Hospital Acquired Infections

Speech delivered on Wed 2nd Mar 2005

House of Commons Debate, 2nd March 2005

Hospital infections such as MRSA are not new—they were not conjured into existence in 1997. No matter how convenient that idea might be for the narrative of the Conservatives' general election campaign, it simply is not the case. The prevention, control and containment of superbugs has been a long-standing issue for the NHS and other health care organisations, both in this country and overseas. What is new is that, since the National Audit Office report of 2000, there has been a gradual and growing realisation of the scale of the challenge posed by superbugs, of the £1 billion cost of dealing with the consequences of infection that the report identified and of the annual toll of 5,000 preventable deaths.

First and foremost, the National Audit Office's message to the Government and the national health service in 2000 was, "Get a grip." Better management and clinical information were key to having an impact on the problem. To be fair, the Government instituted a system of mandatory reporting of MRSA bloodstream infection rates in 2001. Until that point, there was no clear measure of the scale of the problem. In 18 years in power, the Conservatives were content to rely on a voluntary reporting system that under-reported the problem—dramatically in parts of the country, but significantly across the country. That allowed MRSA rates and those for other superbugs to get out of control.

I must say to those on the Opposition Front Bench that it is not a sufficient argument to say that the Conservatives in government were not to blame because Labour in opposition did not ask the questions. That is an inexcusable rationale for saying that the Conservatives are not to blame. Indeed, Conservative Government policy on MRSA fell into three parts: say nothing about MRSA, learn nothing about MRSA, do nothing about MRSA. Nothing new there then.

Mandatory reporting helps only if it is smart mandatory reporting—if it helps organisations and clinicians to learn and change the way they work—but the system introduced back in 2001 fails that test. Collecting hospital MRSA rates might help headline writers to scare patients, but it fails to give front-line staff and management the information they need to fight infection.

According to the most recent NAO survey of infection control teams, when asked about the practical impact of collection of hospital MRSA rates, 27 per cent. of teams said it had no obvious effect. That is hardly a ringing endorsement from the experts on the ground.

In 2000, the NAO recommended that specialty level surveillance of hospital-acquired infections should be introduced. In the follow-up report last July, it said that

"there is still a lack of robust information on the majority of infections at both the local and national level. As a result it is still not possible to say whether there has been any tangible measurable progress."

It went on to say that information available from trusts suggested that the improvement had been small. Why? The NAO argued:

"The lack of ownership of surveillance data by clinicians is likely to be one of the main reasons."

More worrying still was the NAO finding that one in five infection control teams were not carrying out any surveillance activity other than mandatory MRSA bloodstream surveillance. Failure to set in place mandatory specialty-specific surveillance of infections has hamstrung the efforts of front-line infection control staff and let patients down.

Patients should have access to reliable and comparable information on infection rates, not just in the NHS, but in the private sector. For patients, doctors and nurses, a critical element in the quality control feedback loop is missing as a result of what the Government have so far failed to do. Putting it in place should be a priority.

The motion refers to the 955 deaths attributed to MRSA in 2003. That figure is based on data from death certificates, but it is clear that that is just the tip of the iceberg. In fact, no one knows precisely how many people die as a consequence of MRSA. The only way to get a true picture of the extent to which MRSA contributes to deaths in hospitals requires, according to the national statistician, Len Cook, special epidemiological research. It is time that more research in that area was commissioned. I hope that the Minister gives us some idea of whether such research will be carried out to achieve a proper fix on the number of deaths from MRSA and other hospital-acquired infections.

In opening the debate, the hon. Member for East Worthing and Shoreham (Tim Loughton) rightly said that front-line staff should have the authority to close wards to control infections, but that should be done by front-line staff with expertise working in collaboration with ward staff—not only matrons, but infection control teams. I agree with Beverly Malone, general secretary of the Royal College of Nursing, who said recently:

"The truth is matrons need to work in collaboration with other health professionals and managers to ensure the system works best for patients."

There should be no question of political targets getting in the way of such critical clinical judgment calls.

The leader of the Conservative party recently called for the return of matron, but why did successive Conservative Health Ministers fail to bring back matron between 1979 and 1997? How was the authority of front-line nursing staff over cleaning, hygiene and housekeeping undermined in the first place?

I believe that the pressure to hit waiting time targets has made matters worse. As the NAO report showed, waiting time targets conflict with the prevention and control of infection. I do not believe that targets can ever capture the complexity of delivering high-quality health care in this country. Targets inevitably miss the point.

Last November, Dr. Andrew Bamji, a senior doctor at Queen Mary's Sidcup trust, said that pressure to meet A and E waiting targets was undermining measures to tackle hospital infections. While Dr. Bamji was on holiday, two patients were admitted to his rehabilitation unit without being screened for MRSA, despite the protests of senior nurses. One of the patients later turned out to be infected with MRSA. Because of the target, a unit that had maintained a more or less MRSA-free record for more than two years became infected.

In December last year Annette Jeanes, lead nurse in infection control at Lewisham hospital—mentioned by the hon. Member for Lewisham, West (Jim Dowd)—said of the four-hour wait target in A and E

"You have people waiting in A and E and you physically do not have the beds to put them in. When a bed becomes available, there is not time to wash the beds and allow them to dry."

Preventing, controlling and containing hospital infections should never come second to political targets.

The rise of the hospital superbugs may have been fuelled by the Government's obsession with targets, but it did not start with that. Day-to-day control of everything that goes on in a hospital ward was first shattered back in the 1980s when a Conservative Government ordered hospitals to contract out their cleaning. Price and price alone became king—quality of service certainly did not. That generated the fragmentation of responsibility on the ward from which we undoubtedly still suffer today.

In 2000, the Department of Health issued a circular setting out a programme of action for the NHS on management and control of hospital infection. There has been no national audit of compliance with that circular and Health Ministers have made it clear that the Government have no plans to undertake such an audit. When "Winning Ways" was published in December 2003, the chief medical officer gave one of the reasons why an audit had not yet been conducted. He said:

"Despite the extent of the guidance issued to the NHS, such data as are available show that the degree of improvement has been small."

Ensuring compliance with guidance should be a priority.

There is no single quick-fix solution to the problem of hospital infections, but it is clear that concerted efforts involving, for instance, screening, hand washing and isolation can reduce the spread of superbugs. Good ventilation systems in wards, theatres and isolation rooms are vital to the combating of infectious diseases. According to the NAO, however, only one in three infection control teams felt that their hospital had appropriate isolation facilities.

The Department's 2000 circular required trusts to undertake risk assessments to determine appropriate provision of isolation facilities in each trust, but according to the NAO's report last year more than 70 trusts still had not done so. Of those who had, just 25 had obtained the necessary isolation facilities. There is no timetable for action on the results of risk assessment and there appears to be no sense of urgency either at the top, in the Department, or on the ground in NHS trusts.

It is a scandal that Ministers do not know how many isolation rooms there are in the NHS. How can the Government's contingency planning to tackle the threat of flu and other pandemics be acceptable and ring true if we do not have such basic information? There should be an urgent audit of current provision and future plans for isolation rooms.

If infection control is to make a difference, everyone who works in health and care must take it seriously. It is not just a problem in hospitals—it is a problem in other care settings as well. The role of infection control nurses and doctors in leading the cultural change is crucial. It must be cause for concern that, four years after the NAO published its first report on hospital-acquired infections, its follow-up report concluded that the budgets of one in four infection control teams had been cut—not increased, but cut. How on earth can they be expected to do their job?

Cutting infection is not rocket science. It is about relearning some of the lessons that Florence Nightingale taught more than 100 years ago. Fighting infection is a task for everyone who works in the NHS. What is needed may not be search and destroy, but it is certainly a zero-tolerance approach to infections in our hospitals.

The Liberal Democrats will vote for the motion, because it sets out the case for urgent action to fight infection. We will not support the Government's amendment, because it is far too long-winded and self-congratulatory. We do not need congratulations tonight. We need definitive action to deal with the problems of superbugs in our hospitals and to ensure that people do not become sicker when they went into hospital to be cured.

END

To read the debate in full take the following link

http://www.publications.parliament.uk/pa/cm200405/cmhansrd/cm050302/debtext/50302-27.htm