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It would be unfair to accuse Ministers of having done nothing. They have actually done an enormous amount. The problem has been that the various levers that they have pulled to try to stem the tide have had only a minimal effect so far. In 2002, as the noble Lord, Lord Patel, said, we had Getting Ahead of the Curvethe first of a whole swathe of strategies and action plans to improve hospital cleanliness, all of them with wonderful, optimistic-sounding titles. There was Winning WaysWorking Together to Reduce Healthcare Associated Infection in England in 2003; Towards Cleaner Hospitals and Lower Rates of Infection in 2004; Saving Lives: A Delivery Programme to Reduce Healthcare Associated Infections including MRSA in 2005; Essential Steps to Safe, Clean Care in 2006; and, this year, Clean, Safe Care: Reducing Infections and Saving Lives. On top of all that, we have had national guidelines, sanctions and targets. Each of these in its own way has been of unimpeachable worthiness, yet last years annual health check by the Healthcare Commission found a lower level of compliance with the three main standards in the hygiene code than in the previous year.
The noble Lord mentioned the cleanyourhands campaign. Good hand hygiene has been described as the single most important measure for controlling transmission in healthcare settings. Contrary to all the sound and fury generated on the subject of ward cleanliness, it now seems that there is not a simple or direct association between the visible cleanliness of a hospital and its infection rates. Of course, that is not to say that cleanliness should count for nothingof course, it shouldbut it is not the most significant driver, so it appears, in the direction of travel.
Still less is it the case that a hospitals infection rates can be linked to whether it contracts out its cleaning, or indeed how much its cleaning budget amounts to. Despite that, we recently had the deep clean initiative. There is no evidence that the deep cleaning of hospitals is a cost-effective use of funds. To be quite brutal about it, it is a populist gimmick. Dr Stephanie Dancer, an expert in microbiology, warned last year that deep cleaning would have only a very short-term impact. She was right. The Countess of Chester Hospital, which spent £300,000 on a deep clean, suffered a C. difficile outbreak four days later, when 26 people became infected. When he made the announcement
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One real criticism that I have of Ministers is that at intervals they have been guilty of instilling false hope and false expectations in the minds of the general public. I know that at party conferences hyperbole tends to intrude, but last year, when the Prime Minister launched the deep clean programme, he said that it was intended to,
He should not have said that. Not only was there no evidence base for saying it, but no work had been done to assess how the £62 million that it cost to carry out the deep clean might have been more effectively spent.
By contrast, screening for MRSA in high-risk patients is potentially very worth while. The Government have proposed that MRSA screening should be introduced for all elective admissions in 2008, and all emergency admissions as soon as possible after that. The problem here is that screening in a hospital setting is logistically complicated. For a start, you need enough space in which to isolate the carriers. Many hospitals do not have that, in part because they are constantly chasing the 18-week target for referral to treatment and the four-hour A&E waiting time target. Beds get full. Again, we have had extravagant promises about isolation facilities, first of all in Winning Ways, and then from John Reid in 2004, who assured us that new hospitals being built had more isolation rooms than ever before. But what do we now find? Last November the Health Protection Agency reported as follows:
Isolation cannot just happen at the wave of a wand. As the MRSA working group pointed out, conventional screening takes three to five days. There are rapid screening techniques, but they are expensive and difficult to perform in large numbers. Reducing rates of MRSA by screening is going to be an uphill battle.
The noble Lord, Lord Teverson, referred to bed occupancy rates. I do not think that one can cite them as the prime or only contributor to rates of MRSA infection. But what high bed occupancy often means is that hospitals are left short-staffed and pushed for time, so that hand hygiene is not always maintained. Increasingly, hospitals have had to resort to hiring temporary staff, whose knowledge may be more limited and whose access to sufficient training may be constrained by lack of time and resources. Significant or notI leave the matter openit is a fact that the Netherlands, which has a low incidence of MRSA infection, has a bed occupancy rate of only 64 per cent.
The noble Baroness, Lady Masham, spoke of the need for good management and leadership in hospitals. She is right but, as she knows, the issue goes deeper than that. The noble Lord, Lord Patel, was kind enough to give me an article from the recent Bulletin of the Royal College of Surgeons of England, which is called Changing the Mindset on Hospital Infections. That title encapsulates it. If we are to crack the problem properly, everyone, from the ward to the board, has to buy into it and see it as their problem, not someone else's. I hope that we will hear from the Minister about some of the ways in which hospitals are moving towards the sea-change in attitudes that is needed if patients are once again to feel confidentas they have a right to dothat hospital is a safe place to be.
Baroness Thornton: I congratulate the noble Lord on securing todays timely debate. As demonstrated by the passionate and well informed contributions, the topic is of great concern to many, particularly to him in his work as chair of the National Patient Safety Agencyand rightly so, as tackling healthcare-associated infections is a challenge for health services around the world and a priority for our NHS. The noble Earl is completely correct about the need for ownership of the problem.
I would like to make the case that we are making good progress towards clean, safe care for patients in the NHS. That is evident in the latest Health Protection Agency data for January to March 2008, published today. Those figures show that MRSA blood-stream infections are down 33 per cent, and that C. difficile infections in the most vulnerable groupthose aged 65-plusare down 32 per cent compared to the same quarter last year. That is significant progress.
The noble Lords work as chair of the National Patient Safety Agency has contributed significantly to that progress. The NPSAs cleanyourhands campaign is a key element in preventing the spread of infections. It has been shown to make a real difference to hand hygiene, therefore making a real difference to patient care and literally saving lives. The NPSA also announced the 2008 hospital patient environment action team scores last Thursday. Thanks to the hard work of the NHS, 98.5 per cent of hospitals are now rated acceptable or above. But we cannot stop there. Trusts are required to deliver a 30 per cent reduction in the number of C. difficile infections by March 2011. The NHS is on course to hit the target to halve MRSA blood-stream infections by the end of March. We will know the
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However, there is no single solution for reducing healthcare-acquired infections, so we have introduced a range of measures. Our Clean, Safe Care strategy builds on comprehensive clinical guidance and gives an overview of all measures. Good hand hygiene, high standards of cleanliness, effective patient screening and sensible use of antibiotics are vital in the fight against infection, as noble Lords have mentioned. In the last year, we have introduced a bare below the elbows dress code to support hand hygiene, increased the number of matrons to over 5,000 and launched a new antibiotics campaign. All acute hospitals have been deep cleaned and we have doubled the departments tailored support team for infections. We are now in the process of introducing MRSA screening across the country. I shall refer to that again when I answer specific questions.
Those measures are backed by significant additional investment. On top of investment in recent years of over £100 million, the Comprehensive Spending Review settlement for future years includes £270 million a year by 2010-11 to tackle healthcare-acquired infections. That all supports the legal requirement for NHS bodies to maintain proper infection control. The new regulator, the Care Quality Commission, will have tough powers to investigate and intervene, strengthening the regulators role in ensuring the NHS meets the required standard. In the mean time, specialist teams from the Healthcare Commission continue to inspect all acute trusts every year.
We are fighting infections on all fronts, but we should not lose sight of the fact that, for all the media hype, the probability of dying from a healthcare-associated infection is relatively low. As the Observer pointed out last Sunday in its feature on 25 things you need to know for a healthy life, people should not fear hospitals. I suspect that my civil servants would advise me not to use this statistic because I do not know what it is based on. However, that article stated that,
The NHS treats around 1 million patients every 36 hours and admits 14 million people to hospital each year. If someone is admitted to an NHS hospital, his chance of acquiring an MRSA blood-stream infection or a C. difficile infection is less than half of 1 per cent.
I now turn to specific points raised by noble Lords. The noble Lord, Lord Patel, asked about the plans we have to collect information on community infections. We have set the latest C. difficile targets across health communities to encourage an approach that encompasses primary care trusts, although we have no current plans to collect information about community-acquired infections. However, we will continue to consider that as we update our surveillance systems.
The noble Lord, Lord Patel, suggested that the trend had slowed and we were not going to hit the target. We think the trend has now reversed and that we are on track to hit the MRSA target. The latest
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The noble Lord asked why we were not screening staff for MRSA and other noble Lords may have mentioned that. The key point is that staff are usually healthy, so they are at less risk of getting or carrying an infection. The problem is not screening the staff, but is the practicemaking people behave in a way that means that infections are not carried from patient to patient. He asked when we would introduce MRSA screening for elective care in 2008. We will introduce it by the end of March 2009. Hospitals are now working on how to deliver it.
The noble Lord asked what we were doing to ensure accurate reporting on death certificates. In July 2005, the CMO issued advice to doctors reminding them to record infections accurately on death certificates. The number of death certificates mentioning C. difficile rose significantly the next year, as shown by the latest Office for National Statistics report.
The noble Baroness, Lady Masham, made a good point about the need to make sure that children in schools were taught about the importance of hygiene. She is also right to point to the importance of combating sloppy practices. The key point about healthcare workers is their practice.
The noble Baroness asked about guidelines on pneumonia. I am not sure which guidelines she referred to, but the suggestion sounded very sensible. We launched a new campaign about antibiotic prescribing in February this year and have highlighted it in department guidelines.
The noble Baroness raised the issue of new ideas, and mentioned mattresses and so on. That is extremely important. We are always looking for new ideas. The Rapid Review Panel was set up in 2004 to review new healthcare-related infection technologies and to provide a prompt assessment of novel equipment and materials and other products or protocols which might be of value to the NHS in improving infection prevention and control, the idea being that you need to look at these things quickly and, if they are effective, roll them out across the piece. We are very much aware that we need to be on top of technology.
The noble Lord, Lord Teverson, asked about antibiotic prescribing. Unfortunately, we are not yet at the stage where antibiotic prescribing across England represents what we recognise is the best practice in the best
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The noble Lord is right that the logistics of screening are significant. There is no question about that, as mentioned also by the noble Earl. Where are we now on screening? As I mentioned, all elective admissions will be screened by March 2009 and all emergency admissions by 2011. The reason for the time is because we know that the logistics of this need to be right.
The noble Lord, Lord Teverson, mentioned bed occupancy. There used to be a correlation. However, we have issued guidance to infection control teams to talk to bed managers. Now we think there is no correlation. Trusts with high bed occupancy rates have reduced infection numbers as much as those with low bed occupancy rates.
The noble Lord asked what we were doing to ensure that those in nursing homes were as protected as those in hospitals. We will produce guidance shortly for infection control in care homes. This consultation is due to start this summer. With the creation of the new regulator, it will be much easier to roll that out because we will have one regulator looking across the piece from healthcare to social care.
The noble Earl, Lord Howe, asked about deep cleaning and whether it was a gimmick. We need to be clear that the cleanliness of our hospitals is a matter of utmost importance. Clean, tidy and safe hospitals and staff are very important to patients, and are what they expect. Deep cleaning is not different cleaning, but it was a way of galvanising hospitals. It is a concentrated programme, often using new equipment and specialist skills. We are not repeating the national deep clean, but the Healthcare Commission will be looking at this when it inspects.
The noble Earl asked why we were screening for MRSA and not C. difficile. We have considered whether universal screening of patients for C. difficile was the best way forward. It would not have the same clinical benefits as MRSA screening, which is why we only target patients over 65 who have diarrhoea. We are keeping this clinical evidence under review and will act quickly to respond if there is any new and emerging evidence.
Will MRSA screening be cost effective? Available evidence indicates that it can be cost effective due to reduced morbidity and lower NHS treatment costs, but there will be an inevitable start-up cost in the introduction of the service.
I thank noble Lords for the many points they have raised. I apologise if I have missed anything. I will look at the record and certainly write to people. I hope I have demonstrated that the NHS is working very hard and making good progress. I assure noble Lords that we will continue to support and encourage the NHS to ensure that patients receive the clean, safe care that they deserve.
The noble Lord said: As a former journalist, it pains me to say that the number of occasions on which I am able to pay genuine tribute to the work of the press are sadly limited. However, this afternoon is a rare exception. I make no bones about saying that I have taken an interest in the subject before Members of the Committee this afternoonwell off my usual beat, as some people will realisewholly and solely because of the Daily Mirrors splendid campaign on behalf of our troops.
The Daily Mirrors work has been in the best traditions of popular journalism: passionate, yet scrupulously researched. I remember the remark of the great Harry Evans, under whom I briefly served when he was editor of the Sunday Times, who said, Your campaign is only working when your readers start to get bored with it, in reference to a Sunday Times campaign on cones in roads. The Daily Mirror has been willing to run that risk by persevering with this campaign when others have been satisfied to fill their columns with gossip and girls. That persistence has been most admirable. I also pay tribute to Colonel Richard Kemp CBE, who once led our forces in Afghanistan and who has been as gutsy in this campaign for recognition as he was in that one. They have been not only admirable and gutsy, but successful. My third tribute is to the Government: Ministers have listened. When I first tabled my Question, it called for medals for the killed as well as for the wounded. That is no longer necessary, as the Government have now agreed that Britons who lose their lives in the tragic conflicts in Iraq and Afghanistan should be recognised with an appropriate medal. It therefore only remains to push the door open a little wider, and extend that recognition, as my Question asks, to the seriously wounded.
Of course, anybody who joins our Armed Forces does so in full knowledge of the potential personal costs they may pay for their patriotism. However, it is my contention that the wars we are considering here are different from those we fought in the past in a way that makes recognition more desirable. The fact is that our nation has been divided over these conflicts in Afghanistan and Iraq. Not only have the men and women involved had to face enemy fire, but they have suffered the ricochets of friendly fire from those in Britain who believe these wars to have been misjudged. Are they risking their lives in a good cause?
That is not a situation that troops in most conflicts have had to face. Generally, wars fought by Britain have been those where the nation stood behind its Governments course. At a time when surveys are showing some problems with service moralenot of the individuals involved but their feelings about how the services as a whole are keeping their morale upwe need to do the right thing. Let us show our soldiers, our airmen and our sailorslet us let their families, their sons and daughters, and their sons' sons and
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I am not sure that the opposition to what is proposed comes from Ministers. Reading the words, I fear that others stand behind the Ministers; namely, some of our senior servicemen. Without making too much of it, I find it slightly ironic that top brassmany of whom like nothing better than to parade with a chest bedecked with medals of all kindsshould be resistant to granting any similar recognition to the men and women who serve under them.
One of the arguments to be heard thundering round the corridors of power is that such an award would be unprecedented. When you come to think of it, so was the first ever Victoria Crossso is every medal when it is first awardedand so, very relevantly, was the first Purple Cross, awarded more than 200 years ago, which our American cousins and allies across the Atlantic award to their servicepeople in similar circumstances.
Another argument is that it is difficult to draw a distinction between seriously injured people and others, wounded or not. However, that is implicit in the awarding of any medal. One has to decide what deserves a VC, an MC or any other medal. It requires very fine judgments, which are hard to make. At least this medal would have an objective justificationnamely, a serious injuryand I do not believe that that is beyond the power of humankind to resolve. I cannot help observing that very few serious injuries are suffered by those sitting behind large desks in the Ministry of Defence.
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