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Lord Selsdon: My Lords, we have talked of Lister, Florence Nightingale and Canute in this debate, and I suppose it would be right for me to go back even further. I shall explain to your Lordships the reasons why I speak.
I was for many years a director of a company called Terme di Porretta, the oldest spa company in the world, whose technical team found Aquae Sulis and operated many of the Roman baths around the world. We did not cure people, we rehabilitated and treated them. We were taught that disease could be spread by water, by air, by touch, by food and, in war, by blood. Plus c"a change. As I look at the right reverend Prelate the Bishop of Portsmouth, I recall that next year is the year of Nelson and Trafalgar. People would lose their legs and their limbs because of splinters from cannonballs, not from the cannonballs themselves, and from septicaemia and amputation.
In our spa company, the one thing we used, even in ancient days, was fire, because fire would burn everything. Later, we even used maggots; they were used extensively in the First World War and are coming back into use. That is the first reason I speak.
The second reason is that my wife had a small operation on her leg in one of the private hospitals. We went away for Christmas and while we were away, she was ill. She was in great pain and seemed to be infected.
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We took her to a very elderly doctor, the only one who was available at the time, who used to fish in Scotland and enjoy quite an amount of whisky. He said, "This is rather like the war. It is a question of gangrene. We could try maggots, but I think it may be a disease special to the United Kingdom, and you should take your wife back immediately to London. Drive in the fast lane because it is smoother and will be less bumpy for her".
My wife's own doctor's son had a car accident and went to a similar hospital to have a metal plate inserted. He now finds that MRSA is incorporated within the stainless steel in the pits thereof, and the whole thing may have to come out.
This morning, in preparation for this debate, I went to see the Health Foundation. I was reminded, very gently, with a piece of paper, that 44,000 people are killed in hospitals every year, due to the wrong prescription of medication, the wrong treatment or through hospital-borne diseases. That is 110 people per day, more than are killed by road accidents or accidents at work. So this is a broad problem, before we come to the individual technicalities of the disease.
In my international world, I have been exposed to legionnaires' disease, SARS, blackwater fever, polio and meningitis, but I was never frightened until I went to the AIDS ward in Barts, where they have wonderful treatment. Somehow, going on that dark night, with rain and not much light, you thought you had walked back into the past.
When I learnt about MRSA, I began to be frightened even to go into hospitals. I was brought up at a time when there was no central heating, you had a cold bath in the morning and were brought up to believe that coughs and sneezes spread diseases and, as the 1942 campaign said, you should trap the germs in your handkerchief. This is a long time ago, but I have been fortunate enough not to have had to go to hospital; I do not seem to suffer much. But when I see the fear of people who need a minor operation that they may contract something serious in hospital, that is worrying. I worry that even this debate may create too much fear.
We have various initiatives. The noble Lord, Lord Hunt, spoke about the Government spending £4 million on patient protection, but, fundamentally, certain changes have to be made. I shall now try to make a speech as though I were a Minister, which I never have been and never will be. But if I were, I would say that we have more hospital beds per thousand of the population than the United States, Canada, Australia and much of Scandinavia. We have 3.9less than in Scotland, where they have 4.1. Even more importantly, we have more people employed per acute bed than any other OECD nation. We have between five and six, whereas France and Germany have between one and two.
I do not make this point to say that there is anything wrong, because four members of my family have worked in the National Health Serviceone is working in it now. I have learnt an awful lot from them over time, and I have a great respect for the NHS. However, if any of us were ever ill, we were always
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advised to go to a vet because they had wider experience of diseases that could be carried by mammals, and a longer period of training, particularly in Scotland.
What is the Government's plan? What plan is there? We see the biggest level of proposed investment in the health service of any nation for years. In programmes of rehabilitation, St Mary's alone cost £800 million or more. So at some time in the future, things will be all right, but how do we cure the present situation? My microbiologist, as I am proud to call him, advised me that effectively, 25 per cent of people carry MRSA. As the noble Lord, Lord Turnberg, said, it is in your nose but it is also principally in your armpits and, believe it or not, it used to be and still can be, under the wigs of eminent members of the legal profession, where it festers. But it does not cause any harm until it spreads. The skin shedding that takes place in hospitals, where skin mixes into the dust, is a method of transferring the disease.
When we look at the hospital beds in the private and the public sector, they are all integrated in one way. We have 192,000 beds in the public sector in the United Kingdom; we need 100,000 more. Of those 192,000, it is sad to realise that only half are available for acute patients; many are for those with mental or learning difficulties, or for geriatrics. The occupancy rates are around 85 per cent or even more and, in some cases, over 100 per cent because of people going in and out twice in one day.
We need new hospitals and improved facilities, and these will come over time. In the mean time, is it a question of cleanliness? Not necessarily, I am advised. Eighty per cent of all hospitals have MRSA. This is third-party advice, and I can never take third-party liability. So what is the problem? I am told that cleaning the hospitals could reduce that figure by 25 per cent, but the infection would still be there. The possibility lies in decontamination, which is what we used to get rid of cockroaches in ships, but even that was not very successful. Alternatively, you build a whole range of new hospitals and hope that in time the disease may not have mutated yet again.
I am advised that there are different types of bug in different parts of the country, according to weather and people. If you need an operation, you might be better to go further away where there will be a different type of bug. It is no different to the different types of mosquitoes that can resist DDT.
It is, if one thinks dispassionately, an interesting subject. There is no political division on it; none at all. I hope that the noble Lord, Lord Warner, will not attack those on our Benches for getting things wrong. If we cannot get the investment in the health service and in its restructuring, these diseases will fester and may even continue to expand.
I wish the health service well; I feel sorry for all those who work in it who know that they need more facilities. We know that there is little that can be done in the short term, other than to be aware of the dangers, of which we must all be aware in the coming years.
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Baroness Neuberger: My Lords, like other noble Lords I welcome and applaud the initiative of the noble Baroness, Lady Gardner, in calling for this debate. Also, like the noble Viscount, Lord Bridgeman, I was particularly moved to hear the personal story of the noble Baroness, Lady Pitkeathley, about her encounter with MRSA.
The Secretary of State for Health is to be congratulated for his announcement on 5 November of a new target of halving super-bug infections by 2008. I am not normally one to be positive about targets because they tend to have perverse consequences. However, this target was announced at the Chief Nurses' Conference, and the new Chief Nursing Officer, as other noble Lords have already said, is a wonderful and remarkable woman. She is an old colleague and a friend to the King's Fund, where I was formerly chief executive. She has been given a remarkable target of halving that infection rate. I am sure that she will take a practical lead, as the noble Lord, Lord Hunt, has suggested, in issues of nursing style. She is fairly formidable and fairly practicalthe noble Baroness, Lady Murphy, has already alluded to that.
Many noble Lords who have already spoken have said much of what I wanted to say. However, some areas have not been touched on yet. Christine Beasley has taken on the need for training more than one million National Health Service staff in the area of infection control and hospital-acquired infections. Of course, that is only really the beginning, vast though it is.
She will also have to look at other areas particularly infection control in care homes because so many people in care homes go in and out of hospital. We know that much of the MRSA comes in from patients who have it already. At the moment, the Commission for Social Care Inspection looks at infection rates but not specifically at MRSA. Unless we look at the issue adequately in care homes we will not get some of the information that we need in considering how MRSA comes into our hospitals. That needs to be added to Christine Beasley's already vast list.
As regards hand-washing, I should say to the noble Lord, Lord Turnberg, that, yes, the ladies do very much like the gels. The real problem is that they like them so much they keep disappearing. Therefore, there is a real issue in regard to hand gels because finding one when you need one is actually quite difficult.
There is a separate issue about the washing of hospital uniforms in hospitals. It is a big problem in the NHS. We appear to be different from many other European countries and from much of the private and voluntary sector in that regard. Uniforms should only be washed in hospitals; they should not go home to domestic washing machines, which is still very much the practice in the UK. We do not know for certain whether this is one of the ways in which MRSA continues, but it is clearly poor practice because the temperature of domestic washing machines is not adequate. There are others who know far more about
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this than I do. I am told that the temperature of domestic washing machines is not adequate and that you can pick up infection as uniforms are transferred from home to hospital, back home again, and so on.
I want to pick up on the issue of the private finance initiative and hospital building and design. The noble Baroness, Lady Masham, made an important point. There has been a great deal in the news about UCLH and the gap between beds, but this is a much broader issue. There were not enough adequate break clauses in the early PFI contracts and so, as design needed to changefor instance, to deal with hospital-acquired infections we needed to have more single rooms or greater distance between bedsthere was not the capacity to break the contract and to say that there needed to be a change in provision.
It seems to me that the Government need to look closely at that to see if we can renegotiate with some of the PFI providers to change the way in which the contract is delivered. We simply cannot have beds too close together or an inadequate supply of single rooms when we are seeing the trend of hospital-acquired infections still going up. Tony Harrison did some work for the King's Fund some years ago now and it was clear that the absence of break clauses made it difficult to allow for new design developments. It is clear that this is the case in this area.
I have experience of cleaning staff from my time chairing an NHS trust. I was the chair of Camden and Islington community health services at the same time as the noble Baroness, Lady Gardner of Parkes, was chairing the Royal Free and the noble Baroness, Lady Murphy, was chairing one of the north-east London community trusts. We gathered together to bemoan our fate on many occasions. Against all instructions from on high, I resisted contracting out our cleaning services in the mid-1990snot because there was a principled objection to it but because we wanted to keep our cleaning staff who were a key part of the teams, particularly when working with the elderly mentally ill and the very frail elderly, for whom we had some 600 beds. If we had contracted out, our cleaning staff would not have remained with us.
It is vital that we are clear that it is not an issue of whether cleaning staff are contracted out or whether they are employed by an NHS trust; it is about whether they are included in the teams and whether they have some say in how the work is carried out. It is not adequate to say that nurses should manage cleaners. If they are given some responsibility, the cleaners themselves will take a lead. We still have a very hierarchical attitude in our NHS and the cleaning staff are seen as the lowest of the low. That probably does not encourage them to do the kind of job that we wish to see.
There is an issue about the cleaning staff being part of the team, being included in the new training and being encouraged to make their views known, including when they see doctors and nurses not washing their hands and not carrying out adequate infection control procedures. They, too, can see what is going on. Anecdotally, many people will say that if you really want to know what is
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going on in a hospital, ask the cleaners. They see everythingalthough perhaps not always the dirt under the beds.
I say to the noble Baroness, Lady Murphy, that things were quite bad in the 1980s and 1990s, but they were not that good in the 1960s and 1970s either. In the psycho-geriatric units, I certainly remember walking through absolute filth on the floors because no-one thought that those hospitals were worth bothering about. We have had a long spell of inadequate concern about cleanliness.
Because we have no centrally held statistics on care homes and the admission of patients from care homes with MRSA or other hospital-acquired infection, we are missing a trick. I suspect that we need to merge the collection of data between the Commission for Social Care Inspection and the Healthcare Commission, who should look at the whole picture through a national review of the state of infection control in the NHS in England. That must include community services. Perhaps that would give us a clearer picture of what precisely is going on.
I want to address the question of urgency. I know that before I came here your Lordships debated the issue of hospital-acquired infections on several occasions. One year ago, the Chief Medical Officer issued a plan, Winning Ways; Working Together to Reduce Healthcare Associated Infection in England. He admitted then that,
"healthcare associated infection has in the past not been as high a priority for action as some other aspects of healthcare".
That is right. The targets have been elsewhere, which has led to perverse behaviours. Admissions times have been terribly important, as have accident and emergency waiting times.
The real problem is that there has been a lack of time for those concerned with infection control to wipe down mattresses between one person leaving a bed and another person coming into it. There has also been a paucity of hand hygiene agents. In that case, the lack of time is absurd.
There has to be a decision about whether it is more important to get the infection rates downin which case we will have to leave a gap between patients, which might mean that waiting times go upor to keep the waiting times down, which will make it very difficult to keep infection rates down. We often have to make choices in public policy; the Government have to make that decision. It does not seem possible at the moment to have it both ways. We cannot keep waiting times and infection rates right down. Will the Minister address the issue of what choices the Government will make in that area?
People are now talking the problem up and making it into a great national scandal. It is serious, but it is not a scandal. There are wonderful people working within the NHS and outside trying to make things better.
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