Devine: That is outrageous. The hon. Gentleman is right. Let me explain the process. Whether the contracts were won by the private sector or in house, the cleaning hours fell by two thirds in most cases. The scenario that I painted at the start of one domestic coming on duty at 7.30 am and working till 2 and another working from 4 till 8 was replaced by an individual who worked in four, five or six wards, whether that was privatised or in house.
Reference has been made to laundry services. Exactly the same scenario prevailed there. Working as a nurse, I had 12 uniforms. At any given time, four were in use, four were on the way to the laundry, and four were in the laundry. Again, after privatisation, that was cut down. In practice that meant that the majority of nurses started washing their uniforms themselves, adding to the difficulties. In some hospitals the turnover of staff was more than 100 per cent. There was no training for staff coming on duty. There were numerous stories of new people turning up in the morning and working on a ward an hour later.
We must remember the politics of the time. The early 1980s was the start of the No Turning Back group, many of whom were advisers to private contractors. What did the Conservatives do? They said that there was no problem, yet in a debate in 1997, my hon. Friend the Member for Thurrock (Andrew Mackinlay) highlighted a report prepared by the Conservatives in 1990. That confidential document stated:
Infection control costs are always difficult to assess, but there is general agreement that the costs of ignoring strains of EMRSA are higher than those of controlling them, particularly when the costs of potential legal action are included. Litigation by an infected patient is a growing hazard of MRSA outbreaks in hospitals and it is therefore important to demonstrate that well-documented and effective control measures are implemented.
Andrew Mackinlay (Thurrock) (Lab): I want to place on the record the fact that if people revisit the Official Report for that debate they will see that the hon. Member for Orpington (Mr. Horam), the Conservative Minister replying from the Dispatch Box, accused me of scaremongering.
Official figures...show that the peak of the problem occurred in 1986.[ Official Report, 19 March 1997; Vol. 292, c. 859.]
Yes, we may be entitled to some criticism, but we all have problems and difficulties in relation to the issue. At least we have come to the Chamber and said that there is a problem, and we are facing up to it. That was not the case with the Conservative party.
Miss Ann Widdecombe (Maidstone and The Weald) (Con): May I first apologise for not having been here during most of the opening speeches? I had already told Mr. Speaker that I was coming from Market Harboroughsplendid placeand was at the mercy of both trains and a passage across London in the rush hour.
I am grateful for the opportunity to speak in this debate, particularly as my trust forms such a central part of the motion. I digress for just a couple of seconds to answer the gibe made by the hon. Member for Livingston (Mr. Devine). He said that because I had private health insurance, I was some sort of terrible public liability. I point out to him that every time that I pay full whack for my prescriptions I take a burden from the NHS. Although I am an OAP, I still pay full whacka bit more than the hon. Gentleman pays, and people benefit from it.
However, I digress; I shall pull myself back into order before you do, Madam Deputy Speaker. I turn to the main part of the motion. I make no apology for repeating what I said when I raised a question with the Under-Secretary of State for Health, the hon. Member for Brentford and Isleworth (Ann Keen), after the publication of the report into Maidstone and Tunbridge Wells NHS Trust. I have since had a meeting with her and I reiterated the point then.
The crux of the matter relates to authority and accountability in the wards themselves. No matter how good the chief executive or matron, they are not on the ward all the time. They cannot be. Ward sister, however, is on one ward for an entire shift and therefore authority and accountability need to be vested in her. It is clear that that system has broken down in large parts of the NHS and in particular in my own trust. I do not wish to go over again the problems that my trust has faced, because the crucial thing now is that we look forward and try to put right what has gone wrong. We should address ourselves to the future, rather than always harp on about the past.
Nevertheless, I have to say that, despite all the publicity around that report and all the local press and media coverage, I still got a letter from a constituent saying that she had recently visited a relative in hospital where a nurse had dropped a syringe on the floor, picked it up and gone to use it. The nurse was stoppedthis is the crucial pointnot by a ward sister but by an observant relative, who said, Hey, you cant use that. The role of a ward sister should be almost wholly supervisory. She should be going round the ward saying, Nurse, that drip is empty, Nurse, that patient has been ringing the bell, or No, nurse, you dont use that syringeyouve just dropped it on the floor. That is the ward sisters
job, together with issuing appropriate instruction of the nurses as to why not to use the syringe that has just fallen on the floorif such instruction should really be necessary.
However, the ward sister does not do such things anymore, and there are three reasons for that. First, her role has become confused and she spends far too much time commissioning blankets and bandages instead of supervising the nurses. Secondly, she spends rather too much time filling in forms. If this Government do not get to grips with form-filling, targets and box-ticking, a lot of time will be diverted from the sharp end of patient care. The ward sister also nurses, because when there are nursing shortages she has no choice but to do so; and while she is nursing, however admirable that may be, she is not supervising others. Thirdly, there is an air of what I might describe as excessive egalitarianism whereby she no longer likes to boss. When I went to see the Minister, she told me rather endearingly how she used to be bossed tremendously, even to the extent that she was not allowed to plump up a pillow because it released germs into the air. Indeed, she told me that she never plumps up her pillows at home having learned that lesson so thoroughly. What a difference between that level of supervision and what we have today. We need the ward sister bossing, however nicely and politely, and taking control of the ward.
Ward design has a major role to play, although I know that that cannot be put right by the middle of Tuesday afternoon. I have had one very positive experience of the NHS in recent years, when I took my mother into Royal London hospital under trauma procedures. The wards there were of the old Nightingale design, which meant that all the nurses could see all the patients all the time and all the patients could see all the nurses all the time. Nobody was ringing bells for people to appear round double corners, which is the layout of most modern wards. Given that the Government are boasting about how many hospitals they are building, perhaps before they build any more they might revisit the whole issue of ward design and how easy it is for nurses to be supervised in a situation where they can hardly ever be seen.
Miss Widdecombe: That must be right. We need to get right back to the sorts of situations that the Minister described to me, with meticulous attention paid to hygiene whether it relates to pillows or syringes, let alone telling a patient to go in the bed, which, as she will be aware, is what happened at Maidstone.
I would like something terribly simple: an air of carbolic, as I described it to the Minister. I had some sympathy for the hon. Member for Livingston when he described the situation that used to prevail in hospitals, whereby one was immediately hit in the nostrils by the scents of disinfectant, carbolic, floor scrub and every other horror. Now, even hand-washing is a forgotten discipline. It would be helpful if very basic hygiene practices were restored.
As a slight digression, I also think that we need to look at the NHS as a whole and ask whether what we have is going to last us to the end of the 21st century or
whether we need to carry out some serious restructuring. That does not mean the sort of piecemeal restructuring going on at the moment, which is afflicting my trust, where in order to have a trauma specialism at one hospitalI have nothing against such a specialismpeople going in under accident and emergency procedures have to travel 17 miles on B roads before they may be attended to. Nor do we want, as also proposed under the reconfiguration, those using maternity services to have to travel down to Tunbridge Wells, so that anyone whose labour runs into difficulty at Maidstone will be taken there along 17 miles of B road. Tunbridge Wells is a splendid place, but no one wants to travel 17 miles by B road when they are in severe orthopaedic trauma, or in a complicated labour. Therefore, those sorts of reconfiguration are not the answer.
We need to consider the financing of the NHS, and whether those who can do so should be encouraged to take some of the costs on themselves. We need to face the fact that the state cannot do everythingit does not. What, after all, would the hon. Member for Livingston say to those who were told to go blind in one eye before the other could be dealt with? The state cannot do everything, and it is time that it stopped pretending that it can. By pretending, it is running a three-tier NHS. At the top are those who get their NHS treatment or who choose to go private; at the next stage are those who cannot get their NHS treatment and can go private but do not want to do so; and at the third stage are those who do not get their NHS treatment, and could not go private if they starved themselves for a month. If we do not look at the whole picture of the NHS, we betray the most vulnerable in the population.
Shona McIsaac (Cleethorpes) (Lab): I come to this debate as someone who has actually cleaned hospitals in a previous job. I have cleaned up after patients who have been suffering from the conditions in question, and it is tough to do so, particularly when dealing with something like clostridium difficile, and the sheer number of spores that are produced in the faeces of someone with diarrhoea as a result of C. difficile. They are produced in enormous numbers, and it is quite tough to clean all the surfaces involved to ensure that there is no transmission from the environment. I did that work many years ago, so the situation is not new. C. difficile has been with us for many decades, and it is only recently that there have been particular problems, which I shall come to later.
I want to start by talking about methicillin-resistant Staphylococcus aureus. I have listened to debates on this issue so many times in this House. I listened to what the hon. Member for South Cambridgeshire (Mr. Lansley) said, and I believe that he oversimplifies a complicated subject. He makes comparisons with other countries, such as the Netherlands, but when we are dealing with MRSA, we are dealing with something like 17 different strains. The strains prevalent in hospitals in places such as the Netherlands are different from those prevalent in this country.
Shona McIsaac: Given the time pressure, I will not. In this country strains 15 and 16 are the most prevalent, and those strains are the most resistant of allfar more resistant than the ones prevalent in the Netherlands and Denmark. Those are the strains most prevalent in Japan, too, for example, and no one who has been to Japan and seen hospitals there would say that they had problems with their cleaning regimes and hygiene. As we are talking about such a serious issue, we have to keep in mind the science that underlies the subject.
Mr. Lansley: The hon. Lady accused me of oversimplifying by trying to draw an analogy with the Netherlands, but in fact I was citing the chief medical officer, who, in December 2003, drew attention to the experience of the Netherlands and the use of a search-and-destroy strategy. If it is good enough for the chief medical officer, it ought to be good enough for the Governmentbut it was not.
Shona McIsaac: The hon. Gentleman has missed the point that I am making. This issue is far more complicated than is often evident in short debates such as this, as we tend to make simplified speeches. Of course we should take note of what happened in the Netherlands, but if we simply transferred everything that was done in that country to the UK, it would not have the same effect, because we are dealing with different strains of MRSA.
Some 30 per cent. of us carry Staphylococcus aureus on our body: one third of the Members who will go into the Division Lobbies tonight carry it on their bodies. Some of us even carry resistant strains, but the majority of us are healthy individuals. Staphylococcus aureus acts opportunistically, and targets people with compromised immune systems who are vulnerable to it. Most of us will not be troubled by MRSA.
We have to consider why Staphylococcus aureus has become a problem in this country. It is largely to do with the inappropriate prescribing of antibiotics in past decades. People were often given antibiotics almost like sweeties: if someone had a snuffle or a cold, they would be given antibiotics. It was quite wrong to give people antibiotics in those circumstances, as they killed off many of the less damaging strains of Staphylococcus aureus, so that the resistant strains came to the fore and became increasingly prevalent. We must therefore look at prescribing regimes, and hold back from prescribing so many antibiotics. That is as true for C. difficile as it is MRSA.
The Northern Lincolnshire and Goole Hospitals NHS Foundation Trust is my local NHS trust. It is responsible for three hospitals, and it pioneered the cleanyourhands initiative. MRSA rates have continued to decline, and the trusts target is one case a month across all three hospitals. The trust has one of the lowest MRSA rates in the country, because it pioneered that initiative, butand this is a gripe I have with the Governmentit was told to reduce that rate by half. Given that it already has one of the lowest rates, the statistics become quirky. If we have two cases a month, one of which might be acquired in the community, not hospital, we will not reach our target. People will report the trust as a failing regime, but in fact the chances of acquiring MRSA in those hospitals is minimal.
I pay tribute to the phenomenal work undertaken by those hospitals to bring the rates down. For example, they assume that everyone who is admitted is MRSA-positive unless proven otherwise. Everyone has to undergo an alcohol body wash to decolonise the body of MRSA, and the hospitals will soon progress to nasal decolonisation as well. The cleaning in those hospitals is in house, and that is welcome. They are considering more innovative ways in which to deal with cleaning to reduce not so much MRSA but other infections.
Let me consider C. difficile. Again, I pay tribute to Diana, Princess of Wales hospital, Goole hospital and Scunthorpe district general hospital. They are working hard on C. difficile and putting in place cleaning regimes to tackle the environmental contamination that can occur from the multitude of resistant spores that C. difficile produces. Their work is phenomenal.
The right hon. Member for Maidstone and The Weald (Miss Widdecombe) is present, and I emphasise the fact that I do not believe, considering the science behind the subject, that we will ever completely eradicate C. difficile. There are 100 typesI think type 027 causes the problems that we are experiencing in the UK. It produces many toxins, which lead to fatalities. It is so resistant and produces so many spores that I am not sure whether we shall completely eradicate it. However, the work being done to reduce it is welcome. Again, we must stop prescribing so many strong broad-spectrum antibiotics, which destroy the good bacteria in the intestine, thus allowing the production of the toxins. That is a serious problem.
I pay tribute to the work in my area to reduce the rates of C. difficile and MRSAI will not go into detail about pseudomonas or norovirus this afternoon. However, I should like the Government to consider the statistical quirks, which show that one case per month across three hospitals is fine, but two cases mean the red zone. We must reconsider that. It was disheartening for staff to be told that they were in the red zone because there were two cases, as opposed to one, across three hospitals.
Mr. Lee Scott (Ilford, North) (Con): I shall be brief, and stick to the present rather than looking back to the time of Florence Nightingale. I begin by praising all our nurses and doctors, not only in my constituency but throughout the country. They do a wonderful job and we should be proud of them.
I want to consider what affects my constituency and start with the case of a 40-year-old man, whom I visited at his home because he was too ill to come to my surgery. He had been admitted to Whipps Cross hospital, one of two hospitals that services my constituency, with a severe orthopaedic complaint. He was then transferred to the Royal orthopaedic hospital, so I make no accusation about where he contracted MRSA. However, he contracted it. Six months on, he has been unable to work, go out properly or function normally. It has wrecked his life. Those things are affecting our constituents today. Another case is that of a lady whose daughter took her to King George hospital. Tragically, she lost her life through C. difficile. I will not go into more detail because the family has asked for formal investigations into the matter.
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