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21 Nov 2007 : Column 1292

Secondly, we need to go beyond the initial response on infection control and implement a zero-tolerance approach to hospital-acquired infections such as C. difficile. The national target of a 30 per cent. cut is fine as far as it goes, but we need to rebuild confidence to match the confidence that people on the continent and people using the private sector have in their hospitals. They fully expect to come out of hospital without having acquired an infection.

Greater urgency is required. The excellent matron of Kent and Sussex hospital, Linda Summerfield, took me on a tour of the wards recently. They were spotless and their cleanliness could not be faulted; nevertheless we saw physically inadequate facilities. In an intervention earlier, I mentioned the lack of changing facilities. The Royal College of Nursing is clear: every nurse should be able to travel to work in their own clothes and change on site into a uniform that is laundered on site and guaranteed to be free of infection. That is impossible at Kent and Sussex hospital, because the changing facilities have space for only a dozen people at a time, in a trust that employs many hundreds. There is an urgent need to address such facilities.

Curtains are another factor. It is imperative that hospitals have disposable curtains, rather than tatty old curtains that attract the spores that contribute to C. difficile. When I put that point to the trust’s chief executive, he told me that there were plans to replace the curtains over time, but that is not good enough. The situation is urgent, so if it is clear that disposable curtains will make a difference they should be used throughout the entire trust immediately. I am concerned about the lack of progress on that issue.

We need to consider the adequacy of the management team that replaced the previous, inadequate team. We have a new, interim chief executive and I have no personal complaints about his authority or capability to manage the trust, but I am concerned about the fact that he is only part-time. He is also the chief executive of the Ashford and St. Peter’s Hospitals NHS Trust in Surrey. The headline on the press release announcing his appointment was “Glenn Douglas to split time equally between two organisations”.

A trust needing as much care and attention as ours requires a full-time chief executive. Of course, we require a skilled individual and I should be delighted if Mr. Douglas, with his skills, was appointed full-time as interim chief executive. He may be spending too little time at Maidstone and Tunbridge Wells although, to be fair, I do not think that is the case. However, we cannot engage in a smoke and mirrors exercise and pretend to people in Surrey that they have the full-time attention of their chief executive, given that hospital-acquired infections in his home trust increased by 88 per cent. over the past year. If there is one lesson we should learn from this whole episode it is that we cannot keep the public in the dark with nudges and winks about what is going on in the NHS. If the man is supposed to be running two trusts we need to know about it, and people in Maidstone and Tunbridge Wells need the same clear message as people in Surrey.

Finally, as we reflect on the grossly inadequate supervision given by the failed management of the trust over the past few years, we can see that there is a general problem of accountability. I would be hard-pushed to say to whom any of the NHS institutions in my area—the
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strategic health authority, the Maidstone and Tunbridge Wells NHS Trust or the West Kent PCT—are accountable. If I ask questions of the Health Secretary about local issues he will say it is a matter for the local trusts, but I have no direct means of holding them to account, other than, occasionally, to embarrass them publicly, which is a crude mechanism. I hope that we will reflect on the lessons and design in the appointment of new non-executive directors, not just in our own trusts, but more widely across the NHS, a more genuine means to hold NHS managers to account.

We should make it clear to non-executive chairmen that they have a duty to the public. That applies to George Jenkins, the interim chairman of Maidstone and Tunbridge Wells trust, and every non-executive chairman of NHS bodies throughout the country. Their role is not always and everywhere to defend management. In the absence of anyone else—although that absence is a fault of the system—their responsibility is to represent our constituents and take management to task when necessary. The Maidstone and Tunbridge Wells non-executive directors and chairman failed abjectly in that responsibility. I look to the new chairman of our trust, and the new non-executive directors to be appointed, to exercise that role.

Mr. Oliver Heald (North-East Hertfordshire) (Con): My hon. Friend’s description rings a bell. It is an example of systematic incompetence, which is a factor that we see across government.

Greg Clark: There is a pattern of incompetence, but also a pattern of a lack of accountability. That does not extend just to the NHS. One positive message that we can take from the situation to ensure that such an event is never repeated is to re-inject more accountability to local people into the NHS and other bodies that need it, so that managers feel that they are being scrutinised at all times.

6.40 pm

Anne Milton (Guildford) (Con): Of all the reports that hon. Members may have read recently, none is more damning or more distressing to read than the Healthcare Commission’s report into the outbreaks of C. difficile at Maidstone and Tunbridge Wells NHS Trust. I have no doubt that the sense of betrayal among local people is immense. The success of the NHS is largely down to the confidence and trust that people have in the organisation and its staff. There is no doubt that the majority of NHS staff continue to work to achieve exactly that end. The rise in health care-acquired infections has seen the loss of that trust, a loss of confidence and an increasing sense that NHS staff are no longer in control of their own decision making.

We have heard some excellent speeches. I did not entirely follow the speech made by the hon. Member for Livingston (Mr. Devine), but I am concerned that his attempt to focus on the events of 20 years ago or more was simply an opportunity to deflect attention from the failures of the Government today.

As a former nurse, I thank my hon. Friend the Member for Ilford, North (Mr. Scott) for his tribute to nurses across the country. He gave a particularly evocative account of two of his constituents, one of whom sadly died. He also raised the issue of large payouts to senior
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managers, which continues to concern a number of hon. Members, particularly when those managers have presided over significant failures in trusts. He was generous, however, in his praise of the Secretary of State.

The hon. Member for Vale of Glamorgan (John Smith) was also generous in his political stance and raised the important issue of venous thromboembolism. The hon. Member for Wellingborough (Mr. Bone) mentioned his concern for his constituents, who are served by a hospital with the worse C. difficile rates in the country. As well as paying tribute to all NHS staff, he also mentioned the experiences of one of his constituents.

My right hon. Friend the Member for Maidstone and The Weald (Miss Widdecombe) talked about authority and accountability on the ward through the ward sister. I am sure that I speak for all hon. Members when I say that her anecdote about a nurse who went to use a syringe that had fallen on the floor was truly shocking. She also mentioned the confused role of senior nurses, nurses covering shortages and form-filling. She spoke with her usual and much-welcomed common sense.

The hon. Member for Cleethorpes (Shona McIsaac) spoke passionately about the prescription of broad- spectrum antibiotics. She paid tribute to her local trust, which I gather is a centre of excellence. She also mentioned the fact that figures can be extremely misleading.

My hon. Friend the Member for Tunbridge Wells (Greg Clark), like my right hon. Friend the Member for Maidstone and The Weald, was particularly touched by the recent events, which left 90 people dead, while 270 deaths had C. difficile cited as a contributory factor. My hon. Friend has campaigned long and hard for a new hospital and has been particularly concerned about the issues associated with built structures, nurses and their uniforms and the practices that are followed. No one knows better than him the urgency with which the matter needs to be dealt.

My hon. Friend the Member for Tiverton and Honiton (Angela Browning) mentioned leg ulcers. Labour Members mentioned research and the overuse of antibiotics. In particular, the hon. Member for Bridgend (Mrs. Moon) mentioned treatment with maggots. My hon. Friend the Member for Westbury (Dr. Murrison) talked about the need for the Government to face up to the situation and cited individual constituents’ experiences.

My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) spoke from the Front Bench and focused in particular on screening, isolation and bed occupancy. He also referred to the Government’s plans for a deep clean. In particular, he noted that the Department of Health had said that there was no central programme for that, nor any plans to monitor progress, and that it was a matter for local determination. In addition, the Department said that no dates had been set for commencement or completion of the deep clean, that there would be no new money for it nor any repeat programme. Finally, my hon. Friend noted that the Department had supplied no news on training—perhaps the Minister will be able to bring us up to date about exactly what training will be given to help NHS staff to achieve this so-called deep clean. It seems to me, and I am sure to many Opposition Members, to be no more than a gimmick.

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A Healthcare Commission report was published in July in response to requests from the chief medical officer for ways to reduce infection rates. It stated:

health care-acquired infections

It would be awfully welcome if the Secretary of State listened to this bit, as it is the one that I do not think that he entirely understands. He needs to grasp the difference between targets and outcomes. He does not support outcome-driven activity, but he does support process-driven targets. For exactly the reasons cited in the Healthcare Commission report to which I have referred, he needs to pay attention because, if he continues with his obsession with targets, we will not see any improvements.

The report found that 45 per cent. of trusts were experiencing difficulties with accident and emergency targets. In addition, 29 per cent. of trusts told the commission about difficulties with waiting times and lists for the treatment of in-patients, while 36 per cent. reported that they had experienced difficulties reconciling the management of health care-acquired infections and cleanliness with the fulfilment of financial targets. The Secretary of State continues to deny that evidence.

Moreover, the report found that 46 per cent. of trusts do not have a programme to check the cleaning of beds and the spaces around them. Only 48 per cent. of trusts report all health care-acquired infections, and 19 per cent. report none. Another 26 per cent. report less than half of such infections, and 62 per cent. do not audit readmission to hospital of people suffering from them. The report is truly damning about what is going on.

Until the Secretary of State starts to listen, and to accept the causes and consequences of health care-acquired infections, rates will continue to rise. Protesting about the progress that has been made while denying the figures and causes will not get anywhere. The right hon. Gentleman asked that this debate be non-party political, but he must accept the facts. The problems are to do with bed-occupancy rates, targets, competing priorities, antibiotic prescribing habits, the number of nurses on wards and the number of hand basins available per bed. They are also to do with our built structure, and with training, monitoring, audit and the need to change practices on the basis of that audit.

The Secretary of State maintains that infection rates here are similar to those in the rest of Europe, but I doubt that that is any comfort to the relatives of the 90 patients who died in west Kent. We must adopt a ward-to-board approach, but hospital boards must be able to make decisions on the basis of clinical need, not of Government targets. That means that some targets must be let slip sometimes, but a culture in which senior managers do not listen to what is happening at ward level because they fear not meeting Government targets and thus getting sacked will mean that what happened at the Maidstone and Tunbridge Wells NHS Trust will occur again.

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I urge the Government to look again at the debate. I urge them to rise to the challenge that health care-acquired infections raise. I urge them to return to decisions made on clinical grounds by clinical staff in clinical settings. I urge hon. Members to support the motion.

6.49 pm

The Parliamentary Under-Secretary of State for Health (Ann Keen): We have had a lively debate and covered much very necessary ground. I will endeavour to cover the numerous queries raised, but I hope that hon. Members will understand if I write to them if I am unable to answer specific questions.

What is clear from today’s debate is that we all agree that tackling health care-associated infections is, and will continue to be, a key challenge for the NHS. It is also clear that the issue is not confined to England; it is a worldwide challenge. In fact, infection rates are higher in the United States, where medicine is practised and funded very differently from the NHS. We must learn from the tragic mistakes that we have heard about and redouble our efforts, of course, to ensure that every patient gets the safe, high-quality care from the NHS that is their right.

Hon. Members’ contributions have been very informative. My hon. Friend the Member for Livingston (Mr. Devine) has, of course, great experience in the NHS and put his heart into dealing with the heart of much of the matter. We must have properly qualified staff who are dedicated to being part of our team, whether they are ward cleaners—the domestic staff, as they were called—or work right up on the board, as good, positive leadership is required.

Of course, the right hon. Member for Maidstone and The Weald (Miss Widdecombe) made some very relevant points. In particular, I agree with what she said about the sister or charge nurse who is in charge of the ward. Ward designs were mentioned. Of course, we cannot have separate rooms and isolation and continue to have Florence Nightingale wards, which she mentioned.

Mr. Adrian Bailey (West Bromwich, West) (Lab/Co-op): On ward design, does my hon. Friend accept that the technology of hospital equipment is very important? Colson Castors has developed a microbiologically resistant castor specifically for hospital beds and trolleys. Will the Department consider that as part of the armoury of policies designed to curb such infections?

Ann Keen: I thank my hon. Friend for that comment. It is the duty of us all to look at every innovation and change in technology and science to help with this important health care issue. Hon. Members on both sides of the House have mentioned research, and we could consider it in an all-party way, because of the victims and their relatives and given the seriousness of not doing so. I make a plea to look at all the experience together to try to bring about a safer health care environment for all our constituents. To do that, much of Lord Darzi’s review of the NHS is addressing one of the main issues—quality and safety—and I look forward to the consultation, to which Members who have spoken today will contribute.

My hon. Friend the Member for Vale of Glamorgan (John Smith) is a champion of tackling DVT, especially through the work of his all-party group, and patient safety is paramount to him.

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I accept the invitation to visit, made by the hon. Member for Wellingborough (Mr. Bone), and it is very important that I do so. I have visited many constituencies to date and seen the improvement. In particular, I was able to see the change that has been made at the Countess of Chester hospital, when my hon. Friend the Member for City of Chester (Christine Russell) invited me to Chester—an area that I hold dear to my heart, because I started my NHS work as a clerk at Chester infirmary.

The hon. Member for Tunbridge Wells (Greg Clark) mentioned that money should be made available for changes in design and, very importantly, for patient safety. I remain concerned that money is being mentioned, because the money is available for such things to take place, and I am happy to investigate that further.

In relation to the uniform guidance—an issue that was raised by the Opposition Front-Bench spokesman—it is recognised good practice for staff to change at work before going home. There is no evidence of a risk of infection, but there is evidence of an effect on patient confidence, which is of course important.

We must remember that the latest figures from the Health Protection Agency show that we are heading in the right direction in tackling infection. I am looking forward to seeing how best we can demonstrate the effects in further reducing health care-associated infections. The further investment highlighted by the Secretary of State in his opening speech will cover further measures such as screening for MRSA for elective patients. It will also ensure that every acute trust has undergone a deep clean by 31 March next year. I hope that Members on the Opposition Front Bench will note that that is not a gimmick; it is a reality. It will happen by 31 March next year.

The private sector, in the main, undertakes elective surgery, which is very different from the work that our NHS does. The Health and Social Care Bill, introduced last week, will establish a new regulator. I urge hon. Members to vote to support the new tough powers that will allow that regulator to investigate and intervene on issues such as health care-associated infection.

The issues of targets and bed occupancy have been raised. Patients have a right to clean and safe treatment, regardless of where in the NHS they are treated. I am very clear that if trusts fail to deliver that, senior managers and trust boards will be held accountable. As has been said, that will go right down the line from the ward to the board. There are no excuses. The management of complex systems, such as health organisations, requires the balancing of many different priorities.

Mr. Lansley: Will the Minister give way?

Ann Keen: In a moment.

Anna Walker, the Healthcare Commission chief executive, said:

Nor do high levels of bed occupancy prevent trusts from reducing MRSA. Over the last 24 months, the extent to which trusts with high bed occupancy have reduced their MRSA levels is similar to that of low
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occupancy trusts. For example, Sherwood Forest Hospitals NHS Foundation Trust has reduced its MRSA rate significantly more than the national average, while maintaining high levels of bed occupancy. We are expecting a report from Professor Barry McCormick at the end of the year, which will update his previous report on bed occupancy.

My fellow Ministers and I were shocked by the situation described by the Healthcare Commission in its report into Maidstone and Tunbridge Wells NHS Trust. I have been on the record as saying that the report was

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