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I also want to cite the case of my daughter, who went into Barnet general hospital when she was pregnant earlier this year. My wife and I visited her. I used the alcohol scrub to wash my hands, but I noticed many visitors to the hospital not using it and not being asked to use it. That is not the fault of the nurses on duty, who are simply rushed off their feet and unable to do that. I blame the management and the powers that be, but I do so pragmatically—I am not looking today to have a political go at anybody. We need to try to resolve the problem, for the sake of all our constituents.
Mention was made earlier of the chief executive of Maidstone and Tunbridge Wells trust. The House might be interested to learn that her partner was the chief executive of our trust, Barking, Havering and Redbridge trust, who surprisingly resigned within seven days of her resigning, allegedly—the trust will not release the figures—receiving a substantial sum of money for going on and furthering his career elsewhere.
Miss Widdecombe: About £1 million, wasn’t it?
Mr. Scott: Well, I can only say that the allegations were about £300,000, and £1.1 million into a pension, although those are allegations. The figures have not been released and I have no way of verifying that. What happened was disgraceful, whatever settlement was received. However, families who have lost relatives have asked the police to investigate that chief executive, so I shall be careful in what I say, as I would not want to affect that.
When the head of the NHS recently appeared before the Select Committee on Health, I asked a question about that chief executive. The implication was that he had not quite gone voluntarily, and might have been helped on his way. That is in the minutes as a matter of record, as any hon. Member who reads them will clearly see. My point is that if the person in charge is not doing their job, there is a knock-on effect on everyone else and a price to pay, and that price is too high for our constituents. However—this will come as a shock to my side, who should please forgive me—I want to say thank you to the Secretary of State, who has agreed to look into the case of that chief executive. I believe that it might be too late to stop any payments, but I would be grateful if that could be looked into, and if the correspondence, for which I am also grateful, could be passed on.
I am not going to list the things that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) mentioned earlier, but if we do not tackle the problem in a number of different ways, we will be letting down the people who put us in this place. We owe it to them and to ourselves—we could all be patients—to rectify the problem. Let us do it now. That will have to come from the top—from the Secretary of State.
6.12 pm
John Smith (Vale of Glamorgan) (Lab): I congratulate the Opposition on choosing the subject of this debate, which represents good use of an Opposition day. I do not want to disappoint them too much, but I will not vote for their motion, although I welcome the opportunity to take part in this debate, which I have found extremely interesting up until now.
It would be remiss of us to have a debate on what is seen by the general public as one of the biggest patient safety issues in the country and not put that debate in its proper context. We have had a chance today to raise some of the many issues associated with MRSA and C. difficile, but we should do so in a balanced way and look at the wider picture of problems with patient safety and of public concern about national health issues.
That was touched on by the hon. Member for North Norfolk (Norman Lamb), who opened his speech by saying that we needed to see the issue in context. The hospital-acquired infections of MRSA and C. difficile are a matter of great concern, but they are as nothing compared with the problem of hospital-acquired venous thromboembolism. The hon. Member for Ilford, North (Mr. Scott) talked about the tragedy of his constituent going in for orthopaedic surgery and coming out with the dreadful infection of MRSA. However, believe it or not, his constituent was 25 times more likely to come out with a potentially fatal or debilitating venous thromboembolism, which could involve deep vein thrombosis, than he was to contract MRSA or C. difficile. According to the latest recorded figures, just over 2,000 NHS patients died after contracting MRSA. In the same period, as far as we know—I ask the House to listen carefully to this figure—25,000 patients a year died from hospital-acquired venous thromboembolism, yet we hear very little about it.
The hon. Member for Beverley and Holderness (Mr. Stuart) made the valid point that the difference between the two kinds of hospital-acquired conditions is that the figures for the deaths caused by the superbugs are collated accurately by the NHS, yet the number of deaths caused by hospital-acquired venous thromboembolism are not collated properly. So when we say that 25,000 people a year are dying unnecessarily from hospital-acquired venous thromboembolism, that is a great underestimate. That figure comes from the Health Committee’s report in 2005, which, I am pleased to say, was accepted in full by the Government and the chief medical officer, but it is almost certainly a great underestimate of the exact figure. I refer the House to the seminal work of Dr. Ander Cohen of King’s College hospital, one of the leading epidemiologists in the country. He suggests that the figure is at least double the one that I have just cited.
These are huge numbers, so when we have a debate on hospital-acquired diseases and patient safety issues, for goodness’ sake let us look at them in context. The Government have rightly decided to spend £270 million a year on tackling hospital-acquired infections such as MRSA, C. difficile and some of the new conditions that have recently been identified, yet they are spending less than £30 million a year on the prevention of venous thromboembolism.
It has been made clear from the start of this debate that tackling those superbugs is not a simple business. In fairness to the hon. Member for South Cambridgeshire (Mr. Lansley), he said that we needed to take a comprehensive approach. We need new research into medicines, a review of bed occupancy and more deep cleaning in our hospitals. Even if we had all those things, however, there would be no guarantee that they
would have the desired effect. As far as deep vein thrombosis is concerned, however, all that we need to do is to introduce mandatory risk assessments in all patients in the NHS, which is relatively easy compared with treating the superbugs. We know that that could save at least 15,000 lives a year and avoid the tragedy associated with this unnecessary loss of life.
The chief medical officer, having been asked to report on this matter by the Government, recommended that we should produce mandatory risk assessments for all NHS hospitals, certainly in England. He made that announcement last April. Shortly afterwards, National Institute for Health and Clinical Excellence guidelines were issued which contained the same recommendation for the risk assessment of patients using a relatively simple questionnaire, to enable doctors to work out what thromboprophylaxis—preventive treatment—could be applied. This devastating loss of life could be prevented at very low cost and, in some cases, at no cost at all. Those recommendations came out seven months ago, and we welcome the steps that the Government have taken.
The all-party parliamentary group on thrombosis conducted a survey, starting in August, that was published this week. It surveyed 174 NHS hospitals and received a very good response. Eighty-one per cent. responded, and 99 per cent. of those hospitals said that they were aware of the chief medical officer’s recommendations on dealing with this condition—I stress that this is hospital-acquired; this is not DVT in the community—and of the NICE guidelines, both of which recommended mandatory risk assessment. We do not want to decry—indeed, we want to encourage—such responses in future, but sadly, fewer than a third—only 32 per cent.—actually implemented risk assessments on all their patients, as recommended. We calculate that it is seven months since the recommendations and guidelines came out.
Once again, I ask the House to listen carefully. We have heard figures on deaths from MRSA and C. difficile, but they are as nothing compared with the number of deaths from hospital-acquired deep vein thrombosis. We calculate that since April to today, approximately 11,000 patients have died. The all-party group on thrombosis and the excellent charity Lifeblood believe that those deaths were unnecessary and were relatively easily preventable. If we did something now, we could offset the cost of those who suffer this dreadful illness but survive—usually after orthopaedic surgery and general medical treatment—and re-present themselves to the NHS. No correlation is made with their presence in hospital, but the cost of those patients re-presenting themselves back to the NHS is £640 million a year.
I welcome what the Government have done since the Health Committee report two years ago. They have moved quickly and comprehensively, but we cannot wait another 18 months for these mandatory risk assessments to come into our hospitals, which could mean thousands, if not tens of thousands, more patients—especially in England, but in the whole of the UK—dying from this condition.
6.21 pm
Mr. Peter Bone (Wellingborough) (Con):
It is a great pleasure to follow the hon. Member for Vale of Glamorgan (John Smith), who made a powerful and well argued
point about an issue that I had not appreciated before. However, I would argue that it is not a question of having one or the other; we need to save lives in respect of both.
I shall speak mainly about C. difficile, as the hospital that most of my constituents have to attend has the worst rate of C. difficile in the country. I am pleased to see my hon. Friend the Member for Kettering (Mr. Hollobone) in his place, as I am talking about Kettering hospital. I know that my hon. Friend pays a great deal of attention to this matter.
The likelihood of someone getting C. difficile in Kettering hospital is three times the national average. I hope to make constructive points tonight, as I refer to a particular constituency case, but there must be some reason why Kettering hospital has such a high rate. One thing that we know about our primary care trust is that it is the worst funded in the country. The national capitation formula shows that, this year, our PCT is £38 million underfunded, as it has been for every one of the last four years—so we are talking about substantially more than £140 million. We know another important factor, which is that the hospital is very efficient, but that the capacity is never there. A bed is emptied and another patient goes in. We thus have underfunding, high capacity and the top rate for C. difficile. I do not want to make a party political point, but there does seem to be some correlation between the three. I do not believe that we could have the worst funded area, a highly efficient hospital and the highest rate of C. difficile without there being any sort of correlation.
I want to pay tribute to the staff of the NHS, particularly in my area. The doctors, nurses and ancillary staff are superb. They helped save my wife’s life and I spent a lot of time in local hospitals seeing what happened. On the capacity problem, I recall my wife having a major cancer operation. She was lying in a hospital bed with drains; she had just come back from the theatre. The ward was full of course, and they cleaned it while she was there. They started to clean the bed and above it, and they sprinkled dust all over her, because they had no other opportunity to clean the ward. Lack of capacity is one of the problems we face. If there was more capacity in hospitals, and fewer targets, the situation would improve.
I know that the chief executive of Kettering hospital is working very hard to improve the situation there, and I understand that the latest figures show an improvement; I think we are now the fourth worst in the country, so we are going in the right direction.
Shona McIsaac: I am listening carefully to what the hon. Gentleman says, and it is clearly a concern if there is a particularly high incidence of clostridium difficile in his local hospital. Has he asked the hospital about their prescribing regimes, because generally speaking C. difficile is brought on only by over-prescribing powerful broad-spectrum antibiotics?
Mr. Bone:
I am grateful to the hon. Lady for her intervention, and I listened to what she said in her powerful speech, but may I move on to discuss a specific case study? A number of people have come to see me about C. difficile in my area, and one family has been willing to go public about what happened. It is to
do with the case of Mr. Frederick Harrison who, sadly, died a few months ago in Kettering hospital. Let me read what Mrs. Harrison, his daughter-in-law, said:
“My father in law was admitted to KGH in March 2007 after a fall. He was kept in overnight as he had a slight temperature. They then said he could not be discharged until the Monday because no Doctor was available to sign the paperwork. That weekend the ward he was in was closed to visitors for a week because of an outbreak of diarrhoea.
My father in law was then transferred to the new isolation unit as he had contracted C-diff. He was there for 4 months in isolation, no children allowed to visit, and visitors and visiting time was limited. Although all the nurses were absolutely fantastic he was told to soil the bed, which he found very distressing.
We were advised he was clear of the infection and he was moved to the Isebrook Hospital for rehabilitation. He started to slowly recover, but again after a fall, we were told the C-diff was back and he was transferred back to KGH isolation unit.
He died on 11 September 2007 after almost 7 months in isolation. There was no mention of C-diff on the death certificate.
On registering the death my husband was told that this was to keep the statistics down. This cannot be right. This is a horrible, degrading infection and we would not wish any other families to go through this. However we also could not have gone through a post mortem or inquest at the time, and did not contest the fact that it was omitted from the death certificate.”
I think that many people would understand Mrs. Harrison’s concern. She concluded by saying about Mr. Harrison:
“Yes he was 86 but before March he was reasonably healthy.
I am not a Doctor but after 7 months in isolation C-diff must have been a contributory cause of death.”
I want to make the point that that highlights: there appears to be under-recording of deaths from C. difficile.
Andrew Mackinlay: I wholeheartedly agree with the hon. Gentleman. In the last Parliament, I drew that to the attention of the then Member for Welwyn Hatfield when she was a Treasury Minister, because the Office for National Statistics has responsibility for the veracity of the death certificates, not the national health service. This problem will go on and on unless Ministers instruct that if doctors and hospitals do not complete death certificates accurately and candidly that will be treated as a serious disciplinary offence.
Mr. Bone: I welcome, and agree with, that intervention. I have taken the matter up and have received a letter from the Society of Registration Officers. It says that it is not down to its officers to decide what is on a death certificate, but that they have to put down what the doctor says. I can understand that when Opposition politicians are jumping up and down and complaining, people in hospitals where there is concern about C. difficile are under pressure not to record the facts properly.
I know that the Government are beginning to take this seriously, because I have been given a document, dated 3 October, in which the chief medical officer says:
“there is still a widespread belief that the figures underestimate the mortality associated with both MRSA and C. difficile. This is compounded by the idea that doctors are reluctant to put information about HCAIs on certificates, or indeed that they are discouraged from doing so.”
My point is that we must have tougher standards, so that we properly record the number of C. difficile deaths. Unless we do that, we will never be able to tackle the problem.
The Parliamentary Under-Secretary of State for Health (Ann Keen): The hon. Gentleman raises such an important point that I should answer it at this stage. There is a duty on doctors to record the cause of death accurately on death certificates. The chief medical officer wrote to all doctors to remind them of the importance of giving full and accurate information on death certificates. MRSA or C. difficile infection will be cited on a death certificate if the certifying doctor considers it to have been the underlying cause of death. Many patients who become infected with an HCAI have other serious and potentially fatal underlying medical conditions.
I assure the hon. Gentleman that I am aware of the case that he mentions and that the chief executive in Kettering has taken the point very seriously. I believe that we are addressing the hon. Gentleman’s concerns.
Mr. Bone: I am grateful for the Minister’s intervention.
My hon. Friend the Member for Kettering reminded me before the debate of our request last May for a Department of Health Minister to come to Kettering general hospital to examine the problems that it faces. We have not received a response to that invitation, so I would like to make it again today.
6.31 pm
Greg Clark (Tunbridge Wells) (Con): I pay tribute to my hon. Friend the Member for Wellingborough (Mr. Bone). His powerful speech went to the heart of an important problem, and I hope that the Minister will take it further into account.
I agree with my right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe): the overwhelming mood in west Kent is that we must move on and rebuild confidence in our local NHS having learned the lessons. If we are to do that, we must not ignore lessons that are still to be learned from the report. Discussion about the headline measures to tackle infection control has continued, but in the brief time available to me I want to mention four contributions that we must continue to take into account in the weeks and months ahead.
First, if any possible good could come out of the report, it is that it has concentrated Ministers’ minds on the need for a new hospital to serve the people of west Kent. The two hospitals in my constituency, the Kent and Sussex and the Pembury, must be two of the most decrepit in the country. Pembury hospital is a converted workhouse. The buildings that are not part of the workhouse are wooden huts. It is impossible to imagine patients and staff of a hospital elsewhere in the country suffering from such conditions in the 21st century. I welcome my right hon. Friend’s support, and I hope that the sad opportunity that this report has given us to press the case for a new hospital will ensure that it is delivered after decades of waiting.
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